BOTH Ethics Q

[acciddropping]

If a Japanese family does not want their non-Englishing speaking grandmother know of her terminal cancer, you as a physician have to agree with the family or you as a physician have to tell the grandmother through an interpreter.
Thanks.

---

Members don't see this ad.

 

[ChessMaster3000]

If a Japanese family does not want their non-Englishing speaking grandmother know of her terminal cancer, you as a physician have to agree with the family or you as a physician have to tell the grandmother through an interpreter.
Thanks.

gotta get the interp--than can ask thru interp if patient wants to know dx. imagine if it was an english-speaking family, it would not be any different.

 

[Fatalis]

unless the grandma had designated the family member to the be the health care proxy....

 

[ulikedaggers]

gotta get the interp--than can ask thru interp if patient wants to know dx. imagine if it was an english-speaking family, it would not be any different.

If that's one of the answer choices, yes. If the only choices are you must tell the patient and you must not tell the patient, then it could fall under therapeutic privilege and you don't have to tell the patient.

 

[ChessMaster3000]

If that's one of the answer choices, yes. If the only choices are you must tell the patient and you must not tell the patient, then it could fall under therapeutic privilege and you don't have to tell the patient.

No, it would not fall under therapeutic privilege. Therapeutic privilege can only be invoked if there is a threat of psychological distress and subsequent harm (esp physical) if the diagnosis was revealed. The story you described does not indicate as such. Do not let different languages make you think about the ethics differently, as test-writers love to go after that. It doesn't change the ethics.

 

[ulikedaggers]

No, it would not fall under therapeutic privilege. Therapeutic privilege can only be invoked if there is a threat of psychological distress and subsequent harm (esp physical) if the diagnosis was revealed. The story you described does not indicate as such. Do not let different languages make you think about the ethics differently, as test-writers love to go after that. It doesn't change the ethics.

I'm pretty sure being informed you have terminal cancer is in the top 5 for causing psychological distress. Cancer diagnosis is actually one of the classic examples of when therapeutic privilege can be used. You tell the patient their diagnosis slowly and in pieces, instead of "you have terminal cancer". Furthermore, this case isn't about the language barrier, it's about the cultural barrier and cultural differences absolutely do change the ethics. Again, in the real world you would just get a translator and ask the patient what they wanted. But if the answers are "don't tell the patient because their culture dictates not to" or "tell the patient regardless of their cultural belief" the correct answer is the former.

 

[mcloaf]

I'm pretty sure being informed you have terminal cancer is in the top 5 for causing psychological distress. Cancer diagnosis is actually one of the classic examples of when therapeutic privilege can be used. You tell the patient their diagnosis slowly and in pieces, instead of "you have terminal cancer". Furthermore, this case isn't about the language barrier, it's about the cultural barrier and cultural differences absolutely do change the ethics. Again, in the real world you would just get a translator and ask the patient what they wanted. But if the answers are "don't tell the patient because their culture dictates not to" or "tell the patient regardless of their cultural belief" the correct answer is the former.

I'm by no means an expert about any of this, but it seems to me there's a big difference between breaking news like this slowly and considerately vs. just not telling somebody because their family doesn't want you to do so. Additionally, I'm not sure I'm comfortable saying that I know enough about another culture to be able to distinguish cultural differences vs. just family wishes; that seems like a dangerously slippery slope. Assuming she's competent and doesn't have a proxy, Grandma's right to make her own healthcare decisions and your duty to her as a patient shouldn't change just because she's Japanese and doesn't speak english.

Was there an answer given to this question, OP?

 

[ChessMaster3000]

I'm pretty sure being informed you have terminal cancer is in the top 5 for causing psychological distress. Cancer diagnosis is actually one of the classic examples of when therapeutic privilege can be used. You tell the patient their diagnosis slowly and in pieces, instead of "you have terminal cancer". Furthermore, this case isn't about the language barrier, it's about the cultural barrier and cultural differences absolutely do change the ethics. Again, in the real world you would just get a translator and ask the patient what they wanted. But if the answers are "don't tell the patient because their culture dictates not to" or "tell the patient regardless of their cultural belief" the correct answer is the former.

Was there a longer version of the case that you summarized? If the case went into detail about the culture and gave any reason whatsoever about why they do not want their mother to know the dx, then therapeutic privilege may be considered. But if the question only says that the family is Japanese, you cannot assume that their culture dictates not telling a patient about the terminal diagnosis. You really have to be careful about the assumptions made in a question. When in doubt, stick to making fewer assumptions about the circumstances.

 

[ulikedaggers]

I'm by no means an expert about any of this, but it seems to me there's a big difference between breaking news like this slowly and considerately vs. just not telling somebody because their family doesn't want you to do so. Additionally, I'm not sure I'm comfortable saying that I know enough about another culture to be able to distinguish cultural differences vs. just family wishes; that seems like a dangerously slippery slope. Assuming she's competent and doesn't have a proxy, Grandma's right to make her own healthcare decisions and your duty to her as a patient shouldn't change just because she's Japanese and doesn't speak english.

Was there an answer given to this question, OP?

All true. I just have a hard time choosing the "tell the patient even at the risk of crossing cultural boundaries" answer. But as you say, there is only a presumed cultural boundary since the request was by the family and not by the patient herself.

Was there a longer version of the case that you summarized? If the case went into detail about the culture and gave any reason whatsoever about why they do not want their mother to know the dx, then therapeutic privilege may be considered. But if the question only says that the family is Japanese, you cannot assume that their culture dictates not telling a patient about the terminal diagnosis. You really have to be careful about the assumptions made in a question. When in doubt, stick to making fewer assumptions about the circumstances.

Well, there is and there isn't. In ethics class here we learned that "some cultures" don't want to be told certain things. The two examples were Navajo tribal members not wanting to know about procedural risks and Japanese people not wanting to be told of their terminal illness. Of course, we aren't supposed to assume that all people of X ancestry want/don't want what is stereotypical of X ancestry. You're right about sticking to fewer assumptions.