A nationwide survey of Japanese public perceptions of the necessity of antemortem informed consent for Rapid Autopsy...

Rapid Autopsy Programs (RAP) are essential research infrastructures for precision medicine, providing high-quality biospecimens. While international standards emphasize the importance of antemortem informed consent, Japan's ethical and legal frameworks for RAP remain underdeveloped. Currently, Japan lacks a consistent approach to postmortem tissue utilization, with requirements for individual consent varying significantly between pathological autopsies, systematic dissection, and organ transplantation. This study aims to clarify Japanese public perceptions regarding the necessity of antemortem consent for RAP in comparison with these established methods to inform the development of future ethical guidelines.

A nationwide internet survey was conducted in January 2025, involving 3,102 participants representative of the Japanese population's sex, age, and regional distribution. Participants viewed an educational video explaining four methods of postmortem tissue utilization: pathological autopsy, RAP, systematic dissection, and organ transplantation. To prevent bias, actual names and current legal statuses were not disclosed. Respondents rated the necessity of antemortem individual consent for each method using a six-point Likert scale. Statistical analyses were performed to identify differences between methods and demographic influences.

The survey revealed a strong public preference for antemortem consent across all methods. Specifically, over 70% of respondents agreed that antemortem consent is necessary for pathological autopsies, and over 85% expressed the same view for RAP, systematic dissection, and organ transplantation. The results showed a marked discrepancy between Japan's current legal system-which often relies on family consent-and public ethical awareness emphasizing individual will. While 90% valued antemortem consent for respecting individual wishes, over 50% acknowledged the difficulty of refusing a physician's request and emphasized the importance of family intentions. Women and older adults placed significantly greater importance on antemortem consent for RAP.

The Japanese public maintains high expectations for individual antemortem consent that exceed current legal requirements for some procedures. However, the findings also highlight the role of "relational autonomy," where family involvement and the clinical-research power dynamic influence decision-making. Developing an ethical framework for RAP in Japan requires not only prioritizing individual autonomy but also implementing "supported decision-making" and a clear separation between clinical and research teams to ensure social trust and cultural compatibility.