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Worlds Apart?: Chinese and American Internists Adhere to Similar Ethical Standards for Persons with HIV/AIDS

By MD Feldman, J Zhang, H. Tabor, SR Cummings, T. Coates.

[Tu.B.170] WORLDS APART?: CHINESE AND AMERICAN INTERNISTS ADHERE TO SIMILAR ETHICAL STANDARDS FOR PERSONS WITH HIV/AIDS.

MD Feldman, J Zhang, H. Tabor, SR Cummings, T. Coates. Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, USA and the State Science and Technology Commission, Beijing, Peoples Republic of China.

Objective: There has been speculation, but little data, about cross-cultural differences in approaches to clinical ethical dilemmas such as truth telling, the role of family's wishes, and assisted suicide, that arise in the care of HIV infected persons. In particular, there have been no direct comparisons of bioethical practices between the US and China in the care of persons with HIV/AIDS. Our objective was to test the hypothesis that Chinese and US internists have different ethical standards with HIV/AIDS patients about informing them of terminal diagnoses (truth telling), the role of family versus patients wishes, and assisted suicide, as compared with patients with other medical problems.

Methods: We developed 15 clinical vignettes followed by a series of multiple choice questions. The vignettes and questions were translated and back translated into Chinese and English and pre-tested in each country. We surveyed 40 randomly selected internists on staff at both university and community hospitals in San Francisco and Beijing.

Results: 95% of the US internists but none of the Chinese internists surveyed would inform a patient with cancer of her diagnosis (p<.001). However, when the terminally ill patient had AIDS instead of cancer, 100% of US and 90% of Chinese internists would tell the patient the diagnosis. Similarly, while only 15% of Chinese internists, but 30% of the Americans, were willing to assist a terminally ill cancer patient obtain enough narcotics to end her life (p<.05), 45% of the Chinese internists were willing to withhold life sustaining treatment from a terminally ill patient with AIDS. Both Chinese and American internists were in strong agreement that physicians should inform patients of the results of their HIV tests, and both agreed that partners have an obligation to inform each other of a positive test. When family members wishes conflicted with patient's preferences regarding treatment of life threatening conditions, Chinese internists were more likely to follow the family's instead of the patient's preferences (65%) than were US internists (5%; P<.001), irregardless of the patient' diagnosis.

Conclusions: Clinical ethical practices between US and Chinese internists were more similar with patients with HIV/AIDS than with patients with other serious medical problems. US internists virtually always and Chinese doctors almost never tell cancer patient's their diagnosis, but both groups would generally inform patients of an AIDS diagnosis. US physicians are much more willing to assist in ending the life of terminally ill patients with cancer, but only somewhat more willing to withhold life sustaining treatment from a terminally ill person with AIDS. However, Chinese physicians give greater weight to family than to patient preferences irregardless of the underlying illness. We conclude that differences in clinical ethical practices between internists in the US and China are less extreme in the care of persons with HIV/AIDS.

E-mail: Mitchell_Feldman@ucsfdgim.ucsf.edu

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