Raising issues regarding consents to physical treatment of psychiatric patients

Abstract

In Japan, a sufficient legal framework has not yet been established for the “consent” of a patient with impaired judgment due to psychiatric symptoms who undergoes physical treatment. In particular, from an ethical perspective, careful consideration should be given when providing invasive medical interventions including surgery and chemotherapy. In this paper, we presented 4 cases in which the patients’ psychiatric symptoms had seriously affected their consent to physical treatments, objectively assessed each patient’s ability to consent, and discussed the issues. Additionally, proxy consent by family members, which has conventionally been given in Japan, lacks legal basis. Therefore, we introduced a case in which we had requested the University Ethics Committee to review the validity of the consent. Finally, we compared and examined the current status concerning proxy consent in various foreign countries and raised issues for the future establishment of regulations in Japan.