Ethics Question: Are cultural differences important for informed consent?

[BigFace]

Are cultural differences irrelevant in informed consent?

[optimist]

Not being entirely sure about what you meant by your question, I will take a shot at it: Cultural differences are especially relevant in informed consent. Culture plays such a big role in how a person view the world, and more specifically, health care situations. If anything, more attention would need to be given to people with cultures that differ from your own because you need to really make sure that they understand the choice(s) to be made within the context of their culture.

 

For example, if you are considering the process of informed consent in relation to getting a patient to sign to be placed in a long term care facility, there are some cultures that believe very strongly in keeping family members at home, so this would need to be explored and well planned. Or, take the example of the blood transfusion in another thread (don't shoot me please!): as culture is often tied with religion, you would definitely want to help the patient explore the ramifications of making the decision to accept or refuse the transfusion.

[frenchfrog]

I know that there are some cultures where patients are not told bad news, so this is a matter of disclosure. As well there may be some cultures who still want their physician to be more paternalistic and make all the decisions without consulting them (the patient). However, as a physician, you can't just assume that because someone is of a particular culture, you shouldn't inform them properly. The only definite exceptions to informed consent are waiver by patient, incapacity of patient, and emergencies.

Thus if your patient explicitly says that they waive their right to informed consent for cultural reasons, then there is some relevance.

In 'Doing Right', the author says that the important thing is to always explicitly offer to the patient the opportunity to know, as well as explore the patient's reasons for the waiver.

[wanttobedoc]

I agree with the above posts. I think as medical professionals we have a responsibility to be aware of our own culture and possible cultural biases we may have in providing healthcare (awareness is the first step). Then we have to make sure we do thorough assessments with our patients, including cultural and social assessments so we can better understand our patients' beliefs and health "behaviours". This will allow us to provide more efficient healthcare treatment and better outcomes for our patients if we are both on the same "page". I think it is important to explain the consent process to all patients and why it is necessary and this includes ensuring the patient completely understands everything you are telling him/her if there is a language barrier (unbiased interpreter necessary). The patient needs to be offered the truth first on a case by case basis regardless of culture or what their family thinks is "best" for them. If the patient still declines then reasons for that should be explored, adn the "waiver" recorded. This is not a stagnant refusal of consent though, because if the patient's medical condition changes or new treatments come available this issue needs to be continually re-evaluated otherwise it would be negligent practise.

[BigFace]

Hi,

 

All very good posts.

 

My answer is No, culture is not irrelevant as the idea or concept of consent or autonomous action is a cultural construct unto itself. To assume ones culture takes precedence over anothers is ethnocentric or otherwise unethical. In the presence of appropriate circumstance, as mentioned in above posts, it would be ok to not give out particular information.

 

BigFace,

[AMmd]

Not being entirely sure about what you meant by your question, I will take a shot at it: Cultural differences are especially relevant in informed consent. Culture plays such a big role in how a person view the world, and more specifically, health care situations. If anything, more attention would need to be given to people with cultures that differ from your own because you need to really make sure that they understand the choice(s) to be made within the context of their culture.

 

For example, if you are considering the process of informed consent in relation to getting a patient to sign to be placed in a long term care facility, there are some cultures that believe very strongly in keeping family members at home, so this would need to be explored and well planned. Or, take the example of the blood transfusion in another thread (don't shoot me please!): as culture is often tied with religion, you would definitely want to help the patient explore the ramifications of making the decision to accept or refuse the transfusion.

I agree.

although i dont really get what you mean by your question...

[BigFace]

I agree.

although i dont really get what you mean by your question...

 

Hi,

 

Its a question that stumps many people, not because of complexity but simply because "they" are without the means to extend past their own existence. Concent to some is a simple delineation of facts pertaining to your treatment. However, you are gaining concent from a person who has "beliefs". Beliefs that may be in contrast to your own...so yes culture is an important part of attaining consent...consent is not a simple delineation of facts.

 

Hope i have cleared up my question for you.

 

BigFace,