“Why would you take away her last hope? If you tell my mother about the metastatic colon cancer she will die immediately! That would be cruel and I forbid you!” Luping’s son and I spoke in low voices just outside her hospital room. He continued, “I brought my mother to America to receive the very best medical care, and now you want to tell her there’s no cure? We would NEVER do this in China!”
I glanced in Luping’s room, where the elderly lady was alert but fragile and clearly in pain. I turned back to her son. “But this is America,” I explained, “Here the rules are very stringent: Everyone must be told of their diagnosis!”
Thorny ethical tensions are common when we care for people from other societies. For this reason cross-cultural skills are part of INMED core curriculum.
How would you respond to Luping’s health information disclosure crisis? And how would you do so in a way that is also culturally sensitive? Two ethical orientations are especially relevant:
• Universalism – the concept that certain principles apply to virtually everyone in virtually every setting. Today for example we most all agree that genocide and female genital mutilation are illegal regardless of nation or culture. In the case of Luping, universalism and health information disclosure would dictate that she be notified about her diagnosis regardless of the consequences.
• Multiculturalism – the concept that everything is acceptable except intolerance itself. Today in healthcare settings the imperative to provide language interpreter services is an example of multiculturalism. In the case of Luping, multiculturalism would dictate that the traditional norm for sharing bad news be respected and she be told nothing of her terminal diagnosis.
What would YOU tell Luping regarding her diagnosis? How would you handle her son’s concerns? How would health facility regulations influence your actions? Please post your comment on the INMED Facebook Group or email your comments to [email protected].
In such ethical and cultural dilemmas contextualization is a useful guideline, calling for consideration of all points of view and negotiating the best possible agreement. Contextualization starts by asking all the interested parties – in this case the patient, the son and the doctor – to express their views. A conversation with Luping herself about what sort of information she does or does not want to know may help to resolve the standoff.