Ethnicities’ Medical Views Vary, Study Says : Diversity: Study finds many Korean Americans and Mexican Americans prefer not to be told of fatal illness. Most blacks and whites say they want to know.

Shining a unique light on the city’s vital and sometimes vexing diversity of peoples, USC researchers have found that, compared with blacks and whites, Mexican Americans and Korean Americans hold profoundly different views on such basic medical assumptions as the right to die and the control of one’s medical destiny.

The major finding of the study, which drew on interviews with 800 elderly Los Angeles County residents from the four groups, was that 45% of Korean Americans and 65% of Mexican Americans would not want to be told if they had a fatal illness. Also, both groups generally expected family members to make medical decisions for them if they were gravely ill.

In contrast, nearly 90% of blacks and whites would want an unvarnished prognosis. And most of them would not want to burden their families with wrenching medical decisions, preferring to express their therapeutic wishes in advance in documents such as living wills.

On one level, the new research, the most comprehensive analysis of ethnic attitudes toward life-and-death medical decisions, should sensitize doctors to the core values of people from various cultures. Beyond that, it reveals curious shortcomings in the increasingly pervasive American medical mind-set.

U.S.-trained physicians “may have lost sight of the fact that, for many cultures, the family unit is more important than the individual in decision-making,” said the study’s director, Dr. Leslie J. Blackhall, an internal medicine specialist and ethicist at Los Angeles County-USC Medical Center. The findings appear in today’s Journal of the American Medical Assn.

Blackhall added, “I don’t think that we in the dominant Western culture have an absolute lock on the best ethical way to make these choices.” Also on the research team were anthropologists, translators, a statistician and a law scholar.

Lawrence O. Gostin, a Georgetown University law professor, said the study highlights how doctors, partly to avoid liability, have gone too far in encouraging patients to control their own treatment.

“We’re now in a society where the doctor feels he has to burden the patient with every single bit of information and get the individual patient to make the crucial decisions for him or herself,” Gostin said. As a result, he added, medicine “has lost a lot of its humanity and compassion.”

All the subjects, who were 65 or older, were interviewed and filled out a questionnaire posing numerous hypothetical medical dilemmas. For instance, given that a physician believes that a patient is going to die of cancer, should the physician tell the patient?

One reason for the Koreans’ reluctance to hear such a prognosis was their basic belief in the unity of mind and body, said UCLA anthropologist Kyeyoung Park, a consultant on the study. In that sense, she said, the body reacts to bad news received by the mind.

“That kind of truth-telling is almost like a death sentence” to traditional Koreans, she said. “They think a doctor should be very optimistic, say ‘You’re going to live longer, you’re going to be OK.’ ”

An overarching value that contributes to the Koreans’ preference for letting family members make key medical decisions was hyodo , or “filial piety,” Park said. Accordingly, parents expect their children to care for them in their dotage, and they assume that family members understand what they would want.

Similarly, Blackhall said, the Mexican Americans surveyed generally believed deeply in the relationship between hope and health, often explaining that a blunt terminal prognosis would “make them die faster,” Blackhall said.

Interestingly, while the blacks and whites surveyed would not want to burden family members with medical decisions, the Koreans and Mexicans wanted just the opposite: A family should lighten a patient’s burden by sharing, if not taking over, that responsibility. For them, “autonomy is not viewed as empowering,” the researchers say.

When asked whether the patient, the doctor or the patient’s family should make decisions regarding life-prolonging technology, 28% of Koreans, 41% of Mexicans, 60% of African Americans and 65% of whites believed the patient should be in control.

Compared with the family-centered medical ideal cherished by many Koreans and Mexicans, the standard American emphasis on individual autonomy appears to be not only self-centered but perhaps somewhat selfish, Blackhall said.

The USC researchers say that the differences among the groups primarily reflect the subjects’ cultural and religious beliefs, not simply their education, income or years spent in the United States.

What they conclude is that doctors should not take a patient’s wishes for granted. Instead, the researchers say, doctors should first “ask their patients if they wish to receive information and make decisions or if they prefer that their families handle such matters.”

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Study Questions

Among the questions asked on the study of 800 elderly Angelenos to determine their opinions on medical care:

* Diagnosis: A physician diagnoses a person as having cancer that has spread to several parts of the body.

a) The physician believes that the cancer cannot be cured. Should he or she tell the patient that they have cancer?

b) Should the physician tell the patient’s family about the cancer?

*

* Prognosis: The physician believes that the patient will probably die of the cancer.

a) Should the physician tell the patient that he or she will probably die?

b) Should the physician tell the patient’s family that the patient will probably die of the cancer?