Lulu Wang’s recent film “The Farewell” 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 actual 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 the face of difficult news, doctors inform the patient’s family first, and the family decides whether to share the information with the individual patient. This contrasts starkly with the Western medical system, in which the patient is always the first (and sometimes the only) one to receive medical news, and the doctor informing the family first or failing to fully disclose the situation to the patient would constitute malpractice.

Intrigued by this movie, I found that withholding truth is not exclusive to China but rather widespread in Asia and some parts of Africa. 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. The primary reason people cite 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 diagnostic and therapeutic options, doctors struggle with how to present negative information and how much detail to provide. The literature is divided over whether full disclosure or withholding of the truth is more beneficial to patient outcomes (or if any significant difference even exists). It comes down to a difference in approach and opinion.

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.

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.