TY  - JOUR
T1  - Whose Voice Counts in Family-Mediated Consent? A Scoping Review of Patient Participation, Decisional Authority, and Cultural Variation across East, South, and Southeast Asian Clinical Settings
A1  - Li Wei
A1  - Yuki Tanaka
A1  - Chen Hao
A1  - Ravi Patel
JF  - Asian Journal of Ethics in Health and Medicine
JO  - Asian J Ethics Health Med
SN  - 3108-5059
Y1  - 2026
VL  - 6
IS  - 2
DO  - 10.51847/DmHIgH98P9
SP  - 147
EP  - 158
N2  - Clinical decisions involving family members are often described through broad contrasts between individual autonomy and family-oriented decision making. Such contrasts obscure important differences between family presence, assistance, influence, information control, surrogate action, and final decisional authority. They can also encourage unwarranted generalization across heterogeneous Asian healthcare settings. To map how patient participation and decisional authority are defined, operationalized, and represented in literature concerning family-mediated clinical decisions across East, South, and Southeast Asia, and to identify the clinical, relational, institutional, and cultural conditions associated with variation. A scoping-review approach informed by JBI methodology and PRISMA-ScR reporting principles was used. Evidence was charted according to country or region, clinical setting, actors, decision context, form of patient participation, family role, location of practical or formal decisional authority, methodological design, and contextual conditions. Studies and contextual sources were interpreted separately so that family involvement was not assumed to constitute either patient exclusion or shared decision making. Figure 1 reports identification and selection stages through 63 included studies. The mapped literature showed substantial variation within as well as between countries. Patient participation ranged from receipt of information and expression of preferences to deliberation and final decision control. Family involvement likewise ranged from supportive interpretation, navigation, emotional assistance, and dyadic planning to control over disclosure, communication with clinicians, or treatment decisions. Cancer care, serious illness, advance care planning, and end-of-life decisions were prominent contexts. Evidence from routine, non-cancer, and South Asian settings was comparatively limited. Country labels alone explained little of the observed variation; decision type, patient preference, illness stage, institutional routines, communication practices, and legal or professional arrangements frequently altered the practical distribution of authority. Family-mediated consent in Asian clinical settings cannot be adequately characterized by the presence or absence of family participation. The more informative question is how patient voice, information access, deliberative influence, and final authority are distributed in a particular decision and whether that distribution corresponds to the patient’s own preferences. Cultural interpretation is strongest when linked to specific relational and institutional arrangements rather than treated as a national attribute.
UR  - https://smerpub.com/article/whose-voice-counts-in-family-mediated-consent-a-scoping-review-of-patient-participation-decisional-2l65fnppwy2mbou
ER  -