Posted by Suzanne Salimbene. Within our medical framework, few would dispute the belief that every patient should be entitled to the highest quality of care available regardless of race, ethnicity, and socioeconomic status. However, the notion of what constitutes quality of care is highly subjective. To the American trained caregiver and health professional who has been educated from birth to view personal autonomy and the right (as well as the responsibility) to make one’s own healthcare decisions, the concept of quality care is intrinsically tied to informed consent and patient autonomy. Inherent in this view is also providing the patient with full disclosure of all treatment options and an honest diagnosis/prognosis so the patient is given (in American eyes) his or her inalienable right to choose. What is often forgotten, or, more likely unfathomable to American caregivers, is that patients’ rights should also include the right of refusal.  This right of refusal includes not only the right to refuse the recommended treatment, but also the right to refuse to know—in other words the right to be provided personally with information regarding his/her illness and prognosis. It also includes the right to refuse to act as an autonomous entity and takepersonal or autonomous responsibility for medical decision-making. A growing number of patients in today’s medical environment come from what are known as collectivist cultures. In their worlds, the autonomy we, in America, view as a person’s right is equated with isolation.  Individualism is viewed as selfishness.  In these cultures, healthcare decisions are made, not by the individual, but by the family and/or community. Consideration of what is good for the group is part of that process. Often, information that might be considered frightening or disheartening to the ill person is conveyed to the family, the head of the family, or the head of the community rather than the patient.  That/these person(s) is/are responsible for both medical decision-making and for determining how much information should be disclosed to the patient, and when and how it is disclosed. By insisting on the patient’s right and duty to assume responsibility for autonomy and the right to informed consent, American caregivers are infringing, both on the family’s right and duty to assume the responsibility for the patient’s well-being and on the patient’s right to be cared for and protected from distress by a loving and caring family and/or community. In such cultures, it may be advisable to broaden our view of the very closed physician/patient relationship to a triad which can be expressed as a physician/family/patient relationship.How do you, personally feel about patient autonomy, full disclosure of diagnosis and prognosis, and the patient’s right to be part of the treatment-decision-making process? Share your response below!This three-part series will further explore  medical ethics and the patient’s right to choose whether to be informed of a diagnosis or accept or reject the recommended treatment plan, and offer some suggestions regarding how healthcare professionals can balance American medical ethics with differing views on autonomy and informed consent.