Japanese nurses' perceptions about disclosure of information at the patients' end of life.

Information disclosure at the end of life is one of the most debated ethical issues in Japan. This paper, using data from a larger questionnaire survey in which 147 Japanese nurses participated, describes nurses' perceptions about this issue. The nurses perceived that non-disclosure of impending death information to patients was the norm in Japan due to its traditional values. This non-disclosure of information has various impacts on clinical nurses. Tension was evident between the Japanese traditional concepts supported by some nurses and the shift toward Western cultural and ethical values supported by other nurses. The nurses confronted uninformed patients who became suspicious, isolated, angry, or died unprepared for their life's ending. The nurses were placed in the middle between the patient and the family, as nurses became keepers of family secrets, or between nurses' ethical obligations to the patient and those of the institution. The nurses had the belief that at the patient's end of life, it is important to change health professionals' attitude from curing to caring.