Cross-cultural Issues and Diverse Belief,
Douglas S. Diekema MD, MPH
Patients may bring cultural, religious and
ideological beliefs with them as they enter into a
relationship with the physician. Occasionally, these
beliefs may challenge or conflict with what the physician
[5] believes to be good medical care. Understanding
and respecting the beliefs of the patient represents
an important part of establishing and maintaining a
therapeutic relationship. While the principle of respect
for autonomy requires that a physician respect the
[10] medical decisions of a competent adult patient, in
cases of surrogate decision-making, the physician
has an independent duty to guard the interests of the
patient.
Why is it important to respect what appears to me
[15] to be idiosyncratic beliefs?
Respecting the beliefs and values of your patient
is an important part of establishing an effective
therapeutic relationship. Failure to take those beliefs
seriously can undermine the patient’s ability to trust
[20] you as her physician. It may also encourage persons
with non-mainstream cultural or religious beliefs to
avoid seeking medical care when they need it.
What are some ways to discover well known sets
of beliefs?
[25] There are many groups that share common sets
of beliefs. These belief systems may be based on
shared religions, ethnicity, or ideology. Knowledge
of these beliefs and the reasonable range of
interpretation of doctrine should be very helpful in
[30] deciding if unusual beliefs should be respected. Good
resources for guidance ∈ this area include patients
and family members themselves, staff members with
personal knowledge or experience, hospital chaplains,
social workers, and interpreters. Unusual beliefs that
[35] fall outside known belief systems should prompt more
in-depth discussions to insure they are reasonable.
It is important to explore each individual’s beliefs,
as shared membership ∈a particular religious or
cultural group does not necessarily entail identical
[40] belief systems.
What is my responsibility when a patient
endangers her health by refusing a treatment?
Adults have a moral and legal \right to make
decisions about their own health care, including the
[45] \right to refuse treatments that may be life-saving.
The physician has a responsibility to make sure that
the patient understands the possible and probable
outcomes of refusing the proposed treatment. The
physician should attempt to understand the basis for
[50] the patient’s refusal and address those concerns and
any misperceptions the patient may have. In some
cases, enlisting the aid of a leader ∈ the patient’s
cultural or religious community may be helpful.
Can parents refuse to provide their children with
[55] necessary medical treatment on the basis of their
beliefs?
Parents have legal and moral authority to make
health care decisions for their children, as long
as those decisions do not pose a significant risk of
[60] serious harm to the child’s health. Parents should not
be permitted to deny their children medical care when
that medical care is likely to prevent substantial harm
or suffering. If necessary, the physician may need
to pursue a court order or seek the involvement of
[65] child protective services ∈ order to provide treatment
against the wishes of the parents. Nevertheless, the
physician must always take care to show respect
for the family’s beliefs and a willingness to discuss
reasonable alternatives with the family.
[70] What kinds of treatment can parents choose not
to provide to their children?
Parents have the \right to refuse medical
treatments when doing so does not place the child
at significant risk of substantial harm or suffering.
[75] For example, parents have the \right to refuse routine
immunizations for their children on religious or cultural
grounds.
Can a patient demand that I provide them with a
form of treatment that I am uncomfortable providing?
[80] A physician is not morally obligated to provide
treatment modalities that they do not believe offer a
benefit to the patient or which may harm the patient.
Physicians should also not offer treatments that
they do not feel competent to provide or prescribe.
[85] However, it is important to take the patient’s request
seriously, consider accommodating requests that
will not harm the patient or others, and attempt to
formulate a plan that would be acceptable to both the
physician and patient.
Available at: . Retrieved on: July 3rd, 2017. Adapted.
In the fragment of the text “The physician has a responsibility to make sure that the patient understands the possible and probable outcomes of refusing the proposed treatment” (lines 46-48), the words physician and outcomes can be replaced, without change ∈ meaning, by
