Compromised Autonomy, and Asian Autonomy:
Commentaries on Glock & Goldim, and Dena
Hsin-Chen Hsin
- Frank J. Leavitt, Ph.D.
Chairman, The Centre for International Bioethics
Faculty of Health Sciences
Ben Gurion University of the Negev, Beer Sheva, Israel
Fax: + 972-8-6477633
E-mail: yeruham@bgumail.bgu.ac.il
Eubios Journal of Asian and International Bioethics 13 (2003), 8.
Glock
and Goldim, in this issue (Informed consent in Gerontology) raise an important
question which should have been raised years ago. Ever since autonomy became a dogma of biomedical ethics, it has been
assumed by too many people that it is a very simple matter to obtain from
patients "informed consent" for treatment or research. But in order for consent
to be free and informed, the patient has to be in a calm and lucid mental
state, and has to understand rather clearly what one is assenting to. This
might be more of an exception than the rule. Glock and Goldim discovered
deficiencies in the ability of geriatric patients to understand what they are
assenting to. But the same question arises in many other branches of medicine.
How many psychiatric patients can understand a research protocol? What about
pediatric studies? Perhaps an older child can be just as capable as an adult of
understanding. But when it comes to small children and infants, there can be no
genuine informed consent. Allowing the parents as "surrogates" is simply a
fiction. Parents have the right to consent to treatment of their children when it
is to the child's clear medical benefit. But if it is only for research, what
right have the parents to volunteer their children? A child is not the personal
property of the parents, like a motorcar or bicycle. Similar questions can be
raised in obstetrics. Women are asked to sign informed consent forms (intended
more to protect the hospital in case of error, than to ensure the "autonomy" of
the patient) for an epidural injection during childbirth. In many cases it is
the woman's first delivery, she is frightened, and in pain. Can such a
signature count as evidence of free, informed consent? A woman should be
explained the alternative methods of dealing with pain in childbirth (epidural,
LaMaze, meditation, Yoga, etc.) shortly after a positive pregnancy test. Then
she will have plenty of time to read books, take courses, and prepare for the
situation if she wishes. If she, after all that, still insists on epidural, it
is her right to do so, and her consent will be informed. But this is often not
the case.
In
the last issue, Dena Hsin-Chen Hsin (The language barrier cripples Asian
bioethics. EJAIB (2002) 12:211) wrote
about the difficulties of Asian bioethicists, who have to communicate in
English at international conferences. I still have a more optimistic attitude.
With all due respect, I don't think she should have let Darryl, a Cambridge
graduate, check the English of her paper. She should have published it as is,
full of Asian idioms. She might even have put in some transliterated Chinese
words. International English is a changing, developing language. There are no
laws which require anybody to speak or write English like they do in such
economically, politically and militarily powerful, but no longer very
culturally significant places as Britain and North America. We Jews have always
spoken English as we please, and such words as kosher, chutzpah,
shalom, Shabbat, etc, are recognized today
in the Oxford English Dictionary. Other Asians, starting with Asian
bioethicists, can intensify the Asian conquest of English, freely adding Asian
words and idiom. With optimistic patience, we can turn International English
into a language which we can comfortably speak at Asian Bioethics conferences,
even though it will be quite unrecognizable to the Queen of Britain.
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