Autonomy from the Family: A History of Public Policy on Medical Decision-Making in Japan

This article proposes a decision-making approach that articulates the roles of the patient and family in informed consent in healthcare decisions, based on the results of a historical overview of bioethics policies in Japan. From the late 1980s through the mid-1990s, patient autonomy was the focus of attention in cases involving disclosure and brain death. More recently, family consent has been the focus of other medical ethics cases. I propose a decision-making approach that consists of two steps reflecting: (1) the ethical implications of patients autonomously providing their families with permission to make decisions on their behalf and (2) the legal implications of preventing families from refusing treatments that patients previously consented to on the basis of their own free will.