“Truth-Telling” in Medicine

Have you seen Lulu Wang’s recent film “The Farewell”? It is about a Chinese family in which the matriarch is gravely ill with cancer, and neither her doctors nor her family informs her of the diagnosis. The Chinese title of the film “别告诉她” translates literally to “Don’t Tell Her.” 

This practice is known as “withholding truth.” It is rooted in Confucianism, which prioritizes the family over the individual. In this philosophy, the medical patient is the family rather than the individual. Doctors inform the family first, and it is the family’s decision whether to share the information with the individual patient. 

Intrigued by this movie, I found that withholding truth is not exclusive to China but rather widespread in Asia and some parts of Africa and Europe. An article entitled “Truth telling for patients with esophageal squamous cell carcinoma in Henan, China” in the journal Cancer Biology and Medicine indicated that only about 42% of patients hospitalized for esophageal squamous cell carcinoma in Henan, China, were aware of their true diagnoses. Only 4% had learned the diagnosis from their doctors; the rest were informed by family members or discovered it themselves. Another study showed that only 44% of family members of cancer patients surveyed believed that the patient should be informed of their true diagnosis.

As an American, I am fascinated by this cultural contrast in truth-telling. The primary reason people give for withholding grave information is that informing the patient can induce depression or aggravate the disease. Of course, even in the Western medical system, which requires doctors to truthfully and completely inform patients of their diagnosis and treatment options, doctors often struggle with how to present grave information and how much detail to provide. The literature is divided over whether disclosure or withholding of the truth is more beneficial to the patient (or if any significant difference even exists). 

What do you think? Does your culture err on the side of disclosure or withholding of the truth to the individual? Have you experienced this situation firsthand?

References

Wang, D, Peng, X, Guo, C et al. “When clinicians telling the truth is de facto discouraged, what is the family’s attitude towards disclosing to a relative their cancer diagnosis?” Support Care Cancer 21, 1089–1095 (2013). https://doi.org/10.1007/s00520-012-1629-y. Accessed 10 May 2020.

Zhang LQ, Chen PN, Wang HL, et al. “Truth telling for patients with esophageal squamous cell carcinoma in Henan, China”, Cancer Biol Med. 2017; 14: 83-9. doi: 10.20892/j.issn.2095- 3941.2016.0090. Accessed 8 May 2020 at www.cancerbiomed.org/index.php/cocr/article/view/1011/1127

Leave a Reply

Your email address will not be published. Required fields are marked *