Ethical decision making on truth telling in terminal cancer: Medical students' choices between patient autonomy and family paternalism

Shuh Jen Sheu, Shu He Huang, Fu In Tang, Song Lih Huang*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

INTRODUCTION: The effect of medical education is often hard to evaluate. We tried to assess whether a 2-hour, small-group discussion could alter student perspectives on truth telling. Currently, in Taiwan it is common practice to consult with the family of a terminally ill patient before telling the truth to the patient, which may be in conflict with patient autonomy. METHODS: The study was based on content analysis of self-reflective written texts after a 2-hour group discussion on a clinical case describing a truth-telling situation. The changes in decision patterns regarding the emphasis placed on patient autonomy versus family paternalism and the connection to related moral reasoning were subjected to focus analysis. RESULTS: The students' initial attitudes regarding the subject of truth telling were categorised into 4 patterns, namely, patient-centred (n = 46), family-centred (n = 20), simultaneous informing (n = 1), and situational informing (n = 5) modes. The discussion stimulated perspective changes in many of the students and their attitudes were then regrouped as patient-comprehensive (n = 35), family-centred (n = 1), and family-comprehensive (n = 36) modes. It was found that variations on 'common sense' and moral reasoning existed prior to the class and the students initially tended to overlook the complexity of truth telling in terminal cancer. Through the discussion and reflective learning, they were enabled to acknowledge the vulnerability of both the patient and his or her family, and to make decisions based on more comprehensive considerations. CONCLUSION: Group discussion seemed to be able to enhance ethical consideration. Further research is required to determine whether the benefits of this approach can be translated into behavioural changes in practice.

Original languageEnglish
Pages (from-to)590-598
Number of pages9
JournalMedical Education
Volume40
Issue number6
DOIs
StatePublished - Jun 2006

Keywords

  • *truth disclosure
  • Attitude of health personnel
  • Decision making
  • Ethics, medical
  • Humans
  • Neoplasms/*psychology
  • Students, medical/*psychology
  • Terminally ill

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