Chinese Clinical Ethicists Accept Physicians’ Benevolent Deception of Patients

In “Deception and the Clinical Ethicist,” Meyers (2021) defends the argument that the clinical ethicist should sometimes be an active participant in the deception of patients and their families. Meyers also expresses the point that in some cultures it may be acceptable, even obligatory, for a family to take on medical decision-making, deceptively protecting the patient from some “burden.” In Western countries, physicians discuss diagnoses with patients immediately, emphasizing the importance of their rights to informed consent and autonomy. However, in contrast to this Western individualistic approach, physicians in many Eastern countries, such as China, Singapore, and Japan, take a family-centered approach to cancer diagnoses/prognoses disclosure (Gan et al. 2018). The present commentary focuses on the ethical issues of deception and truth-telling in medical practice in China. The subject of bioethics has seen dramatic development in China in past decades; however, benevolent deception still occurs in some contexts and the trend toward full disclosure of cancer diagnoses has progressed slowly (Gan et al. 2018). Although the Western principle of autonomy has been introduced into bioethical discussion in East Asian countries, it is far from being generally accepted in biomedical practices (Fan 1997). We start with a typical case: Mr. C, a 71-year-old Chinese man with five children has been diagnosed with advanced lung cancer. The physician deemed him terminally ill with only 6 months left to live and suggested that the only treatment that could prolong his life was chemotherapy. Mr. C received routine chemotherapy in the Department of Pulmonary Medicine. To protect Mr. C from anxiety, depression, and loss of hope, his children deceived him and represented the chemotherapy as simply a regular therapy for the treatment of pneumonia. Mr. C was optimistic about his recovery until he overheard his diagnosis; a few days after finding out the depressing truth, he passed away (Zhang and Min 2020). In fact, it is a prevalent phenomenon in China for family members to deliberately conceal a cancer diagnosis from their loved ones. In a 2018 survey involving 143 cancer patients in Beijing, 85.9% of the patients agreed that they relied much on their families during the treatment process, and 78.0% hoped that their families could make all of their medical decisions (Gan et al. 2018). Furthermore, in a study involving interviews with 20 Chinese physicians with more than 10 years of experience in oncology, 100% of the interviewees stated that they would first inform patients’ families about diagnoses and prognoses and would withhold the truth from patients if family members asked them to do so (Gan et al. 2018). Another study from China reported that only 34.4% of family members thought that patients with a terminal illness should be informed of the diagnosis; when the hypothetical diagnosis changed from terminal illness to early-stage cancer, 30.1% of families still wanted to shield patients from the information (Jiang et al. 2007).