Lost in ‘Culturation’: medical informed consent in China (from a Western perspective)

Abstract

Although Chinese law imposes informed consent for medical treatments, the Chinese understanding of this requirement is very different from the European one, mostly due to the influence of Confucianism. Chinese doctors and relatives are primarily interested in protecting the patient, even from the truth; thus, patients are commonly uninformed of their medical conditions, often at the family's request. The family plays an important role in health care decisions, even substituting their decisions for the patient's. Accordingly, instead of personal informed consent, what actually exists is 'family informed consent'. From a Western perspective, these features of Chinese law and Chinese culture might seem strange, contradicting our understanding of doctor-patient relationship and even the very essence of self-determination and fundamental rights. However, we cannot forget the huge influence of cultural factors in these domains, and that 'Western' informed consent is grounded on the individualistic nature of Western culture. This article will underline the differences between the Western and the Chinese perspectives, clarifying how each of them must be understood in its own cultural environment. But, while still respecting Chinese particularities, this paper advocates that China adopt patient individual informed consent because this is the only solution compatible with human dignity and human rights.

Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: An Updated Systematic Review

“…Across the above categories, a total of 43 interventions (72%) were noninteractive and 17 (28%) were interactive. Eight of the interactive interventions included test/feedback or teach-back components, including 1 audiovisual intervention, 39 5 digital interventions, 72,76…”

“…Explicit protection from nonconsensual medical treatments and procedures have long been upheld by international law, although actual practices of informed consent vary by country and may be influenced by cultural context. [14][15][16][17][18][19][20] Overall, there has been a trend toward more patient-centered informed consent standards in recent years. [21][22][23] There are not, however, international ethical guidelines for clinical informed consent similar to those that have been developed to regulate human subject research.…”

Barriers and Enablers in the Implementation of a Quality Improvement Program for Acute Coronary Syndromes in Hospitals: A Qualitive Analysis Using the Consolidated Framework for Implementation Research

“…There is a lack of adequate policy and resource support during NCPCP implementation, and raising patient awareness about chest pain emergencies is a social project that requires the collaborative efforts of government, communities, and medical staff [42]. In terms of patient informed consent, Chinese patients tend to have "family autonomy" [43], where the family plays an important role in medical decisions [44]. In Western countries, autonomy is purely individualistic, and patients' wishes and preferences take a leading role in deciding treatment [45].…”

Ethical Considerations in Clinical Trials for Disorders of Consciousness

“…Divergent philosophical perspectives and attitudes surrounding autonomy, paternalism, and the role of the individual in society have inspired varied approaches to conceptualizing and prioritizing informed consent across cultures. For example, collectivist conceptions of personhood, family, and interdependency have been theorized to influence distinctively family-oriented paradigms of informed consent in China and Japan [ 39 , 40 , 41 , 42 , 43 , 44 ]. The need to advance the rigor and integrity of informed-consent procedures across regions represents a challenge and opportunity; building cross-cultural bridges to study and integrate divergent philosophies of autonomy with the common aim of protecting the safety and well-being of research participants, and particularly those who may lack decisional capacity, such as persons with disorders of consciousness, is a growing ethical imperative [ 45 , 46 , 47 , 48 , 49 ].…”