Curable cancers and fatal ulcers. Attitudes toward cancer in Japan

Abstract

Japanese patients having terminal cancer are generally not told their true diagnosis. Japanese physicians deem it unethical to reveal a 'death sentence' and the patient's family provides support by reassuring the patient that he will recover. This behavior, strange to many Americans, seems best explained by a symbolic interactionist approach. The Japanese public views cancer as a polluting force leading to death. Family members express their concern in this stressful situation, not by open verbal communication, but by immersing themselves in proper role behavior. The patient also has a specific role in the deception, although he may suspect the true diagnosis. An ironic situation results in that an 'independent' American patient has wider opportunities for support as death approaches, but a 'dependent' Japanese patient faces death alone. As cancer technology changes public images, we suspect that cancer will be more openly discussed. Yet the symbolic behavior that surrounds cancer in Japan today will continue whenever death is seen as prolonged, deforming, and uncontrollable.

KIE: The culturally-conditioned behavior of the Japanese in regard to cancer and its diagnosis is analyzed. Contrary to the current view in the United States that the terminally ill patient should be told the true nature of his or her illness, Japanese society normally does not impart this difficult truth under similar circumstances. The supreme duty of the Japanese physician is to keep the patient alive, and that implies doing everything possible to prevent the patient from losing the will to live or committing suicide. However, family members are informed of the diagnosis and participate in the deception by reassuring the patient that recovery is certain.