Cultural Influence of Medical Decisions

A child was born with a serious heart condition that could not be treated surgically. The parents, immigrants from a non-western country, were informed about the poor prognosis and that any treatment would only postpone death. However, it was emphasized that treatment would not be discontinued if they disagreed. Gradually over several weeks, the situation grew worse. The nurses felt that the child was suffering severely and that the suffering was being prolonged by the active treatment. The parents, however, strongly resented withdrawal of treatment.

• According to the parents’ religion and culture, could the physicians’ assurance that ‘‘nothing will be done unless you accept it’’ have given the parents a sense of responsibility for the death of their child?
• Would a paternalistic approach, stating that the physician would bear the responsibility of the decision that futile but life prolonging treatment must be withdrawn, have been preferable to the parents and reduced the number of weeks of suffering for the child, the parents, and the nurses?
• How is the decision made between the duty to inform or to respect and patients’ rights to autonomy?

Apply Theory (Specific Professional Healthcare Competencies + Clinical Medical Ethical Principles) to Practice in order to provide Optimal Patient-Centered Care (OPCC)

J Med Ethics 2005;31:73–77. doi: 10.1136/jme.2003.003954