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Chinese and U.S. internists adhere to different ethical standards

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Abstract

OBJECTIVE: To determine whether internists in the United States and China have different ideas and behaviors regarding informing patients of terminal diagnoses and HIV/AIDS, the role of the family in end-of-life decision making, and assisted suicide.

DESIGN: Structured questionnaire of clinical vignettes followed by multiple choice questions.

SETTING: University and community hospitals in San Francisco and Beijing, China.

SUBJECTS: Forty practicing internists were interviewed, 20 in China and 20 in the United States.

MEASUREMENTS AND MAIN RESULTS: Of the internists surveyed, 95% of the U.S. internists and none of the Chinese internists would inform a patient with cancer of her diagnosis. However, 100% of U.S. and 90% of Chinese internists would tell a terminally ill patient who had AIDS, rather than advanced cancer, about his diagnosis. When family members’ wishes conflicted with a patient’s preferences regarding chemotherapy of advanced cancer, Chinese internists were more likely to follow the family’s preferences rather than the patient’s preferences (65%) than were the U.S. internists (5%). Thirty percent of U.S. internists and 15% of Chinese internists agreed with a terminally ill patient’s request for sufficient narcotics to end her life.

CONCLUSIONS: We found significant differences in clinical ethical beliefs between internists in the United States and China, most evident in informing patients of a cancer diagnosis. In general, the Chinese physicians appeared to give far greater weight to family preferences in medical decision making than did the U.S. physicians.

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This work was supported by the Henry J. Kaiser Family Foundation Faculty Fellowship in General Internal Medicine (SRC).

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Feldman, M.D., Zhang, J. & Cummings, S.R. Chinese and U.S. internists adhere to different ethical standards. J GEN INTERN MED 14, 469–473 (1999). https://doi.org/10.1046/j.1525-1497.1999.06318.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.1999.06318.x

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