The focal article of current commentary is comparative analysis of patient privacy and autonomy in China and the United States. Commentary critically examines the significant differences in ethical frameworks, legal structures, and cultural influences on healthcare decision-making. This commentary argues for a more integrated ethical framework that incorporates relational autonomy, institutional ethics oversight, and shared decision-making models to bridge the gap between these two systems. Drawing on global bioethics’ perspectives, this discussion proposes actionable solutions to address ethical dilemmas in diverse healthcare settings. Additionally, the commentary explores the role of globalization and technological advancements in shaping ethical medical practices, as well as the potential for harmonizing ethical principles across cultures. The rise of artificial intelligence (AI) in healthcare, big data ethics, and the ethical implications of cross-border medical practices are identified as emerging concerns that necessitate further ethical scrutiny. Ultimately, this commentary emphasizes the need for a globally adaptive ethical approach that balances cultural diversity with universal patient rights. The articles included in this commentary for literature review were carefully selected based on their relevance to ethical frameworks, legal structures, and cultural influences in healthcare decision-making, with inclusion limited to peer-reviewed studies published in English within the past 10 years to ensure contemporary relevance and scholarly credibility.

Patient privacy, Patient autonomy, Ethical dilemma case, Law, Culture, Bioethics.

In an era where medical advancements and digital records transcend borders, the balance between patient privacy and autonomy has become a pressing ethical dilemma on the global stage. This issue is particularly significant as different countries uphold varying ethical frameworks and legal standards, shaping how patient rights to privacy and autonomy are protected and exercised worldwide.[1] This commentary addresses the global ethical challenges surrounding patient privacy and autonomy, examining how diverse legal and cultural perspectives influence their implementation in healthcare systems worldwide.

Autonomy is defined by the right to self-determination and respects the individual’s right to make informed decisions.[2] According to Kant’s famous saying, “Autonomy of the will is the property the will has of being a law unto itself (independently of every property belonging to the objects of volition)” (Kant 1785, 108). Rational beings make moral law for themselves and can regard themselves as authors of the law. Thus, autonomy is manifested when rational agents “will” the moral law. For Kant, the moral law is categorical, not hypothetical, imperative. Privacy refers to an individual’s right to control their personal information and be free from unwanted intrusion or observation.[3]

The ethical principles of patient privacy and autonomy form the cornerstone of modern healthcare, yet their interpretation and implementation vary significantly across cultures and legal systems. The growing complexity of medical ethics, driven by globalization and technological advancements, has intensified debates on how best to balance individual rights with societal and cultural values.[4] In an era of rapidly evolving healthcare policies and artificial intelligence-driven medical interventions, questions surrounding ethical decision-making have become more urgent than ever.[5]

Relational autonomy, a fundamental tenet of medical ethics, is often challenged by cultural perspectives that prioritize collective well-being over individual decision-making. In China, medical decision-making frequently involves family members, reflecting Confucian values that emphasize relational ethics.[6] Conversely, 3 in the United States, bioethical principles strongly support individual autonomy and informed consent, underscoring the primacy of patient rights.[7] These contrasting approaches raise important questions about how ethical principles can be applied in culturally diverse settings without compromising fundamental patient rights.

This commentary critically analyzes Zhang et al.’s comparative study on patient privacy and autonomy in China and the United States. It argues that while cultural and legal differences shape healthcare decision-making, a more integrated ethical framework is needed to reconcile these variations. By incorporating relational autonomy, shared decision-making, and institutional ethics oversight, healthcare systems can better balance patient rights with cultural considerations. Additionally, this commentary explores the ethical implications of globalization, artificial intelligence, and big data in shaping medical ethics and highlights the necessity of a globally adaptive ethical model.[8]

Cultural and legislative perspectives from China and the United States
Relational autonomy refers to an understanding of individual decision-making that acknowledges the social, cultural, and interpersonal relationships influencing a person’s choices.[9] In clinical practice, this means that respect for autonomy involves recognizing the patient’s social context, including familial and cultural dynamics, rather than focusing solely on isolated individual preference. Relational autonomy and privacy are, as bioethical constructs, reflective of culturally sensitive approaches to patient decision-making by integrating the socio-cultural environment and interpersonal dependencies into the concept of autonomy and privacy.[10]

In China, relational autonomy aligns closely with Confucian ethics, which emphasize family cohesion, filial piety, and collective decision-making. Here, the role of the family is not merely supportive but often central in clinical decisions, with legislation implicitly accommodating these practices.[3] For instance, under the Law of the People’s Republic of China on Basic Healthcare and Health Promotion (2019), healthcare professionals are encouraged to respect both the patient’s and family’s opinions, reflecting a culturally embedded form of autonomy. Relational privacy is increasingly recognized; it’s often interpreted within the broader context of social harmony and state interests, rather than solely through the lens of individual rights.[11] The Personal Information Protection Law (PIPL), enacted in 2021, provides a comprehensive framework for data protection, but its application is shaped by China’s unique legal culture and emphasis on social order.

In contrast, U.S. healthcare legislation such as the Patient Self-Determination Act (1990) is rooted in the principle of individual autonomy, legally mandating informed consent and advance directives. However, applying relational autonomy in this setting invites a re-evaluation of rigid individualism, particularly in multicultural communities where collective input is valued. It allows for culturally competent care by legitimizing patient decisions that are influenced by family, religion, or community, as long as the patient retains agency.[12] From a legislative standpoint, relational autonomy can be viewed as a normative bridge that harmonizes culturally specific practices with legal mandates for patient rights.[13] Privacy theorist Alan Westin defined relational privacy as “the claim of individuals, groups, or institutions to determine for themselves when, how, and to what extent information about them is communicated to others.” This was revolutionary in its approach. Basically, Westin argued that citizens should retain ultimate control over their personal data, including how much of their personal information is disclosed and to whom, how it should be maintained, and how it should be disseminated, therefore creating the groundwork for current understandings of privacy. By 1974, the U.S. introduced federal privacy legislation.[14]

A critical examination of privacy and consent
Two cases of patient privacy violations: the unauthorized use of a patient as a clinical teaching subject in China and the unauthorized filming of a patient’s treatment in the U.S. These cases underscore the need for robust informed consent policies. The inclusion of a systematic ethical review process in Chinese hospitals, similar to the role of Institutional Review Boards (IRBs) in the U.S., could mitigate privacy concerns and reinforce patient rights (Grady, 2015). Informed consent should be a standard procedure in all healthcare settings, yet its interpretation varies widely. Studies indicate that cultural factors significantly influence how consent is obtained and how it is understood. In China, healthcare professionals may assume implied consent in cases where explicit consent is not legally mandated.[15] Meanwhile, the U.S. legal framework emphasizes patient autonomy and informed decision-making, reinforcing a stricter interpretation of privacy rights. The challenge is to develop a universal ethical standard that accommodates cultural diversity while upholding patient rights.

Moreover, multiple studies have highlighted the historical and philosophical foundations of consent in different cultures. Western bioethics, rooted in Kantian ethics and liberal individualism, places autonomy at the forefront, thereby shaping the stringent informed consent laws in countries like the United States. In contrast, Chinese medical ethics, influenced by Confucianism, emphasizes the role of relationships and social harmony, often leading to collective decision-making rather than strict individual consent.[16] These fundamental differences present challenges in standardizing informed consent practices globally.

Furthermore, studies suggest that the legal enforcement of consent regulations varies significantly based on sociopolitical factors. In the U.S., legal mechanisms such as the Health Insurance Portability and Accountability Act (HIPAA) ensure compliance with patient privacy regulations, whereas China has historically relied more on institutional policies rather than legally binding patient rights frameworks. This discrepancy suggests that ethical education and regulatory reforms are needed to bridge these gaps.

Another concern is the evolving nature of consent in digital healthcare. With advancements in telemedicine and electronic health records, new ethical dilemmas surrounding data privacy and cybersecurity are emerging. The application of AI in diagnostics raises additional concerns regarding algorithmic transparency and patient awareness.[17] Ethical frameworks must evolve to address these issues while preserving patient autonomy and data security. Overall, a valuable discussion on privacy and consent.

Contextualizing patient autonomy towards culturally sensitive and relational ethical frameworks in healthcare
The discussion of patient autonomy in the article highlights stark differences between China’s family-centered decision-making and the U.S.’s individualistic autonomy model. The case of Ms. L, where a cohabitant’s refusal delayed a cesarean section, illustrates how familial authority can override personal autonomy in China. Conversely, the case of Mrs. V in the U.S. demonstrates choices that can sometimes undermine patient choice. While focusing on these differences, they do not address alternative autonomy models such as relational autonomy, which integrates family input while ensuring the patient’s voice remains central.[10]

Recent research supports the idea that autonomy is a spectrum rather than a fixed principle. The study suggests that patient autonomy should be interpreted in the context of cultural expectations, rather than through a rigid Western bioethical framework.[6] Similarly, a study argues that relational autonomy, which acknowledges social and familial influences on decision-making, offers a more inclusive approach to respecting patient preferences across diverse cultural settings.[8] Some authors emphasize that contextual autonomy models are necessary in multicultural healthcare environments. For example, medical practitioners working in cross-cultural settings must adopt a hybrid decision-making approach, ensuring that ethical standards align with both global bioethics and local customs.[18,19]

Overall, the evolution of autonomy requires greater flexibility in ethical applications. Instead of treating autonomy as an absolute principle, bioethicists and healthcare practitioners should embrace adaptive models that balance individual rights with cultural and familial considerations.

Future implications
The ethical impact of globalization, including cross-border medical training, telemedicine, and medical tourism, will increasingly shape healthcare practices and ethical standards. AI and big data will continue to influence clinical decision-making, raising concerns about data security, algorithmic bias, and transparency that ultimately impact autonomy and privacy. Predictive analytics in healthcare may 7 revolutionize disease prevention and early diagnosis, but could also lead to ethical dilemmas around data ownership and discrimination. Ethical discussions must evolve in response to rapid technological advancements while safeguarding patient autonomy and privacy.

Recommendations
Universal ethical guidelines, such as those outlined in the Declaration of Helsinki and HIPAA, should be adapted to local cultural and healthcare contexts to ensure relevance and applicability. Establish international ethical oversight bodies to maintain accountability and standardization across jurisdictions in global health practices. Develop ethical AI governance frameworks that promote algorithmic transparency, fairness, and patient-centered care. Ensure patients are adequately informed about AI’s influence in their treatment, reinforcing autonomy, informed consent, and privacy. Implement legal and ethical safeguards to protect patient data from misuse in big data and predictive analytics applications. Foster interdisciplinary collaboration among bioethicists, policymakers, and technologists to address emerging ethical challenges.

Limitations
Cultural diversity complicates the development of universal ethical guidelines, as beliefs about autonomy, consent, privacy, and family involvement vary globally. There is a lack of enforceable international legal frameworks governing ethical practices in cross-border healthcare and AI-driven services. Existing ethical frameworks may not be fully equipped to handle emerging technologies like AI, predictive analytics, and global digital health exchanges. Historical healthcare disparities embedded in AI training data may perpetuate bias, and current frameworks may be inadequate to mitigate these risks.

Future research directions

• How can universal ethical principles be operationalized while respecting cultural pluralism in global healthcare settings?
• What are the best models for international ethical oversight that balance jurisdictional autonomy with global accountability?
• How can AI transparency and fairness be maintained, especially in low-resource settings and non-Western healthcare systems?
• What are the most effective approaches for obtaining informed consent in AI-influenced clinical contexts and cross-border care?
• What ethical frameworks can guide the ownership, use, and protection of big data in international healthcare and research collaborations?

The analysis reveals that autonomy and privacy in healthcare are deeply shaped by cultural and legislative contexts. While U.S. frameworks emphasize individual rights and informed consent, China integrates familial authority and social harmony into medical decision-making. Relational autonomy emerges as a culturally sensitive model that accommodates collective influences while preserving patient agencies. Evolving healthcare technologies and globalized care practices necessitate adaptive ethical frameworks. A flexible, context-sensitive approach to autonomy and consent can bridge cultural gaps and enhance patient-centered care across diverse healthcare systems.

Not reported

This study did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.

Corresponding Author:
Uzma Shaheen
Independent Researcher, Pakistan
Email: shaheen.uzma.1234@gmail.com

Co-Author:
Neelum Naz
Independent Researcher, Pakistan

Uzma Shaheen conducted the literature review and drafted the initial manuscript. Neelum Naz critically reviewed and contributed to the finalization of the manuscript.

Not applicable

The author declares no conflicts of interest.

None

https://doi.org/10.63096/medtigo3062335

Shaheen U, Naz N. Reevaluating Patient Privacy and Autonomy: Cross-Cultural and Legislative Perspectives. medtigo J Med. 2025;3(3):e3062335. doi:10.63096/medtigo3062335 Crossref