Breaking bad news: a Chinese perspective.

The amount of information received by terminal cancer patients about their illness varies across different countries. Many Chinese families object to telling the truth to the patient and doctors often follow the wish of the families. However, a population study in Hong Kong has shown that the majority wanted the information. To address this difference in attitudes, the ethical principles for and against disclosure are analysed, considering the views in Chinese philosophy, sociological studies and traditional Chinese medicine. It is argued that the Chinese views on autonomy and nonmaleficence do not justify non-disclosure of the truth. It is recommended that truth telling should depend on what the patient wants to know and is prepared to know, and not on what the family wants to disclose. The standard palliative care approach to breaking bad news should be adopted, but with modifications to address the 'family determination' and 'death as taboo' issues.