Chinese and U.S. Internists Adhere to Different Ethical Standards

• Published in: Journal of general internal medicine : JGIM 1999-08, Vol.14 (8), p.469-473
• Main Authors: Feldman, Mitchell D., Zhang, J., Cummings, Steven R.
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Bioethics; Biological and medical sciences; Cancer; Chemotherapy; China; Cross-Cultural Comparison; cross‐cultural differences; Decision making; Diagnosis; End of life; Ethical standards; Ethics; Ethics, Medical; family preferences; Female; Health Knowledge, Attitudes, Practice; HIV; HIV/AIDS; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Internal Medicine; Male; Medical sciences; Narcotics; Original; Patient Participation; Patients; Physician-Patient Relations; Physicians; Professional-Family Relations; Public health; Suicide; Suicide, Assisted; Surveys and Questionnaires; Terminally Ill; Tropical medicine; Truth Disclosure; United States; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1046/j.1525-1497.1999.06318.x

OBJECTIVE: To determine whether internists in the United States and China have different ideas and behaviors regarding informing patients of terminal diagnoses and HIV/AIDS, the role of the family in end‐of‐life decision making, and assisted suicide. DESIGN: Structured questionnaire of clinical vignettes followed by multiple choice questions. SETTING: University and community hospitals in San Francisco and Beijing, China. SUBJECTS: Forty practicing internists were interviewed, 20 in China and 20 in the United States. MEASUREMENTS AND MAIN RESULTS: Of the internists surveyed, 95% of the U.S. internists and none of the Chinese internists would inform a patient with cancer of her diagnosis. However, 100% of U.S. and 90% of Chinese internists would tell a terminally ill patient who had AIDS, rather than advanced cancer, about his diagnosis. When family members' wishes conflicted with a patient's preferences regarding chemotherapy of advanced cancer, Chinese internists were more likely to follow the family's preferences rather than the patient's preferences (65%) than were the U.S. internists (5%). Thirty percent of U.S. internists and 15% of Chinese internists agreed with a terminally ill patient's request for sufficient narcotics to end her life. CONCLUSIONS: We found significant differences in clinical ethical beliefs between internists in the United States and China, most evident in informing patients of a cancer diagnosis. In general, the Chinese physicians appeared to give far greater weight to family preferences in medical decision making than did the U.S. physicians.