Ethical decision making and patient autonomy: a comparison of physicians and patients in Japan and the United States.

作者: Gregory W. Ruhnke , Sandra R. Wilson , Takashi Akamatsu , Takaaki Kinoue , Yutaka Takashima

DOI: 10.1378/CHEST.118.4.1172

关键词:

摘要: Background: Patient-centered decision making, which in the United States is typically considered to be appropriate, may not universally endorsed, thereby harboring potential tocomplicate care of patients from other cultural backgrounds inpotentially unrecognized ways. This study compares attitudes towardethical making and autonomy issues among academic andcommunity physicians medical center outpatient clinicsin Japan States. Methods: Aquestionnaire requesting judgments about seven clinical vignettes wasdistributed (in English or Japanese) sample groups Japanesephysicians (n = 400) 65) as well US physicians(n 120) 60) that were selected randomly fromacademic institutions community settings (Tokyo andthe surrounding area) (the Stanford/Palo Alto, CA, area). Responses obtained 273 Japanese (68%),58 (89%), 98 (82%), 55 USpatients (92%). Physician patient compared onindividual items, composite scores derived subsets items relevant autonomy, family authority, physicianauthority. Results: A majority both physiciansand patients, but only a minority agreed should informed an incurable cancerdiagnosis before their terminally illpatient wishing die immediately ventilated, even ifboth doctor patient's want ventilated(Japanese vs p Conclusions: Family andphysician opinions are accorded larger role decisionmaking by sampled than those inthe States, although cultures place greater emphasis onpatient preferences on physician. Our results consistent with view context shapesthe relationship patient, physician, patient'sfamily making. The emphasize need forclinicians aware these affect andfamily responses different situations, potentiallyaffecting satisfaction compliance withtherapy.

参考文章(59)
Henry S. Perkins, Helen P. Hazuda, Josie D. Supik, Cultural differences among health professionals: A case illustration Journal of Clinical Ethics. ,vol. 9, pp. 108- 117 ,(1998)
James Hallenbeck, Mary Kane Goldstein, Eric W. Mebane, Cultural considerations of death and dying in the United States. Clinics in Geriatric Medicine. ,vol. 12, pp. 393- 406 ,(1996) , 10.1016/S0749-0690(18)30235-0
Yasuhiko Morioka, Informed consent and truth telling to cancer patients Gastroenterologia Japonica. ,vol. 26, pp. 789- 792 ,(1991) , 10.1007/BF02782871
B A Koenig, J Gates-Williams, Understanding cultural difference in caring for dying patients. Western Journal of Medicine. ,vol. 163, pp. 244- 249 ,(1995)
J C Barker, Cultural diversity--changing the context of medical practice. Western Journal of Medicine. ,vol. 157, pp. 248- 254 ,(1992)
Kazumasa Hoshino, Bioethics in Japan: 1989–1991 Springer Netherlands. pp. 379- 387 ,(1992) , 10.1007/978-94-011-2846-9_15
Emiko Ohnuki-Tierney, Illness and culture in contemporary Japan : an anthropological view Asian Folklore Studies. ,vol. 45, pp. 137- ,(1984) , 10.1017/CBO9780511621772
Klessig J, The effect of values and culture on life-support decisions. Western Journal of Medicine. ,vol. 157, pp. 316- 322 ,(1992)
Susan O. Long, Bruce D. Long, Curable cancers and fatal ulcers. Attitudes toward cancer in Japan. Social Science & Medicine. ,vol. 16, pp. 2101- 2108 ,(1982) , 10.1016/0277-9536(82)90259-3
Noritoshi Tanida, Japanese attitudes towards truth disclosure in cancer. Scandinavian journal of social medicine. ,vol. 22, pp. 50- 57 ,(1994) , 10.1177/140349489402200109