Patients' preferences for involvement in treatment decision making in Japan

BACKGROUND: A number of previous studies have suggested that the Japanese have few opportunities to participate in medical decision-making, as a result both of entrenched physician paternalism and national characteristics of dependency and passivity. The hypothesis that Japanese patients would wish to participate in treatment decision-making if adequate information were provided, and the decision to be made was clearly identified, was tested by interview survey. METHODS: The subjects were diabetic patients at a single outpatient clinic in Kyoto. One of three case study vignettes (pneumonia, gangrene or cancer) was randomly assigned to each subject and, employing face-to-face interviews, the subjects were asked what their wishes would be as patients, for treatment information, participation in decision-making and family involvement. RESULTS: 134 patients participated in the study, representing a response rate of 90%. The overall proportions of respondents who preferred active, collaborative, and passive roles were 12%, 71%, and 17%, respectively. Respondents to the cancer vignette were less likely to prefer an active role and were more likely to prefer family involvement in decision-making compared to non-cancer vignette respondents. If a physician's recommendation conflicted with their own wishes, 60% of the respondents for each vignette answered that they would choose to respect the physician's opinion, while few respondents would give the family's preference primary importance. CONCLUSIONS: Our study suggested that a majority of Japanese patients have positive attitudes towards participation in medical decision making if they are fully informed. Physicians will give greater patient satisfaction if they respond to the desire of patients for participation in decision-making

The penalty of mutilation for crimes in the Byzantine era (324-1453 A.D.)

Mutilation was a common punishment in Byzantium, which in all probability was introduced from the East. In legislation it was first featured in the "Eclogi"collection of laws of the Emperor Leo Isavrus III (717-,741 AD.). There are, however, indications that this punishment was already established and widespread in the time of Justinian I (527-565 AD.), because some chroniclers of that era state that this was used for gamblers using dice and for homosexuals. The collection of laws of Leo VI the Wise (886-912 AD.), the well-known "Hexabiblos", applied this punishment to a variety of offences such as theft, incest, adultery, attempted murder, sacrilege and the like. This punishment, furthermore, was the main penalty used against rebels and against Byzantine emperors and members of the royal family when they were removed from the throne after a successful insurrection. The basis of the latter punishment was that a mutilated person was excluded from the throne of Byzantium because the emperor was expected to fulfil the customary ideal presupposition of "perfection". No matter how curious it sounds, this barbaric penalty was imposed for reasons of leniency, i.e., to avert the heavier death penalty. © 1997 - IOS Press

Defensive medicine: Two historical cases

The characteristic historical examples of defensive medicine are referred to and analysed. The first of them relates to the behaviour of the eminent and experienced physical Critobulus, a member of the family of Asclepiades of Cos Islands, native island of Hippocrates, who hesitated to undertake the operation on the severely wounded Alexander the Great, who was hurt during the siege of a town of Mallians in India (326 BC). The second case refers to the Byzantine Emperor, Justin II (578 AD), when his physicians hesitated to undertake an operation for a possible wedging of a stone in the urethra, which caused painful inflammation. In both cases, the physicians proceeded to the operation after being reassured by their illustrious patients that they would not be punished in the event of failure. Furthermore, in the second case, of the mentally unbalanced Justin II, the physicians requested, obviously in the presence of witnesses, their immunity from punishment with the symbolic gesture of the handling over of the scalpel to them by the patient. This act symbolised the agreement of the patient to the operation

Is consent in medicine a concept only of modern times?

Although the issue of consent in medical practice has grown immensely in recent years, and it is generally believed that historical cases are unknown, our research amongst original ancient Greek and Byzantine historical sources reveals that it is a very old subject which ancient philosophers and physicians have addressed. Plato, in ancient Greece, connected consent with the quality of a free person and even before him. Hippocrates had advocated seeking the patient’s cooperation in order to combat the disease. In Alexander the Great’s era and later on in Byzantine times, not only was the consent of the patient necessary but physicians were asking for even more safeguards before undertaking a difficult operation. Our study has shown that from om ancient times physicians have at least on occasion been driven to seek the consent of their patient either because of respect for the patient’s autonomy or from fear of the consequences of their failure

Satisfying patients' rights: A hospital patient survey

The aim of this project was to study the way in which patients’ rights are being exercised in everyday hospital practice in Greece. Data were collected by using questionnaires and structured interviews with 600 patients. These patients were found to ignore the fact that special regulations exist regarding their rights. They considered their right to information was being respected, albeit to different degrees. Many patients allowed their doctors to make decisions. The right to confidentiality was not considered as a major priority by these patients because they doubted its applicability. They hesitated to protest when their rights were being violated. They thought that the most effective way of protecting their rights is either through the existence of someone with specialized knowledge or an internal hospital committee. These Greek patients appeared to be relatively satisfied with the way in which their rights were being exercised in hospital. However, a number of improvements could increase patient satisfaction regarding this issue. © 2001, Sage Publications. All rights reserved

Attitudes of a Mediterranean population to the truth-telling issue

The attitudes of the Greeks, a Mediterranean population, to the issue of telling the truth to the patient have been studied. There is no clear answer to the question: 'Do the Greeks wish to be informed of the nature of their illness?'. The answer is: 'It depends'. It depends on age, education, family status, occupation, place of birth and residence and on whether or not they are religious people. However, it does not depend on their sex - men and women have similar reactions to the issue of truth-telling. Although the present study shows lower percentages of those who wish to know the truth than studies on other populations, the conclusion is that, emphasising the need for good communication between doctors and patients, doctors should not lie, but should disclose to their patients the part of the truth they are ready to accept

Attitudes of a Mediterranean population to the truth-telling issue.

The attitudes of the Greeks, a Mediterranean population, to the issue of telling the truth to the patient have been studied. There is no clear answer to the question: 'Do the Greeks wish to be informed of the nature of their illness?'. The answer is: 'It depends'. It depends on age, education, family status, occupation, place of birth and residence and on whether or not they are religious people. However, it does not depend on their sex--men and women have similar reactions to the issue of truth-telling. Although the present study shows lower percentages of those who wish to know the truth than studies on other populations, the conclusion is that, emphasising the need for good communication between doctors and patients, doctors should not lie, but should disclose to their patients the part of the truth they are ready to accept

Overview of European legislation on informed consent for neonatal research

The aim of this paper is to discuss areas of consistency and inconsistency in the law or practice governing informed consent for neonatal research in ten European countries (Denmark, Finland, France, Germany, Greece, Ireland, Norway, Spain, Sweden, and the United Kingdom). In particular, the following areas are examined: whether there is specific law governing informed consent for research and, if so, what it is; the ethical review system, whether there are specific requirements for consent, whether benefit for the individual child is a specific requirement, and whether research of no direct benefit (so called non-therapeutic research) is legally permitted in minors - for example, the taking of extra blood samples purely for research purposes