Impact of Culture and Religion on Truth Telling

The impact of culture and religion on truth telling at the end of life
  1. Clarissa de Pentheny O’Kelly1,
  2. Catherine Urch2 and
  3. Edwina A. Brown3
+ Author Affiliations

      1. 1Imperial College School of Medicine, London, UK
      2. 2Department of Palliative Care, Imperial College Healthcare NHS Trust, London, UK
      3. 3Renal Department, Imperial College Kidney and Transplant Centre, Hammersmith Hospital, London, UK
  1. Correspondence and offprint requests to: Edwina A. Brown; E-mail: e.a.brown@imperial.ac.uk
  • Received September 23, 2011.
  • Accepted September 26, 2011.
Abstract
Truth telling, a cardinal rule in Western medicine, is not a globally shared moral stance. Honest disclosure of terminal prognosis and diagnosis are regarded as imperative in preparing for the end of life. Yet in many cultures, truth concealment is common practice. In collectivist Asian and Muslim cultures, illness is a shared family affair. Consequently, decision making is family centred and beneficence and non-malfeasance play a dominant role in their ethical model, in contrast to patient autonomy in Western cultures. The ‘four principles’ are prevalent throughout Eastern and Western cultures, however, the weight with which they are considered and their understanding differ. The belief that a grave diagnosis or prognosis will extinguish hope in patients leads families to protect ill members from the truth. This denial of the truth, however, is linked with not losing faith in a cure. Thus, aggressive futile treatment can be expected. The challenge is to provide a health care service that is equable for all individuals in a given country. The British National Health Service provides care to all cultures but is bound by the legal principles and framework of the UK and aims for equity of provision by working within the UK ethical framework with legal and ethical norms being explained to all patients and relatives. This requires truth telling about prognosis and...