Ethical decision-making in critical care in Hong Kong

Biomedical ethics has assumed an increasingly important role in medicine over the past 30 yrs, and its development has served the important goal of protecting patients' rights and interests. However, medical ethics has evolved within a Western tradition, and conflict often arises when trying to apply Western medical ethics to patients from other cultures. Using Hong Kong as an example, this article reviews the nature and sources of cross-cultural conflict in the intensive care unit setting that often arises between physicians trained in Western medicine and patients from a Chinese cultural background.

This article draws on the first author's experience as a critical care physician in Hong Kong, and on a review of the literature on cross-cultural interactions in medicine.

Studies were selected that contrasted the approaches of different cultures to common ethical dilemmas in medicine. Review articles examining the relationship between culture and ethics were also selected.

Hong Kong presents an interesting case study because of the coexistence of Western and Chinese medicine in a predominantly Chinese population that practices many Chinese cultural traditions. Whereas contemporary Western medical ethics focuses on individual rights, autonomy, and self-determination, traditional Chinese societies place greater emphasis on such community values as harmony, responsibility, and respect for parents and ancestors. Specific areas of cross-cultural conflict include: the role of the patient and family in medical decision-making; the disclosure of unfavorable medical information to critically ill patients; the discussion of advance directives or code status with patients; and the withholding or withdrawal of life support.