Islamic Medicine History and Current Practice - International Society ...
Islamic Medicine History and Current Practice - International Society ... Islamic Medicine History and Current Practice - International Society ...
TRUTH-TELLING INFORMATION AND COMMUNICATIONWITH CANCER PATIENTS IN TURKEYthe patient and that the social security system that thepatient is bound to does not offer many choices fortreatment. For this reason it is understandable that thesituation is that most physicians are not skilled incooperating with patients, in establishing or maintaininga collaborative relationship with patients and thatpatient also do not have any expectations. When arequest for a relationship like this does not come frompatients it is important for the physician to initiate it.However before everything the physician mustbelieve that this kind of relationship is beneficial andthat there is value in helping the patients be effectiveparticipants (6, 7).Data from a Research StudyRelated to this SubjectData from a limited research study done at AnkaraUniversity Medical Faculty Ibn Sýna (Avicenna)Hospital related to the approach of physician candidatesand physicians on the subject of informingpatients about their diagnosis of cancer will shedlight of the situation in our country. Although thisstudy was only done at one hospital, because it is areferral center and teaching hospital it would not bewrong to say that it reflects the attitudes of physiciansin our country. This study was done with a questionnairegiven to 58 physicians and 150 medical students.In addition interviewing face-to-face 82 newlydiagnosed cancer patients on different services theirlevel of information was determined. At the end ofthe study it was seen that 52% of the physicians andmedical students have a “protector, guardian”approach to the cancer patients. Also it can be acceptedthat the medical students having a paternalisticapproach is an indicator that this attitude will not bechanging in the near future in our country. In theface-to-face interviews with the patients the factsshow that the patients had been informed at a levelfar below that of Western standards, 52 of the 82patients did not have information about their disease(63.4%). It was seen that the patients who had a highchance of recovery had been informed at a higher ratethan the others. The level of informing patients alsoincreased with an increase in the patient’s socioeconomiclevel and educational level (8).When looking at the research results on the subjectof truth-telling and general practice what are theNuket ORNEK BUKENreasons for the differences in the situation in ourcountry from that in Western countries? Althoughthere are signed international agreements at variouslevels in our country it can be said that the necessarylegal foundation and control does not exist currentlyon this subject. On the other hand it seems that it willbe difficult to change the “protector, guardian physicianattitude” that our cultural and social foundationbrings and that is supported by the Islamic religion’s“fatalistic world view.” In fact there is a large numberof physicians who insist that it is not right to say“worrying” things to people with terminal illnesses.In addition during medical education physicians arenot given sufficient information about “giving thepatient bad news” and “informing the patient.”Legal Regulations in OurCountry about Truth-TellingWhen looking at legal documents related to truthtelling in Turkey, we see that the decision is a sovereignunderstanding that is left entirely to the physician.However from the point of view of principles ofmedical ethics we see the principle of beneficenceand doing no harm are given weight in evaluation.When we look at these legal regulations’ relatedarticles that support the physician’s paternalistic attitude,we can say that it is important that the 14 thArticle in the Turkish Medical DeontologyRegulation is related to truth telling. According tothis article it is necessary that the patient be clearlytold their diagnosis and the necessary precautionsthat should be taken related to their diagnosis, howeverthe disease’s bad prognosis should be hiddenfrom the patient. If the patient desires the possibilityof the patient’s abandonment should be consideredand the diagnosis can be told to the family.In the Patients’ Bill of Rights, dated 1998, the 19 thArticle that is related to truth-telling, the decisionabout whether to tell the patient the truth is left entirelyup to the physician. It states that “When there is apossibility of worsening the patient’s illness with a badeffect on the patient’s spiritual make-up and when thecourse and result of the illness is serious it is advisablethat the diagnosis be kept hidden from the patient.” Inaddition when the patient does not request it this kindof diagnosis is told to the patient’s family.JISHIM 2003, 235
Nuket ORNEK BUKENConclusionTelling the truth is just one step in the physicianpatientrelationship and in the process of communication.There is an effect from many other factors in thecooperation of the patient with the physician in theprocess of mature communication. Telling the truth isan important step in treatment and we can neverexempt ourselves from the responsibility to be honestwith our patients by looking at our culture and ourspecial situation. The most important condition ofphysician-patient relationships is mutual trust. Thephysician who makes important life affecting decisionsfor the patient should never be misleading. Atthe foundation of “collaboration” between physicianand patient we again see the concept of “patientrights” in clinical medical activities emerging as aproduct of the relationship that is formed. Whenphysicians tell patients the truth when making decisionsrelated to their own bodies and lives they recognizetheir rights and human values and showrespect for the patient’s rights. The cancer patient’sresponsibility for his own health is closely related tohis education, cultural situation, and economic status.For this reason patient/patient’s family education insociety as well must be in the manner that will developtheir level of responsibility for their problems andbehaviors and will ensure that autonomy is a conceptthat is perceived by the patient.In that case the subject that needs to be consideredshould not be “Should I tell the patient the truth?” but“How can I give the news in an appropriate manner?”It is necessary to give bad news in a manner that thepatient can accept the information about the illnessand by preserving hope. The physician giving themessage that he/she is willing to talk, when theTRUTH-TELLING INFORMATION AND COMMUNICATIONWITH CANCER PATIENTS IN TURKEYpatient is ready to learn the truth about the diagnosis,giving the amount of information that the patientwants, being patient and tolerant, being honest,understanding the patient, are important in giving aguarantee to the continuity of the relationship.REFERENCES1. Surbone A: Truth-telling, Risk and Hope. Annals of TheNew York Academy of Sciences 2000; 913: 72-9.2. Husebo S: Communication, Autonomy and Hope. Annals ofThe New York Academy of Sciences 2000; 913: 440-50.3. Schouwstra J, Blink J: Communication in Cancer Care.Annals of The New York Academy of Sciences 2000; 913:422-4.4. Uskent N: Ornekleri ile Onkolojide Etik. In: Demirhan AE,Oguz Y, Elçioglu O, Dogan H. Eds. Klinik Etik. Istanbul:Nobel Tip Kitabevi 2001: 429-35.5. Senler FC: Kanser Tanisi Almis Hastalarin Bilgilendirilmesi.In: Arda B, Akdur R, Aydýn E eds. II. Ulusal TýbbiEtik Kongresi Bildiri Kitabý. Kapadokya. Türkiye BiyoetikDerneði Yayýnlarý, 2001: 492-9.6. Buken NO: Turkey’s Position Regarding Clinical DrugTrials. Clinical Research and Regulatory Affairs, 2003;20(3): 349-55.7. Buken NO. Buken E: The Legal and Ethical Aspects ofMedical Malpractice in Turkey. Selected Legislation andJurisprudence. The European Journal of Health Law, 2003June; 10(2):199-214.8. Samur M. et al.: Kanser Tanisi Almis Hastalarin BilgilendirilmeDurumu: Hekim ve Hekim Adaylarinin YaklasimlariHakkinda Ankara Universitesi Tip Fakultesi Ýbni SinaHastanesinde Yapilan Sinirli Bir Arastirmanin Sonuclari.In: Arda B, Akdur R, Aydin E. Eds. II. Ulusal Tibbi EtikKongresi Bildiri Kitabi. Kapadokya. Türkiye BiyoetikDerneði Yayýnlarý, 2001 :510-9.9. Saglik Bakanligi Tibbi Deontoloji Tuzugu (TurkishMedical Deontology Regulation, MoH), 1960.10. Saglik Bakanligi Hasta Haklari Yönetmeligi (Patients’ Billof Rights, MoH), 1998.36 JISHIM 2003, 2
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Nuket ORNEK BUKENConclusionTelling the truth is just one step in the physicianpatientrelationship <strong>and</strong> in the process of communication.There is an effect from many other factors in thecooperation of the patient with the physician in theprocess of mature communication. Telling the truth isan important step in treatment <strong>and</strong> we can neverexempt ourselves from the responsibility to be honestwith our patients by looking at our culture <strong>and</strong> ourspecial situation. The most important condition ofphysician-patient relationships is mutual trust. Thephysician who makes important life affecting decisionsfor the patient should never be misleading. Atthe foundation of “collaboration” between physician<strong>and</strong> patient we again see the concept of “patientrights” in clinical medical activities emerging as aproduct of the relationship that is formed. Whenphysicians tell patients the truth when making decisionsrelated to their own bodies <strong>and</strong> lives they recognizetheir rights <strong>and</strong> human values <strong>and</strong> showrespect for the patient’s rights. The cancer patient’sresponsibility for his own health is closely related tohis education, cultural situation, <strong>and</strong> economic status.For this reason patient/patient’s family education insociety as well must be in the manner that will developtheir level of responsibility for their problems <strong>and</strong>behaviors <strong>and</strong> will ensure that autonomy is a conceptthat is perceived by the patient.In that case the subject that needs to be consideredshould not be “Should I tell the patient the truth?” but“How can I give the news in an appropriate manner?”It is necessary to give bad news in a manner that thepatient can accept the information about the illness<strong>and</strong> by preserving hope. The physician giving themessage that he/she is willing to talk, when theTRUTH-TELLING INFORMATION AND COMMUNICATIONWITH CANCER PATIENTS IN TURKEYpatient is ready to learn the truth about the diagnosis,giving the amount of information that the patientwants, being patient <strong>and</strong> tolerant, being honest,underst<strong>and</strong>ing the patient, are important in giving aguarantee to the continuity of the relationship.REFERENCES1. Surbone A: Truth-telling, Risk <strong>and</strong> Hope. Annals of TheNew York Academy of Sciences 2000; 913: 72-9.2. Husebo S: Communication, Autonomy <strong>and</strong> Hope. Annals ofThe New York Academy of Sciences 2000; 913: 440-50.3. Schouwstra J, Blink J: Communication in Cancer Care.Annals of The New York Academy of Sciences 2000; 913:422-4.4. Uskent N: Ornekleri ile Onkolojide Etik. In: Demirhan AE,Oguz Y, Elçioglu O, Dogan H. Eds. Klinik Etik. Istanbul:Nobel Tip Kitabevi 2001: 429-35.5. Senler FC: Kanser Tanisi Almis Hastalarin Bilgilendirilmesi.In: Arda B, Akdur R, Aydýn E eds. II. Ulusal TýbbiEtik Kongresi Bildiri Kitabý. Kapadokya. Türkiye BiyoetikDerneði Yayýnlarý, 2001: 492-9.6. Buken NO: Turkey’s Position Regarding Clinical DrugTrials. Clinical Research <strong>and</strong> Regulatory Affairs, 2003;20(3): 349-55.7. Buken NO. Buken E: The Legal <strong>and</strong> Ethical Aspects ofMedical Malpractice in Turkey. Selected Legislation <strong>and</strong>Jurisprudence. The European Journal of Health Law, 2003June; 10(2):199-214.8. Samur M. et al.: Kanser Tanisi Almis Hastalarin BilgilendirilmeDurumu: Hekim ve Hekim Adaylarinin YaklasimlariHakkinda Ankara Universitesi Tip Fakultesi Ýbni SinaHastanesinde Yapilan Sinirli Bir Arastirmanin Sonuclari.In: Arda B, Akdur R, Aydin E. Eds. II. Ulusal Tibbi EtikKongresi Bildiri Kitabi. Kapadokya. Türkiye BiyoetikDerneði Yayýnlarý, 2001 :510-9.9. Saglik Bakanligi Tibbi Deontoloji Tuzugu (TurkishMedical Deontology Regulation, MoH), 1960.10. Saglik Bakanligi Hasta Haklari Yönetmeligi (Patients’ Billof Rights, MoH), 1998.36 JISHIM 2003, 2
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