Promoting truth-telling (the concept and its practice) with effective communication in medical settings: with particular focus on end of life care in Japan

Inoue, Setsuko (2014) Promoting truth-telling (the concept and its practice) with effective communication in medical settings: with particular focus on end of life care in Japan. PhD thesis, University of Glasgow.

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Abstract

This thesis deals with the concept and practice of truth-telling in medical settings. In particular, it
analyses the way in which truth-telling is enacted in the context of end of life care in Japan. The
thesis addresses not only the content of what is communicated in encounters between physicians
and medical personnel with patients and their family carers (next of kin), it also discusses the way
in which information concerning diagnosis, treatment, and prognosis is communicated. That is to
say, in the quality and integrity of the encounter.
The thesis offers a literature survey of research studies that address truth-telling in medical
settings in the USA, the UK, and in Japan, offering a comprehensive survey of studies written in
English and Japanese. It investigates the history of the concept and practice of truth-telling in
medicine from the turn of the twentieth-century to the present day, and it connects this history to
the developing field of medical ethics. Over the course of this history one can identify a shift –
especially in the West – away from medical paternalism towards patient-centered medical care, in
which patient autonomy and self-determination are highly valued. This has influenced the
understanding and practice of truth-telling in medicine.
Japan, however, has preserved certain cultural values, traditions, and conventions that affect
medical practice. The thesis analyses the effect of these behavioural norms on truth-telling
practices in end of life care in Japan. It is argued that the hierarchical society, strong family
structure, paternalistic culture, and conversational etiquette of Japan tend to stymie effective
communication and limit truth-telling concerning diagnosis, treatment, and prognosis in medical
settings.
In light of the findings of the literature survey, the thesis proposes some concrete ways to
promote truth-telling and effective communication in medical settings, including through the
building of trust between interlocutors and through the reflective praxis of critical and creative
contemplation.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: Truth-telling, end of life, Japan, Physician-patient relationship
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Colleges/Schools: College of Arts > School of Critical Studies > Theology and Religious Studies
Supervisor's Name: Clague, Julie
Date of Award: 2014
Depositing User: julie clague
Unique ID: glathesis:2014-5180
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 23 May 2014 10:59
Last Modified: 18 Sep 2014 09:00
URI: http://theses.gla.ac.uk/id/eprint/5180

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