coping & the culture of disclosure

We recently received sad news that my father in-law in Japan was recently diagnosed with liver cancer. Language barriers prevented deep conversations between me and him, but I always felt we had an unspoken bond. One of our shared activities in Japan was watching the Yankees game during breakfast in the morning. He enjoyed American baseball and we would conversate, smile and nod at each other between the plays. I always remembered our first meeting in Philly, when he mentioned to me (through my wife's translation) that I have "kind eyes". He is skinny as a rail, but he always projected a quiet strength to me. This is the strength that makes me believe that he will fight through his illness.

From my limited perspective, it is interesting to learn about cultural differences in cancer treatment and doctor-patient relationships. Historically, Japanese physicians do not disclose cancer diagnoses to patients. Instead, the doctor will inform the patient's family and they will decide if, when, and how much to inform their loved one of their illness. That process was difficult to comprehend as it would lead to ethics charges and lawsuits in the States - and personally, I would want to know every little detail of my diagnosis and treatment. But again, these differing perspectives are largely cultural. Recently, more Japanese physicians are moving towards selective disclosure based on age, psychological stability, decisional capacity, family support. But unlike most western countries, universal disclosure is not the norm yet.

My wife is fairly Americanized and she finds the doctor-patient relationship in Japan to be curious and at times frustrating. Its not common for older Japanese to question the doctor and at times information is left in the dark for patient and family. This is also a by-product of her mother not wanting to know developments if they are discouraging.

In discussing American strategies of full disclosure and pro-active doctor-patient treatment strategies, my mother-in-law suggests that these approaches are shaped by culture. In her view, many Americans have a stronger sense of self, individuality and a strong belief in some sort of religious faith. These characteristics help them face their illness head-on and foster a postitive working relationship with physicians during treatment.

My mother-in-law points out that the Japanese approach places a premium on delivering compassionate medical care. In her opinion, her husband does not have a strong sense of religious faith (she suggests that Buddhism and Shintoism are utilized as a way of life rather than a fervent faith) and his fragile state of mind would not take the disclosure well.

Coming to terms with helping a seriously ill parent is a difficult process - especially if you live on the other side of the world. Initially there is a sense of helplessness and regret. I consoled my wife towards overcoming these feelings by suggesting we can help by providing counsel to her mother over the phone. Let her talk through these stressful times. Its a form of therapy that works for all involved.