Research article

Clinical Ethics Consultation: Examining how American and Japanese experts analyze an Alzheimer's case

Noriko Nagao^1,2 , Mark P Aulisio³ , Yoshio Nukaga² , Misao Fujita² , Shinji Kosugi¹ , Stuart Youngner³ and Akira Akabayashi^2,4

¹Department of Biomedical Ethics, Graduate School of Medicine, Kyoto University, Kyoto, Japan

²Center for Biomedical Ethics and Law, Graduate School of Medicine University of Tokyo, Tokyo, Japan

³Department of Bioethics, Case Western Reserve University, Ohio, USA

⁴Department of Biomedical Ethics, Graduate School of Medicine University of Tokyo, Tokyo, Japan

author email corresponding author email

BMC Medical Ethics 2008, 9:2doi:10.1186/1472-6939-9-2

Published:	29 January 2008

Abstract

Background

Few comparative studies of clinical ethics consultation practices have been reported. The objective of this study was to explore how American and Japanese experts analyze an Alzheimer's case regarding ethics consultation.

Methods

We presented the case to physicians and ethicists from the US and Japan (one expert from each field from both countries; total = 4) and obtained their responses through a questionnaire and in-depth interviews.

Results

Establishing a consensus was a common goal among American and Japanese participants. In attempting to achieve consensus, the most significant similarity between Japanese and American ethics consultants was that they both appeared to adopt an "ethics facilitation" approach. Differences were found in recommendation and assessment between the American and Japanese participants. In selecting a surrogate, the American participants chose to contact the grandson before designating the daughter-in-law as the surrogate decision-maker. Conversely the Japanese experts assumed that the daughter-in-law was the surrogate.

Conclusion

Our findings suggest that consensus building through an "ethics facilitation" approach may be a commonality to the practice of ethics consultation in the US and Japan, while differences emerged in terms of recommendations, surrogate assessment, and assessing treatments. Further research is needed to appreciate differences not only among different nations including, but not limited to, countries in Europe, Asia and the Americas, but also within each country.