Family Autonomy and Patient Rights to Healthcare in an ‘asian Values’ Context

A parallel can be made between the human rights discourse and the global bioethics discourse along two axes: 1) the ongoing relativist-universalist debate in both fields, 2) the overlap of the two discourses on the issue of the right to treatment as an issue of access.This article links the issue of right to treatment with an analysis of patient autonomy. In bioethics, it has been suggested that the Western individualistic notion of patient autonomy is inappropriate in Asian societies with a socio-centric construction of personhood and decision-making, where the family rather than the individual patient tends to make decisions on treatment. Based on a narrative analysis of physician’s perceptions of ethical dilemmas in a major tertiary hospital in New Delhi, India, we examine the concept of family autonomy. Six different narrative configurations of patient versus family autonomy are identified and contrasted. The analysis shows that while family autonomy is a common practice in treatment decisionmaking, it is problematic as a normative ethical principle to guide clinical practice because it poses yet another barrier to treatment for the patient, and because this practice often conflicts with the patient’s wishes and with what is best for the patient according to a medical assessment. Rather than pursuing an idealised ‘Eastern’ or ‘Asian’ concept of family autonomy as a ‘culturally appropriate’ replacement for the concept of