ABSTRACT

As the articles in this issue show, there are striking differences distinguishing approaches to informed consent and truth telling in the United States, Hong Kong, and mainland China. There appear to be some interesting similarities. Each of the approaches finds some place for family authority and direction by the physician. Each incorporates some form of therapeutic privilege for the physician. Each attempts to protect the interest of the patient. These similarities, however, are overwhelmed by quite distinct approaches to the appropriate role to be played by patients, their families, and physicians in medical decision-making. In addition, these approaches are set within quite different cultural and moral assumptions. A somewhat oversimplified summary of the differences might be put in these terms.

The American approach – the competent adult patient is the usual decision-maker and the presumed source of authority for medical decision-making. The families of patients are involved in the decision-making process only with the consent of the patient or by default when the patient becomes incompetent and has not employed advance directives to provide specific guidance. Except in extraordinary circumstances, deception of the patient is foreclosed.

The mainland Chinese approach – the family of the competent adult patient is the usual decision-maker and the presumed source of authority for 108medical decision-making. Patients are involved in the decision-making process only with the consent of the family or when, in extraordinary circumstances, the physician deems this appropriate. In numerous circumstances, deception of the patient by the family and the physician for his/her medical benefit is accepted.

The Hong Kong approach – the family of the competent adult patient is involved in order to help manage the decisions of the patient; the family is informed first of what must be communicated to the patient and then the physician brings the patient and the family together in the decision process. In usual circumstances, deception of the patient is foreclosed.