Truth-telling and devastating disclosures
Navigating the tension between ethicaland cultural obligations in Saudi Arabia
Background
Truth-telling is the process by which relevant medical information is disclosed to the patient to enable them to make informed decisions about their healthcare. It serves multiple aims; first, it is essential to adequately informed consent; second, it respects patients’ rights to self-determination, third, it fulfills practitioners’ ethical obligations; and fourth, it promotes trust between patients and practitioners. In Saudi Arabia, research suggests that patients support truth-telling, prefer a more collaborative role in decision-making, and want to be involved in difficult decisions at the end-of-life. However, evidence also finds a disparity between the preferences of patients and their relatives, with family members favoring concealment of information to honor and protect patients. The perspectives of Saudi physicians, and the challenges they encounter when faced with these oft-contrasting preferences is not as well explored.
Methods
This research is a qualitative phenomenological study that utilizes a semi-structured interview technique and interview guide. Through thematic analysis of 7 in-person interviews with senior Saudi physicians, this qualitative study attempts to understand the experiences of practitioners who routinely encounter truth-telling dilemmas, particularly in the face of strong family opposition.
Results
Study participants identified family requests for concealment as significant ethical challenges in their practice. They reported experiencing moral conflict between the ethical duty of truth-telling and the cultural norms of a family-based Saudi society that favor concealment.
Conclusions
Although some participants held firm in upholding the ethical duty of truth-telling, others agreed to conceal information. Most participants, however, tried to find a compromise between these contrasting commitments by relying on their own personal experiences and professional judgements.
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