title: Can familism be justified?
abstract: This paper argues against the continued practice of Confucian familism, even in its moderate form, in East Asian hospitals. According to moderate familism, a physician acting in concert with the patient's family may withhold diagnostic information from the patient, and may give it to the patient's family members without her prior approval. There are two main approaches to defend moderate familism: one argues that it can uphold patient's autonomy and protect her best interests; the other appeals to cultural relativism by construing the principle of 'family autonomy' to be incommensurable with that of individual autonomy. We respond to the first approach by explaining how the familist arguments either depend on some unreasonable assumptions or simply fail to articulate. The critique of the second approach is based on our recent survey showing that there is no dichotomy of relevant values between the East and the West: we believe that the result can effectively block the familist's reliance on certain traditional or cultural values to explain their resistance to the incorporation of pluralist values. Despite our disagreement with familism, we consider the Eastern emphasis on the family to be conducive to the communication between patient, family members and medical personnel, which is indispensible to the patient's well being and autonomy. We conclude that respect for patient autonomy is perfectly consistent with the involvement of the family in making medical decision as long as the family plays a merely consultant role.
authors.affiliation: HKU SPACE Community College Community College - Philosophy, 13/F, 28 Wang Hoi Road Kowloon Bay, Kowloon Hong Kong. kycheng@hkuspace.hku.hk
authors.forename: Kam-Yuen
authors.initials: KY
authors.lastname: Cheng
authors.forename: Thomas
authors.initials: T
authors.lastname: Ming
authors.forename: Aaron
authors.initials: A
authors.lastname: Lai
mesh_terms: D032903:Confucianism; D003657:Decision Making / Q000941:ethics; D005195:Family Relations / Q000208:ethnology*; D005202:Asia, Eastern; D006801:Humans; D026684:Personal Autonomy; D010817:Physician-Patient Relations / Q000941:ethics*; D011368:Professional-Family Relations / Q000941:ethics; D012068:Religion and Medicine; D014342:Truth Disclosure / Q000941:ethics*