Promoting truth-telling (the concept and its practice)with effective communication in medical settings:with particular focus on end of life care in Japan

BF Psychology

Inoue, Setsuko ; Clague, Julie

University:University of Glasgow

Department:School of Critical Studies

关键词: Truth-telling, end of life, Japan, Physician-patient relationship;   

Others  :  http://theses.gla.ac.uk/5180/7/2014InouePhD.pdf

来源: University of Glasgow

【 摘 要 】

This thesis deals with the concept and practice of truth-telling in medical settings. In particular, itanalyses the way in which truth-telling is enacted in the context of end of life care in Japan. Thethesis addresses not only the content of what is communicated in encounters between physiciansand medical personnel with patients and their family carers (next of kin), it also discusses the wayin which information concerning diagnosis, treatment, and prognosis is communicated. That is tosay, in the quality and integrity of the encounter.The thesis offers a literature survey of research studies that address truth-telling in medicalsettings in the USA, the UK, and in Japan, offering a comprehensive survey of studies written inEnglish and Japanese. It investigates the history of the concept and practice of truth-telling inmedicine from the turn of the twentieth-century to the present day, and it connects this history tothe developing field of medical ethics. Over the course of this history one can identify a shift –especially in the West – away from medical paternalism towards patient-centered medical care, inwhich patient autonomy and self-determination are highly valued. This has influenced theunderstanding and practice of truth-telling in medicine.Japan, however, has preserved certain cultural values, traditions, and conventions that affectmedical practice. The thesis analyses the effect of these behavioural norms on truth-tellingpractices in end of life care in Japan. It is argued that the hierarchical society, strong familystructure, paternalistic culture, and conversational etiquette of Japan tend to stymie effectivecommunication and limit truth-telling concerning diagnosis, treatment, and prognosis in medicalsettings.In light of the findings of the literature survey, the thesis proposes some concrete ways topromote truth-telling and effective communication in medical settings, including through thebuilding of trust between interlocutors and through the reflective praxis of critical and creativecontemplation.