Informed Consent in a Culturally Diverse Environment: Perspectives in Medical Ethics, Part 3: Ethics and the Decision Maker’s Right to Refuse Recommended Treatment
Posted by Suzanne Salimbene.
The strong commitment to informed consent in US health care is usually accompanied by a belief that the patient (or those making decisions on the patient’s behalf) will consent to a recommended treatment once the practitioner provides adequate information regarding how that treatment will assist in curing the patient, prolonging her life, or reducing her pain and suffering. Today’s diverse patient population has created a new ethical question:What should you—the physician or healthcare professional—do if culture, religion, or lack of trust in the system cause the patient or the patient’s family to refuse the recommended treatment?This now-vital question was vividly brought to light in the 1997 book The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures, by Anne Fadiman. This tragic, true story about a Hmong child and the clash of cultures between the child, her family, and her American doctors is now required reading in many US medical schools.
A few years later, in 2003, another important book utilized case studies of Hmong patients. Edited by Kathleen A. Culhane-Pera, et al, Healing by Heart: Clinical and Ethical Case Stories of Hmong Families and Western Providers developed a model that presented a sliding scale regarding how to handle cultural and religious objections to recommended treatment (page 340).
In general, healthcare workers should review a patient’s or family’s objection to a recommended treatment on a case-by-case basis. If the refusal is in keeping with cultural and religious values and worldview, these preferences should be respected—regardless of our modern-medical perspective. However, if it is a life-or-death intervention, and/or the family seems to be acting from a preference which seem to be idiosyncratic—rather than abiding to cultural or religious doctrine—it may be worth investigating the possibility of obtaining a court order to provide the treatment.
If the patient (or his family) expects a particular intervention to be used and this intervention will not harm him, acquiescing to these beliefs will help him (or them) develop trust in the physician and medical system. In turn, this trust may encourage consent to medical advice and compliance with treatment.How strongly do you feel that patients should respect the knowledge and experience of caregivers and comply with recommended treatment plans? Do you think it is unethical for a physician not to insist on the current method of treatment, even if the patient or her family refuses it? Where would you draw the line?
Posted by Suzanne Salimbene.
The strong commitment to informed consent in US health care is usually accompanied by a belief that the patient (or those making decisions on the patient’s behalf) will consent to a recommended treatment once the practitioner provides adequate information regarding how that treatment will assist in curing the patient, prolonging her life, or reducing her pain and suffering. Today’s diverse patient population has created a new ethical question:What should you—the physician or healthcare professional—do if culture, religion, or lack of trust in the system cause the patient or the patient’s family to refuse the recommended treatment?This now-vital question was vividly brought to light in the 1997 book The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures, by Anne Fadiman. This tragic, true story about a Hmong child and the clash of cultures between the child, her family, and her American doctors is now required reading in many US medical schools.
A few years later, in 2003, another important book utilized case studies of Hmong patients. Edited by Kathleen A. Culhane-Pera, et al, Healing by Heart: Clinical and Ethical Case Stories of Hmong Families and Western Providers developed a model that presented a sliding scale regarding how to handle cultural and religious objections to recommended treatment (page 340).
In general, healthcare workers should review a patient’s or family’s objection to a recommended treatment on a case-by-case basis. If the refusal is in keeping with cultural and religious values and worldview, these preferences should be respected—regardless of our modern-medical perspective. However, if it is a life-or-death intervention, and/or the family seems to be acting from a preference which seem to be idiosyncratic—rather than abiding to cultural or religious doctrine—it may be worth investigating the possibility of obtaining a court order to provide the treatment.
If the patient (or his family) expects a particular intervention to be used and this intervention will not harm him, acquiescing to these beliefs will help him (or them) develop trust in the physician and medical system. In turn, this trust may encourage consent to medical advice and compliance with treatment.How strongly do you feel that patients should respect the knowledge and experience of caregivers and comply with recommended treatment plans? Do you think it is unethical for a physician not to insist on the current method of treatment, even if the patient or her family refuses it? Where would you draw the line?Category: