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

• Main Author: Inoue, Setsuko
• Published: University of Glasgow 2014
• Subjects: 362.17; BF Psychology
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.601617

This thesis deals with the concept and practice of truth-telling in medical settings. In particular, it analyses the way in which truth-telling is enacted in the context of end of life care in Japan. The thesis addresses not only the content of what is communicated in encounters between physicians and medical personnel with patients and their family carers (next of kin), it also discusses the way in which information concerning diagnosis, treatment, and prognosis is communicated. That is to say, in the quality and integrity of the encounter. The thesis offers a literature survey of research studies that address truth-telling in medical settings in the USA, the UK, and in Japan, offering a comprehensive survey of studies written in English and Japanese. It investigates the history of the concept and practice of truth-telling in medicine from the turn of the twentieth-century to the present day, and it connects this history to the 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, in which patient autonomy and self-determination are highly valued. This has influenced the understanding and practice of truth-telling in medicine. Japan, however, has preserved certain cultural values, traditions, and conventions that affect medical practice. The thesis analyses the effect of these behavioural norms on truth-telling practices in end of life care in Japan. It is argued that the hierarchical society, strong family structure, paternalistic culture, and conversational etiquette of Japan tend to stymie effective communication and limit truth-telling concerning diagnosis, treatment, and prognosis in medical settings. In light of the findings of the literature survey, the thesis proposes some concrete ways to promote truth-telling and effective communication in medical settings, including through the building of trust between interlocutors and through the reflective praxis of critical and creative contemplation.