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(Chest. 2001;120:688.)
© 2001 American College of Chest Physicians

Ethics in Decision Making and Patient Autonomy

Abdullah Al-Mobeireek, MD, FCCP

King Saud University Riyadh, Saudi Arabia

Correspondence to: Abdullah Al-Mobeireek, MD, FCCP, Department of Medicine (38), College of Medicine, King Saud University, PO Box 2925, Riyadh 11462, Saudi Arabia; e-mail: mobeireek{at}yahoo.com

To the Editor:

The study by Ruhnke et al (October 2000)1 showed interesting differences between attitudes of American and Japanese subjects to information disclosure and decision making. The situation in Saudi Arabia is similar to that in Japan, and the family-centered model is preferred. In a previous study,2 75% of physicians in Saudi Arabia indicated that they gave information about serious illnesses such as cancer to the family first and then the patient if they approved. Physicians returning home after training in North America experience not infrequently the ethical dilemma highlighted by Ruhnke et al.

We feel that the increasing use of aggressive therapies nowadays and greater awareness in the information era mandate greater patient autonomy. This was also desired by patients in Saudi Arabia.3 On the other hand, patients in the study of Ruhnke et al wished for greater family and physicians’ involvement. Thus, it seems that in the United States the concept of patient autonomy has been overemphasized, while in Japan and Saudi Arabia it deserves more emphasis. Obviously, the individual situation may vary considerably, and we concur with the conclusions by Ruhnke et al that physicians need to exercise some flexibility when performing their role.

References

  1. Ruhnke, GW, Wilson, SR, Akamatsu, T, et al (2000) Ethical decision making and patient autonomy: a comparison of physicians and patients in Japan and the United States. Chest 118,1172-1182[Abstract/Free Full Text]
  2. Mobeireek, A, Al-Kassimi, F, Al-Majed, S, et al (1996) Communication with the seriously ill: physicians’ attitudes in Saudi Arabia. J Med Ethics 22,282-285[Abstract/Free Full Text]
  3. Al-Ahwal, M (1998) Cancer patients’ awareness of their disease and prognosis. Ann Saudi Med 18,187-189




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