I had to have colorectal cancer surgery in April 1999, in a local general hospital in the western part of Japan. A seemingly formal process of informed consent took place in terms of the physician's disclosure and my signing of the consent form. But the physician would never make any disclosure without the presence of my husband, even though I had asked him in advance to tell me everything directly. On the consent form, there was a list of risks and complications of the proposed procedure, but there was no mention of possible alternatives. The consent form was rather archaic in that its preface stated that they demanded of a patient a full understanding of what is to be disclosed and prohibited any protestation against the hospital's medical policies in case of an insurmountable accident (which, in fact, can only be determined by a third party). My physician-oncologist forced me to sign a consent form for an angiography and an arterial injection of an anti-cancer agent in spite of my refusal three times. Also, there was deception in the process of intravenous administration of chemotherapy. I ended up refusing the prescribed regimen because of its serious side effects. The legal doctrine and the ethical, democratic idea of informed consent are two different things. The former may easily be implemented even in Japan, as physician discretion and patient incompetence can justify non-disclosure. Legally, there is no requirement for ascertaining a patient's understanding of what is disclosed, whereas the ethical requirement demands that consent is meaningless if disclosure is inadequate and not understood by the patient. Indeed, only effective dialogue between honest and caring health-care professionals and the patient can effectuate a healing process and prevention of serious medical harm.
