title: Attitudes of Japanese and Japanese-American physicians towards life-sustaining treatment.
abstract: Doctors in different countries have different approaches to bioethical problems. We studied how attitudes to life-sustaining treatment for terminally ill patients differ in Japan and the USA by administering a questionnaire to Japanese (136) and Japanese-American (77) physicians. In a series of clinical scenarios the questionnaire asked what life-sustaining interventions the doctors would recommend to a patient with metastatic gastric cancer. Most Japanese physicians would recommend blood transfusions for gastrointestinal bleeding (74%), total parenteral nutrition for malnutrition (67%), and vasopressors for life-threatening hypotension (61%) when the patient did not know of his diagnosis and outlook. Significantly fewer Japanese physicians would want these interventions for themselves: 29% would want transfusion, 36% would want total parenteral nutrition, and 25% would want vasopressors. 36% of Japanese physicians would override the explicit request of a competent moribund cancer patient to withdraw all life-support. By contrast, among Japanese-American physicians only 42% would recommend blood transfusions, 33% total parenteral nutrition, and 34% vasopressors to a terminally ill cancer patient who did not know of his diagnosis or outlook. Cross-cultural studies in medical ethics can help physicians and the public in different countries to take a fresh look at accepted practices and the ethical reasons behind them.
authors.affiliation: Department of General Internal Medicine, School of Medicine, University of California, San Francisco 94143-0903, USA.
authors.forename: A
authors.initials: A
authors.lastname: Asai
authors.forename: S
authors.initials: S
authors.lastname: Fukuhara
authors.forename: B
authors.initials: B
authors.lastname: Lo
mesh_terms: D000328:Adult; D001213:Asian; D001291:Attitude of Health Personnel; D003431:Cross-Cultural Comparison; D018864:Cultural Diversity; D004992:Ethics, Medical; D006801:Humans; D038622:Internationality; D007564:Japan; D008020:Life Support Care / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D012945:Social Values; D013274:Stomach Neoplasms / Q000556:secondary / Q000628:therapy; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology; D014481:United States; D028761:Withholding Treatment