Akabayashi A, Fetters M D, Elwyn T S
University of Tokyo, Japan.
J Med Ethics. 1999 Aug;25(4):296-301. doi: 10.1136/jme.25.4.296.
The dilemma of whether and how to disclose a diagnosis of cancer or of any other terminal illness continues to be a subject of worldwide interest. We present the case of a 62-year-old Japanese woman afflicted with advanced gall bladder cancer who had previously expressed a preference not to be told a diagnosis of cancer. The treating physician revealed the diagnosis to the family first, and then told the patient: "You don't have any cancer yet, but if we don't treat you, it will progress to a cancer". In our analysis, we examine the role of family consent, communication patterns (including ambiguous disclosure), and advance directives for cancer disclosure in Japan. Finally, we explore the implications for Edmund Pellegrino's proposal of "something close to autonomy" as a universal good.
是否以及如何披露癌症或任何其他绝症的诊断结果这一两难问题，仍然是全球关注的话题。我们介绍一位62岁日本女性的病例，她患有晚期胆囊癌，此前曾表示不想被告知癌症诊断结果。主治医生先将诊断结果告知了家属，然后告诉患者：“你目前还没有患癌症，但如果我们不治疗，病情将会发展成癌症”。在我们的分析中，我们审视了家属同意的作用、沟通模式（包括模糊披露）以及日本癌症披露的预先指示。最后，我们探讨了埃德蒙·佩莱格里诺提出的“近似自主”作为一种普遍善的提议的含义。
