The patient as "subject" and capacity to give informed consent

In line with Western countries, the idea of "capacity assessment" to determine a person's course of treatment is being introduced to Japanese psychiatry. Herein, some problems associated with the informed consent of mental patients are discussed, and a typical case is presented. The author points out that, when involuntary treatment is necessary, the clinician must consider, 1) the self as a "subject" of the incapable, 2) the dissociation between a subject and a choice, 3) the nature of choice in life, 4) contextual assessment of mental intervention in the patient's life situation. Neglecting these issues will lead to inhumane medical practice in psychiatry.