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Arch Hellen Med, 25(2), March-April 2008, 224-230


The recent code of medical deontology, the cancer patient informing process
and the involvement of the Greek family

1Department of Internal Medicine, General Hospital of Rethymno, Rethymno,
2Department of Mother and Child Health, Faculty of Medicine, University of Crete,
3Postgraduate Course in Bioethics, University of Crete, Crete, Greece

The Hellenic Ministry of Health recently published a revised code of medical deontology, regulating a series of clinical ethics issues, including the disclosure of the diagnosis exclusively to the patient. As far as the issue of informing cancer patients is concerned, this regulation seems to ignore the local ethology and, in particular, the involvement of the family in the informing process. During the past three decades, a global change in the practice of informing patients with cancer has been observed. The currently dominant practice of disclosing the truth is based on the respect of individual autonomy. Telling the truth to the cancer patient is more common in north American and northwestern European societies; by contrast in other countries, including Greece, the concealment of the diagnosis continues to prevail. This difference originates from a variety of factors, including family structure. In societies where the family remains powerful, relatives tend to "protect" the vulnerable member from the "bad news". This holds for Greece, where interpersonal relationships become to a great extent intrafamily issues and serious individual problems are handled by the family as a whole. Hence, the disease impacts not only the individual, but the entire family, which responds as a whole. The patient-physician relationship is extended to become a physician-family-patient relationship, in which the role and contribution of the family are far from minimal. The decision-making unit is not the vulnerable member but the family, and the concept of individual autonomy broadens into a "family autonomy". The challenge for Greek society would be to combine the benefits of the patient's autonomy with the positive effects of the family, rather than adopting the patient-informing practices in use by other societies.

Key words: Cancer, Diagnosis disclosure, Family, Greece, Truth-telling.

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