Is Truth Telling to the Patient a Cultural Artifact?

In this issue ofJAMA, Antonella Surbone, MD, describes her dilemma in trying to transfer the ideals of medical ethics she learned in the United States to her native Italy.1From her experience in the United States, she found that truth telling and respect for autonomy have become virtual moral absolutes. On the other hand, in Italy, families and physicians often shield patients from painful truths and difficult decisions. As Dr Surbone points out, what is beneficent in one country may seem maleficent in another country. This contrast in moral perspectives, of course, is not unique to the differences between Italy and North America. It has become a worldwide problem as newer models of medical ethics nurtured in the individualistic soil of North America are introduced to other countries with different moral traditions.2But similar contrasts may exist within a country, for example, between northern and southern Italy,