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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References
Christakis NA. Ethics are local: engaging cross-cultural variation in the ethics for clinical research. Soc Sci Med. 1992;35(9):1079–91.
Qui R-Z. What has bioethics to offer the developing countries? Bioethics. 1993;7:108–25.
Fabrega Jr. An ethnomedical perspective on meidical ethics. J Med Philos. 1990;15:593–625.
D’Andrade RG. Cultural meaning systems. In: Shreder RA, Levine RA, eds. Culture Theory: Essays on Mind Emotion Self. Cambridge, UK: Cambridge University Press; 1984:88–119.
Kleinman A. The Illness Narratives: Suffering, Healing and the Human Condition. New York, NY: Basic Books; 1988.
Sehgal AR, Weisheit C, Miura Y. Advance directives and withdrawal of dialysis in the United States, Germany, Japan. JAMA. 1996;276(20):1652–6.
Asai A, Fukuhara S, Lo B. Attitudes of Japanese and Japanese-American physicians towards life-sustaining treatment. Lancet. 1995;346:356–9.
Forde R, Aasland OG, Falkum E. The ethics of euthanasia—attitudes and practice among Norwegian physicians. Soc Sci Med. 1997;45(6):887–92.
Beyene Y. Medical disclosure and refugees: telling bad news to Ethiopian patients. West J Med. 1992;157:328–32.
Thomsen O, Wulff H, Martin A, Singer P. What do gastroenterologists in Europe tell cancer patients? Lancet. 1993;341:473–6.
Uchitomi Y, Okanura H, Minagawa H, et al. A survey of Japanese physicians’ attitudes and practice in caring for terminally ill cancer patients. Psychiatry Clin Neurosci. 1995;49(1):53–7.
Payne K, Taylor RM, Stocking C, Sachs GA. Physicians’ attitudes about the care of patients in the persistent vegetative state: a national survey. Ann Intern Med. 1996;125(2):104–10.
Blackhall LJ, Murphy ST, Frank G, Michel V, Azen S. Ethnicity and attitudes toward patient autonomy. JAMA. 1995;274(10):820–5.
Davidson B, Lan RV, Davis A, et al. Ethical reasoning associated with the feeding of terminally ill elderly cancer patients. Cancer Nurs. 1990;13(5):286–92.
Qui R-Z. Medicine—the art of humaneness: on ethics of traditional Chinese medicine. J Med Philos. 1988;13:277–300.
Xu T-M. China: moral puzzles. Hastings Centr Rep. March/April 1990:24–5.
Qui R-Z. Morality in flux: medical ethics dilemmas in the People’s Republic of China. Kennedy Inst Ethics J. March 1991:16–27.
Morioka Y. Informed consent and truth telling in cancer patients. Gastroenterol Jpn. 1991;26:789–92.
Kai I, Ohi G, Eiji Y, et al. Communication between patients and physicians about terminal care: a survey in Japan. Soc Sci Med. 1993;36:1151–9.
Harrison A, Al-saadi AMH, Al-Kaabi ASO, et al. Should doctors inform terminally ill patients? The opinions and nationals and doctors in the United Arab Emirates. J Med Ethics. 1997;23:101–7.
Holland JC, Geary N, Marchini A, Tross S. An international survey of physician attitudes and practice in regard to revealing the diagnosis of cancer. Cancer Invest. 1987;5:151–4.
Surbone A. Truthtelling: a cultural or individual choice. JAMA. 1992;268:1661–2. Letter.
Surbone A. Truth telling to the patient. JAMA. 1993;269:989. Letter.
Welch M, Feldman M. Cross-cultural communication. In: Behavioral Medicine in Primary Care: A Practical Guide. Stamford, Conn: Appleton & Lange; 1997:97–108.
Jecker N, Carrese J, Pearlman R. Caring for patients in cross-cultural settings. Hastings Cent Rep. 1995;25(1):6–14.
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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