Eubios Journal of Asian and International Bioethics - Eubios Ethics ...

42 Eubios Journal of Asian and International Bioethics 22 (January 2012)
persons (patients/research participants), and between
different times in the same persons (patients/research
participants). Both of them, such as patients particularly
confronting end of life care and research participants
seeking treatment for their diseases, may not want
aggressive autonomy but rather they may make choices
(22).
congruent with them Kleinman (23) reported that
“ studies of the social context of health care reveal three
structural domains of health care in society: professional,
popular (family, social network, community), and folk
(nonprofessional healers). The great majority of health
care takes place in the popular domain: 70% to 90%.
When they do, decisions about where and when to seek
care, how long to remain in care, and how to evaluate
treatment also occur in the popular domain, most
commonly in the context of the family.” (23)
Shared decision-making models with the involvement
of family not only propose a careful search to determine
the patient needs, family expectations, and desires, but
also a negotiating process between physicians, patients
and family afterwards. This model requires well defined
competences from the researcher and research
participant and also support to understand their situation
and encourage informed choices. Therefore, there is a
need to make an emphasis not only over the importance
of autonomy of the research participant and patient
during the decision making process but also the active
involvement of family. The shared decision making
process is not only a good tool for the protection of
research participants and patients in Asian societies but
also supportive to the patient and research participants of
the western societies as well.
We conclude that Western and Asian societies
should learn from each other
Safety and protection of the research subject are the
prime responsibilities of the researcher in any research.
However in paternalistic Asian societies, where individual
autonomy is ranked second in comparison to the decision
by the elders, research participant and patients are at
high risk of exploitation by the researchers and clinicians.
Therefore, a unique model will be required which will be a
combination of Western concept of individual autonomy
and the Asian perception of family involvement in the
decision making process. This is so that the researcher,
during the decision making process, will not only seek the
permission from the research participant individually but
also from the family of the research participant as well.
This model will be comprised of a triad of the
patient/research subject, family members, and the
researcher or clinician.
Through this model we may be able to avoid
paternalism, to dilute power differences between the
researcher and the research subject and to ensure the
research subject protection in a better way.
The West is required to adopt family involvement in the
decision making process so that a strong connection of
the individual with the family will be established whereas
the Asian culture need to hold individual autonomy. The
implementation of this understanding will decrease the
chances of exploitation of common man in general and
vulnerable group in particular. Furthermore, after
understanding the researcher’s descriptions, knowing all
information, and involving the family in joint decision
making, it will not only make it easy for the research
participant to take part in research, but also for the
researcher to enroll the subject and ensure their safety
and protection.
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