Cultural Aspects of Nondisclosure

Abstract

A basic assumption in current western medicine is that good healthcare involves informed choices. Indeed, making informed choices is not only viewed as “good practice” but a right to which each individual is entitled, a perspective only recently developed in the medical field.Moreover, in the case of ethical decisions, much of the discussion on the role of the family is cast within the autonomy paradigm of contemporary bioethics; that is, family members provide emotional support but do not make decisions for the competent adult patient. The family Is uniformly viewed as an Important proxy decision maker for incompetent patients; but most bioethicists would eschew any decision-making role for the family of mentally competent adult patients. Underlying the discussion of autonomy is the basic assumption in western medicine that good healthcare Involves choices by Informed individuals.

Commentary: Disclosure in Oncology—To Whom Does the Truth Belong?

“…This justification falls under the traditional heading of therapeutic privilege. As well, patients are allowed to actively use their autonomy to defer disclosure to friends or family members if they state that they do not wish to know this information [22].…”

“Knowing is Better”: Preferences of Diverse Older Adults for Discussing Prognosis

“…21 One study of 214 older adults with limited life expectancy (91% white) found that 50% of participants with a prognosis of 5 years left to live and 83% of those with a prognosis of less than 1 year wanted to discuss prognosis with their doctor. 22 Literature from outside the US shows that elders in traditional Chinese families may prefer nondisclosure of poor prognosis, 23,24 though more recent findings from China and Korea suggest that patient attitudes in Asian cultures may be changing in favor of direct, patient-centered disclosure. 25,26 A limited number of studies from the advance planning literature also point to Latinos' unique perspectives on patient-doctor discussions around the end of life.…”

Congruence of Knowledge, Experiences, and Preferences for Disclosure of Diagnosis and Prognosis between Terminally-Ill Cancer Patients and Their Family Caregivers in Taiwan

“…Therefore, in order to protect patients from the harm associated with knowing their diagnosis and prognosis, there is a need to keep information about the disease and prognosis from the patient and to release disease-related information only to patients' families (12)(13)(14). Furthermore, in Asian cultures a model of family autonomy is well-recognized in which family members have legitimate superior decision making authority even over fully competent patients (15,16). Physicians' respect for patient autonomy frequently is subordinate to the power of family (13)(14)(15).…”