Disclosure of true medical information: the case of Bangladesh.

IF 3 1区 哲学 Q1 ETHICS BMC Medical Ethics Pub Date : 2024-10-17 DOI:10.1186/s12910-024-01115-y
Sanwar Siraj, Kristien Hens, Yousuf Ali
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Abstract

Background: Truth-telling in health care is about providing patients with accurate information about their diagnoses and prognoses to enable them to make decisions that can benefit their overall health. Physicians worldwide, especially in the United Kingdom (U.K.) and the United States (U.S.), openly share such medical information. Bangladesh, however, is a Muslim-majority society with different social norms than Western societies. Therefore, we examined whether Muslim culture supports truth disclosure for patients, particularly how and to what extent medical information about life-threatening diseases is provided to patients in Bangladesh.

Methods: This was a phenomenological qualitative study. We conducted thirty in-depth interviews with clinicians, nurses, patients and their relatives at Shaheed Suhrawardy Medical College Hospital in Dhaka, Bangladesh. We also used observations to explore interactions between patients, families and healthcare professionals regarding their involvement in medical decisions and truth disclosure issues. NVivo software was used to identify common themes, and a thematic analysis method was utilised to analyse the datasets.

Results: This study identified three recurring themes relevant to the ethics and practice of truth disclosure: best interest rather than autonomy, the ambivalent value of deception and who understands what. The participants revealed that physicians often withhold fatal medical prognoses from terminally ill patients to ensure the best healthcare outcomes. The results indicate that deception towards patients is commonly accepted as a means of reducing burden and providing comfort. The participants opined that true medical information should be withheld from some patients, assuming that such disclosures may create a severe burden on them. Whether or to what extent medical information is disclosed primarily depends on a family's wishes and preferences.

Conclusions: While truth disclosure to patients is considered an ethical norm in many cultures, such as in the U.K. and the U.S., the practice of concealing or partially revealing severe medical prognoses to patients is an actual medical practice in Bangladeshi society. This study emphasises the importance of recognising a patient's active involvement and respecting the cultural values that shape family involvement in medical decision-making. These findings may have significant policy and practical implications for promoting patient autonomy within Bangladeshi family dynamics and religious-based cultural values.

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披露真实医疗信息:孟加拉国的案例。
背景:医疗保健中的实话实说是指为患者提供有关其诊断和预后的准确信息,使他们能够做出有利于其整体健康的决定。全世界的医生,尤其是英国和美国的医生,都公开分享此类医疗信息。然而,孟加拉国是一个穆斯林占多数的社会,其社会规范与西方社会不同。因此,我们研究了穆斯林文化是否支持向患者披露真相,特别是在孟加拉国,如何以及在多大程度上向患者提供有关危及生命的疾病的医疗信息:这是一项现象学定性研究。我们对孟加拉国达卡 Shaheed Suhrawardy 医学院医院的临床医生、护士、患者及其亲属进行了 30 次深入访谈。我们还通过观察探讨了患者、家属和医护人员之间在参与医疗决策和披露真相问题上的互动。我们使用 NVivo 软件确定共同主题,并采用主题分析方法对数据集进行分析:本研究发现了与披露真相的伦理和实践相关的三个重复出现的主题:最佳利益而非自主权、欺骗的矛盾价值以及谁能理解什么。参与者发现,医生经常对临终病人隐瞒致命的医疗预后,以确保最佳的医疗效果。研究结果表明,作为减轻负担和提供安慰的一种手段,对病人的欺骗被普遍接受。与会者认为,应该对某些病人隐瞒真实的医疗信息,因为披露这些信息可能会给他们造成严重的负担。是否披露医疗信息或披露的程度主要取决于家属的意愿和偏好:虽然在许多文化中,如在英国和美国,向病人披露真相被认为是一种道德规范,但在孟加拉社会,向病人隐瞒或部分披露严重医疗预后的做法却是一种实际的医疗行为。本研究强调了承认病人积极参与和尊重形成家庭参与医疗决策的文化价值观的重要性。这些发现可能对在孟加拉国家庭动态和基于宗教的文化价值观中促进患者自主权具有重要的政策和实践意义。
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来源期刊
BMC Medical Ethics
BMC Medical Ethics MEDICAL ETHICS-
CiteScore
5.20
自引率
7.40%
发文量
108
审稿时长
>12 weeks
期刊介绍: BMC Medical Ethics is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies.
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