Offering Truth

Abstract

The problem of the uninformed patient with cancer can be described in\nmany different ways, for example, as faulty physician-patient communication;\nas an obstacle to good medical care; as a cause of stress among hospital\nstaff; and as a failure to respect patient autonomy. A dimension at least as\nimportant as these, but rarely acknowledged, is the clash it may represent\nbeween diverse cultures and their basic moral commitments. The approach\npresented above reflects an effort to maintain accepted standards of the\nphysician-patient relationship while respecting the cultural background and\nrequirements of families. This form of respect involves reasonable\naccommodation to these cultural expectations but should not be confused with\nuncritical acquiescence. The critical question is, perhaps, this: How should\nwe react to a family that refuses to allow the patient an offering of truth,\nthat maintains that discussion itself to be contrary to cultural norms? Under\nthose circumstances, I believe the offering must be made notwithstanding\nfamily demands. My reasons have as much to do with my beliefs about the nature\nof ethnic and religious moral norms themselves as with the view that in cases\nof conflict, our public morality (as concretized in law) should prevail.