a1 Sociology Department of San Jose State University and an adjunct faculty member of Stanford Geriatric Education Center, Stanford University, Stanford, California
a2 Executive Director of the Stanford University Center for Biomedical Ethics and an adjunct assistant professor of Medical Anthropology at the University of California-San Francisco
a3 Nursing Ethics at the University of California-San Francisco School of Nursing and teaches in the International Cross-cultural Speciality Program at UCSF
A basic assumption in current western medicine is that good healthcare involves informed choices. Indeed, making informed choices is not only viewed as “good practice” but a right to which each individual is entitled, a perspective only recently developed in the medical field.
Moreover, in the case of ethical decisions, much of the discussion on the role of the family is cast within the autonomy paradigm of contemporary bioethics; that is, family members provide emotional support but do not make decisions for the competent adult patient. The family Is uniformly viewed as an Important proxy decision maker for incompetent patients; but most bioethicists would eschew any decision-making role for the family of mentally competent adult patients. Underlying the discussion of autonomy is the basic assumption in western medicine that good healthcare Involves choices by Informed individuals.