Justifying Ethical Claims across Cultures: Global Bioethics and Informed Consent in the U.S. and Japan

Abstract

Principlist ethical justification is the preferred mode of analysis in contemporary bioethical inquiry. Yet increasing bioethical discourse between different cultures has shown that this assumed methodology is problematic across cultures. In this dissertation, I establish a new methodology for cross-cultural bioethical inquiry based not on moral principlism, but on moral particularism. I show how relying on principles for ethical justification easily leads to cross-cultural disagreements, and I propose that ethical justification of practices across cultures is better pursued through a particularist approach that recognizes the practical contributions of institutional and social factors to ethical analysis. I then use this particularist approach to comparatively analyze practices of informed consent in the U.S. and Japan, demonstrating the explanatory power and ethical significance of this approach for one of the most central issues in contemporary global bioethics. This particularist analysis shows that the discourse on informed consent is primarily concerned with how informed consent practices prevent physician paternalism and enable patient autonomy. This discourse privileges American practices and does not reflect global differences in how informed consent practices are conceptualized, institutionalized, and realized. By highlighting distinctive features of the Japanese practice of informed consent, I reveal a number of factors that are routinely omitted from the ethical discussion on informed consent, including psychosocial aspects of information provision and medical decision-making, systemic availability of secondary support staff, and responsibility for decisions and decision-making processes. These factors are most apparent in the Japanese practice, but they are not unique to Japan. Rather, they are significant in the U.S. as well, where the conceptual focus on physician paternalism versus patient autonomy has narrowed the discussion and obstructed a wider perspective on ethical issues in informed consent. While in the U.S. the significance of psychosocial support for informed consent is unacknowledged but delegated, in Japan it is acknowledged yet undelegated. The comparative approach of this dissertation allows us to better address these under-recognized issues in the discourse on informed consent and to improve practices in both the U.S. and Japan.