Globally, the disclosure of a terminal illness prognosis to a patient is a complex and ethically sensitive issue within the field of healthcare. In Asian cultures, particularly, there exists a belief that patients should be shielded from knowledge of their terminal prognosis. This belief stems from a cultural emphasis on maintaining hope, protecting the patient from distress, and having the family assume the burden of communicating such news. However, as healthcare providers, it is crucial to consider both the patient’s right to know and the cultural practices and beliefs of the family. Ultimately, not fully disclosing information to the patient can be seen as an ethical breach, as the principles of autonomy, beneficence, and non-maleficence must be respected.
Autonomy, or the respect for the patient’s right to make decisions about their own medical care, is a foundational principle in medical ethics. Informed decision-making relies on the patient having access to accurate and comprehensive information about their medical condition. When a patient is kept uninformed about their terminal prognosis, their ability to exercise autonomy is compromised. It is essential to recognize that withholding such critical information disempowers the patient and limits their ability to make well-informed choices about their medical care, end-of-life planning, and participation in shared decision-making.
On the other hand, cultural practices and beliefs shape individuals’ attitudes towards illness, death, and communication. In Asian cultures, the belief that patients should be shielded from the truth about their prognosis is deeply ingrained. This cultural practice reflects values such as filial piety, respect for authority, and the collective nature of decision-making. In these cultures, the responsibility of delivering bad news often falls on the family, as they view it as an act of love and protection. Consequently, health care providers need to approach disclosure of terminal prognosis with cultural sensitivity and engage in communication strategies that respect the family’s beliefs and practices.
The challenge then becomes finding a balance between respecting cultural practices and upholding the principles of autonomy and beneficence. Recognizing the importance of cultural beliefs, it may be appropriate to engage in a dialogue with the family to better understand their wishes and concerns regarding disclosure. Such discussions can shed light on the underlying rationale for not disclosing the prognosis and offer insight into the family’s values and beliefs. By engaging in this dialogue, healthcare providers can work collaboratively with the family to reach a shared understanding and find a solution that respects the patient’s autonomy while considering the cultural context.
One approach to striking this balance is to adopt a gradual disclosure model, wherein information is shared progressively, taking into account the patient’s emotional readiness and ability to cope. Initially, the healthcare team may focus on building a therapeutic relationship and assessing the patient’s psychological state. Through open and empathetic conversations, they can gauge the patient’s desire for information and their capacity to comprehend and process the prognosis. This approach allows for a more individualized and culturally sensitive approach to disclosure, considering the patient’s unique circumstances.
Moreover, healthcare providers can collaborate with a culturally competent interpreter or ethnocultural liaison to bridge the communication gap and ensure accurate transmission of information. Involving individuals who are familiar with the cultural practices, norms, and beliefs of the patient can help navigate complex discussions and maintain mutual understanding while respecting cultural sensitivities.
Nevertheless, it is important to acknowledge that not fully disclosing information to the patient poses ethical challenges. The principle of non-maleficence, which dictates the avoidance of harm, becomes relevant in this context. By withholding information, patients may be denied the opportunity to make decisions that align with their values and goals, potentially resulting in unintended harm. Furthermore, the patient may experience distress and a sense of betrayal upon discovering the truth, eroding trust in the healthcare professional. It is, therefore, crucial to navigate the delicate balance between cultural sensitivity and the ethical obligation to respect autonomy and avoid harm.
