Medical Practice and Cultural Myth
Drs. Akabayashi and Hayashi hold that patients’ refusals to make decisions, families’ requests to conceal diagnoses, or terminal patients’ mute nods, are “something like patient autonomy”; yet their cases appear acceptable only because they have unobjectionable outcomes, and not because they somehow approximate “patient autonomy.” This commentary illustrates dangers of ambiguity, adequacy, and family schisms, if the conditions of approximate “patient autonomy” are left unspecified. The author and they agree that cultures should sometimes be allowed to place decision-making in the hands of families or doctors rather than patients; they disagree about whether to defend this by likening it rhetorically to the Western cultural myth of individualist “patient autonomy,” or by acknowledging genuine cultural differences in the range of ethically acceptable medical practices. Philosophically, they defend Japanese decision-making within an overarching myth of individual autonomy, whereas the author defends Japanese decision-making in medical practice framed by cultural and family autonomy.
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