The Ethics of Medical Decision-Making with Japanese-American Elders in Hawaii

SUMMARY

This study reports observations by oncology nurses, doctors, social workers and administrators at Queen's Medical Center (QMC) in Honolulu (N = 50), concerning cultural, religious and institutional factors influencing mentally competent Japanese-American elders signing medical informed consent (IC) documents without understanding them. Sixty-eight percent of respondents reported having observed elderly Japanese-Americans signing IC documents without understanding them. Explanatory concepts of enryo(refraining from imposing one's own interest or desire), oyakoko(filial piety), ishin-denshin(silent communication) and obasute(a traditional practice of sacrificing oneself to avoid being a burden to others), in addition to other cultural concepts are discussed for their possible contribution to “signing without understanding.” Suggestions are made for further research to include elders and their family members to explore the perceptions of IC. The study concludes with recommendations for improvements to the laws, policies, programs and procedures governing the IC process in order to achieve a better fit with the cultural, ethnic and religious characteristics of Japanese-American elderly patients in America.

Key Words:

• Ethics
• informed
• consent
• Japanese-American elders