Exploring the Ethical Dimensions of Cross-cultural Patient Care

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Autonomy (self-determination) is a primary ethical principle in the U.S. However, the ability to make decisions regarding one’s own healthcare isn’t always a fundamental principle in other societies and cultures. Some families may choose to make decisions for an elderly family member, while in other cultures, informed consent is expected to be given by the senior male on behalf of an adult female. While some leeway can be taken by otolaryngologists with the former under the special circumstances of an illness, cultural influence on informed consent may fly in the face of medical-legal requirements for patient consent. Such requirements and regulations must be explained to patients and their families so that they will understand what constraints are placed on a U.S. otolaryngologist. Legal and ethical requirements must be followed, even if they are at odds with requests based on cultural or religious precepts held by the patient and/or their family. Understanding and patience will serve the otolaryngologist well in shared decision-making and informed consent processes where cultural dissonance may occur.

Additionally, the patient’s native country and culture may have quite a different type of patient-physician relationship, one that might be paternalistic or not as engaging as is the case in the U.S. For significant barriers to communication or compliance with therapeutic recommendations, the otolaryngologist may wish to seek the assistance of a “cultural broker,” also known as a community health worker, who can act as a liaison among the patient, the family, and the otolaryngologist to maximize the therapeutic plan’s efficacy.

Finally, religion may play a role in the patient’s response to illness, to the recommended plan of care, and to their own personal quality-of-life perspectives. This may be particularly important in end-of-life decision-making, pain and suffering tolerance, and in the dyadic balance of beneficence and maleficence. In American society, the terms “faith,” “religion,” and “spirituality” are used interchangeably, although there are nuanced differences to their meanings. In other cultures, formal religion often carries a great significance for the patient, providing beliefs and practices that can strongly influence their medical decisions. Faith and spirituality tend to be considered more personal and value based in patients’ lives, often offering solace and a perspective for living (and dying). Otolaryngologists should carefully inquire about such issues when they might have an impact on the patient’s care and treatment but are well advised to remain neutral with respect to their own personal religious beliefs so as to avoid introducing a conflict into the patient-physician relationship.

We have an ethical duty to understand our patients in as much totality as possible, which can be a challenge when language, cultural, and religious issues are unknown or not well understood. Improving our care of patients from unfamiliar cultures first involves acceptance of our lack of knowledge of another culture, followed by a desire to become culturally aware through study and inquiry. With experience comes greater understanding, enhancing our ability to provide the same level of care for all patients, regardless of their country of origin.