2001 Case 5
How to tell the truth to the terminal stage patient.
Is it OK not to tell the bad news if the patient doesn't ask to tell the truth?

The patients is a 71-year-old woman. She was suffering from lung cancer
with bone metastasis. She was admitted to the hospital not for pain treatment
of her back and leg (Not for aggressive cancer tratment pain but for palliative
pain management) .
She was pointed out her lung cancer 2 years ago, but at that time the bone
metastasis was found out, so the docter said to her husband the life life
expectancy would be only 6 months. The husband asked the doctor not
to tell her the true diagnosis if her life was not so long. The husband
did not not want the patient lost the hope to live. So the doctor told the
patient the sharp pain is owing to "The disease of the nerve" .
Although the disease got worse gradually, she could live longer than she
had been expected. The patient did not ask the medical staff or family
about the disease.
Although the husband felt sorry for her not to tell the truth, but he said it is
too late to tell. The patient passed away without knowing her true disease.

yThe question the student raisedz
Could confidential relationship be build between the doctor and the patient
without knowing the true condition?
In this case, the patient seemed she could understand her bad condition and
she did not want to ask the truth. It seemed she was not fearful of her death
but she could accept her death.
This situation such as not tell everything clearly is not so unpopular around the
Japanese, especially in older age. It would owing to the Japanese culture not
to speak everything clearly but fussy. This kind of fussy speaking sometimes
protect the Japanese mind in fearful situation. Is it OK not to tell the bad
news if the patient doesn't ask to tell the truth?

Comment from Susan Long

Dear Dr. Shirahama,
Thank you for posting many interesting cases.  Concerning the question about cancer
disclosure, as a cultural anthropologist I have a somewhat different approach that
bioethicists.  My research in Japan on this topic might be of interest to you because
it takes a descriptive and analytical look at the situation in Japan (as of five
years ago) rather than a normative approach.  I have published several articles,
which I will be happy to send you if you are interested in this gaijin's perspective
on the Japanese situation.

Long, S.O.  (1999).  Family surrogacy and cancer disclosure in Japan.  Journal of
Palliative Care 15: 31-42.

Long, S.O.  (2000).  Public passages, personal passages, and reluctant passages:
Notes on investigating cancer disclosure practices in Japan.  Journal of Medical
Humanities 21: 3-13.

Long, S.O. and Long, B.D.  (1982).  Curable cancers and fatal ulcers:  Attitudes
toward cancer in Japan.  Social Science and Medicine 16:2101-2108.

I assume you already are familiar with the work of Dr. Michael Fetters and his
colleagues on this topic.

I look forward to hearing more of your cases.

Susan Long
Professor of Anthropology
Department of Sociology
John Carroll University
University Hts., OH  44118

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Masashi Shirahama M.D.
Director, Mitsuse National health Insurance Clinic
Clinical Professor, Department of General Medicine, Saga Medical School
2615 Mitsuse, Kanzaki Gun, Saga Ken
842-0301 Japan