Informed Consent In The Context Of Chinese Culture: Theory And Practice

Informed consent, one of the fundamental principles in bioethics, is long considered an effective means in protecting the best interest of both patients and human subjects. However, the role of informed consent in real situation, whether at the level of biomedical research or clinical practice, is far from being satisfacory. Hence doubts have been raised concerning the application of informed consent. Some critics begin to challenge the theoretical support of informed consent. Others tend to draw attention to the incompatibility between theory and practice when informed consent is carried out in the context of a non-Western culture. In China we are faced with similar problems in this respect. For many professionals, these problems are caused by the cultural difference. They argue that the principle of informed consent is built on individualism which is the quintessential element of the Western philosophy. But the core value for the Chinese culture is harmony which is in conflict with the Western culture.This doctoral dissertation, based on a detailed analysis of the problems involved in the implemntation of the principle of informed consent in China, attempts to prove its theoretical justifiability. The author is to approach the issue from three perspectives. In the first place, she will point out that the problems China encounters in the process of applying informed consent is not a China-only phenomenon but problems with universal meaning. Secondly, she will further discuss that individualism which is the theoretical basis of informed consent, is not entirely in conflict with the Chinese culture because the Chinese culture also lays emphasis on the importance of individuals. Finally, she will conclude that the nature of all these problems related to the application of informed consent is actually about how to balance the physician/researcher's obligation for safeguarding the interest of the patient/subject with the patient/subject's autonomous right for protecting itself.To sum up, the author presents her major points as follows: 1) The problems resulting from the application of informed consent in a non -Western cultural situation are caused not by the cultural differences between the West and the East but by misunderstanding of the theoretical support of informed consent. 2) Whether in the West or in the East, the theoretical support of informed consent is always the focus on individualism. 3) In China what is needed is not a restructuring of the theoretical basis of informed consent but more attention to the operational details.The dissertation is made up of seven chapters altogether. Chapter one is about the origin, historical development and content of informed consent. Chapter two is a detailed discussion of the theoretical support of informed consent. After studying the representative philosophical interpretations of the principle of informed consent in the West, the author emphasizes that autonomy or autonomous choice constitutes the essence of informed consent. Chapter three mainly touches upon the problems involved in the application of informed consent in China. The author in this section tries to address issues related to individualism, paternalism and autonomy. She declares that the major concern in the application of informed consent is the lack of respect for autonomy. Chapter four is a comparative study between China and the Western culture. While emphasizing similarities in the application of informed consent in both cultures, the author also points out that the major difference is in the mode of decision-making. Chapter five introduces the topic of individuality or autonomy in the context of the Chinese culture. The author holds that the Chinese culture is not one that negates autonomy. Chapter six summarizes all the major points covered in the previous chapters. In chapter seven the author proposes some suggestions concerning the legalization of informed consent in China.