INFORMED CONSENT

Recent papers[1], [2] have explored the impact of western standards of truth disclosure on traditional Japanese oncology practice.

Although the 1989 Government Task Force for Terminal Care overwhelmingly favoured the merits of truth disclosure, the Bioethics Council of the Japan Medical Association introduced instead setsumei to doi[2]. "Explanation and Consent" sets favourable information above truth disclosure, mandating the Task Force's own principle that disclosure of all information might harm patients.

Previous studies including one in English[3] had shown that health care workers were less willing to tell the truth than their patients were to hear it. Nearly three-quarters of Japanese oncology patients wanted to know for themselves, but only a third thought other terminally ill patients should be told[2].

There is a large range in the proportion of cancer patients wanting a truthful diagnosis in various European and North American populations[4]. Emotional debate is more prevalent than empirical science in the western medical research literature on disclosure and informed consent.

The nocebo effect [see Medical Litigation News Volume 2, Issue 6] of informed consent was explored[5] 18 years ago. Findings were interpreted as indicating better outcome on a number of measures for patients who trusted a paternalistic surgeon.

Reports of the emotional responses to detailed disclosure have been conflicting. In relation to risks of general anesthesia, one study[6] documented an increase in apprehensiveness, anger and anxiety. Another study[7], regarding an impending surgical procedure, reported a decrease in anxiety.

PRACTICE POINT

Prevalent Japanese attitudes highlight the continuing ambivalence of some Western physicians and patients about grim truth disclosure

Many Japanese[1] and some Western physicians would like to return to discretionary truth disclosure according to the perceived wishes of their patients. This desire inevitably influences their compliance with current ethical and legal standards of informed consent.

Copyright 2008 Electronic Handbook of Legal Medicine