SIR

Akabayashi et al¹ presented us with an account of the difficulties when attempting to respect the patient's autonomy while we do not know the patient's own understanding regarding the autonomy we are attempting to respect. Most times we, as doctors, face difficult decisions, we do not have previous, reliable knowledge of the patients' views on the issue which we are finding difficult to resolve. Even previous discussions which happened far from the turmoil of cancer disclosure or similar events, can only be relied upon to a limited extent. We have all seen patients changing their minds in the face of catastrophe, in ways not only unpredictable to their doctor, but also to themselves. Transcultural study of the meanings and practice of individual autonomy provides a very useful way of extending our understanding of these issues, enlarging our horizons, as it does, beyond the anglo-saxon view.

The main point, however, is to construe a definition of autonomy which will encompass the cultural and individual variations of whatever autonomy stands for. Here I can only offer my view that autonomy …