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
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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