Human Rights and Bioethics within Psychiatric Hospitals in Japan

Looking inside the walls of private psychiatric institutions in Japan, this paper explores bioethical concerns for autonomy in a high context culture, amongst people diagnosed with severe mental illness. The objective is to identify contextual components of control in Japanese clinical ethics that affect well-being, including the controversial extended use of bed restraints, and to recommend the need for future research and discussion of culture-specific values in accommodating respect for autonomy. This paper explores how and why these controlling factors need to be exposed, and considered, in any agenda focused on re-conceptualizing autonomy as a human right for people in psychiatric care. The paper sets out why these issues are issues of international human rights and seeks to open the dialogue through exploration of cultural, normative ethics of hospital conduct and psychiatric health care in situational context within Japan. Central to the paper is exploration of respect for autonomy and what this means for a population of people whose voice is seldom heard, always questioned, and who are vulnerable to being second-guessed and abused. This paper calls into focus the roles that sociocultural constructs, history, politics, and cultural values play in a health care system for people with psychosis and aims to contribute inquiry into a global social justice within a culture-bound domain of morals and ethics. In the conclusion and throughout this paper suggestions of careful and culturally sensitive international intervention are put forward as key strategies toward a humane solution for the serious human rights issue of respect for autonomy and agency on behalf of psychiatric patients in Japan.