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Prognosis

In the Asian culture, there is often a belief that terminally ill patients should not be informed about their prognosis. Would you respect the cultural practice and not inform a patient about the prognosis? Is there a way for health care providers to balance the patient’s right to know with respect for the cultural practices and beliefs of the family? Is not fully disclosing information to the patient an ethical breach?

You should

respond to at least two of your peers

by extending, refuting/correcting, or adding additional nuance to their posts.

Reading: Ritter, L.A., Graham, D.H. (2017). Multicultural Health (2nd ed.). Burlington, MA: Jones and Bartlett Learning.

ISBN: 9781284021028

Chapter

10

D#1
End of Life Advice
According to the 2011 Census Bureau population estimate, Asian Americans represent
about 5% of the U.S. population (Ritter & Graham, 2017). Asian beliefs regarding health vary
among different countries of origin. However, many Asian cultures have accepted western
medicine with their traditional practices. Regardless of differences in culture, most Asians
believe in the humanistic view that places emphasis on personal perfection (Ritter & Graham,
2017). This leads many Asians to be very receptive to learning from medical professionals and
accepting their guidance.
Decisions of communication of impending death to a patient of Asian descent are often
considered the responsibility of the oldest male of the family (Ritter & Graham, 2017). If it is
possible, I would communicate the medical information to the patient’s family or next of kin.
Allowing the family to decide what to do with the information is the best scenario. Because there
is a wide range of Asian cultures, I would rather the family decide how that communication
should be had. Rather than trying to decipher the most appropriate method of communication,
the family should be consulted.
If at that point, the family is fully aware of the severity of the situation, and they decide to
keep information from the patient then I would fully respect that decision. My grandmother was
deathly afraid of cancer but eventually contracted liver cancer towards the end of her life. My
mother later explained to me that she and my aunt decided to decline from mentioning the cancer
details to her but explained it as a “sickness in her liver.” This allowed my grandmother to
experience less anxiety at the end of her life and in turn gave my family a general sense of relief
that she was not in a depressive state. This is the same concept that is
so overwhelmingly experienced in Asian culture and is a concept that I am familiar with.
There is a way to balance what the patient should know while also respecting their cultural
beliefs. You can ask the family or proxy of the patient if the information should be shared with
the patient. A proxy is a family member who acts as a surrogate or a decision maker on the
patient’s behalf (Shepherd et al., 2019). The proxy can decide the best course of action. On the
other hand, if the patient is fully aware and able to make his or her own medical decisions, I
would have palliative care visit this patient. A palliative care team is specially trained to handle
these difficult conversations about end-of-life care. I would ask the patient about the level of
detail they feel comfortable discussing. I do believe in respecting their decisions but there is an
ethical dilemma.
Keeping information away from the patient because of religious or ethnical practices could
lead to more harm than good. Based on all the reading I have done about Asian cultures and end
of life care; family involvement is the consistent point. Involving family is especially important
in the Asian community and it should be left to the family on how they want to communicate
terminal illness and end of life care with the patient. Younger family members, particularly
women, feel they must consult with older family members before making medical decisions.
Deference to authority or politeness may result in questions being answered in an affirmative
manner to avoid offending anyone (Ritter & Graham, 2017). Across any culture, politeness,
professionalism, and tone are particularly important when communicating difficult news to
anyone. Beginning with simple information about the medical situation and elaborating further
while maintaining a soft undertone will allow the patient to absorb the information with less
fear. Maintaining an open mind to different cultures is important. The ability to assess small
details in someone’s tone and read someone’s body language helps gauge how to address the
situation.
References:
Ritter, L.A., Graham, D.H. (2017). Multicultural Health (2nd ed.). Burlington, MA: Jones
and Bartlett Learning.
Shepherd, V., Hood, K., Sheehan, M., Griffith, R., & Wood, F. (2019). “It’s a tough decision”: a
qualitative study of proxy decision-making for research involving adults who lack capacity to
consent in UK. Age & Ageing, 48(6), 903–909.
https://doi.org/10.1093/ageing/afz115
D#2
Prognosis in the Asian Culture
Terminally ill patients often have their health desires; however, such patients do receive
what they need because they cannot talk for themselves. Other than the inability to talk, a
patient’s culture can also hinder them from getting information about their prognosis and
participate in the health decision-making process (Jang et al., 2018). In cases such as this of the
Asian patient, where culture contradicts the provision of the western healthcare system, the
health personnel finds it challenging to pick on a particular path of medical intervention.
Although we need to respect a patient’s culture, a patient’s autonomy should take precedence;
therefore, I will respectfully disagree with the cultural practice and inform the terminally ill
patient about the prognosis.
The main principles guiding the ethical practice in healthcare include respect for autonomy,
justice, nonmaleficence, and beneficence. All four ethical principles are important and critical in
delivering quality healthcare services; therefore, a breach of ethical principles leads to unethical
practice. Patients deserve to have full information about their healthcare conditions;
consequently, failure to disclose the full information regarding a patient’s care to them is an
ethical breach (Greaney & O’Mathúna, 2017). Nonmaleficence and beneficence require that a
healthcare provider recommend the best practices, bringing a positive outcome with a possibility
of little or no harm.
Consequently, with the understanding of the ethical principles, I would go against the
culture and ask the patient whether they wish to know their prognosis. However, if the patient
says that they do not wish to know about their prognosis, I would keep it to the family members.
As a nurse, what guides my service is patient autonomy; therefore, I would abide by the patients’
wishes. Autonomy and patient participation in the healthcare decision-making process are critical
in the modern healthcare sector; therefore, failure to inform the patient about the prognosis is an
ethical breach (Greaney & O’Mathúna, 2017). The Asian culture is quite different from other
cultures, including my culture, where patients demand to know their prognosis. Therefore, as a
nurse, we always need to stick by the rules and regulations of the western healthcare system and
incorporate the important cultural practices, such as the complementary and alternative medicine
in the treatment process.
Education is a social health determinant that determines individuals’ ability to change their
beliefs and understanding of the healthcare structure (Berwick, 2020). Health education is
essential in helping the healthcare providers balance the patient’s right to know with respect for
the cultural practices and beliefs of the family. To provide a balance, I would take the family
through a health education process to tell them the importance of informing the terminally ill
patient about their prognosis will change their idea about the cultural belief. A patient needs to
find the strength to take the medications and develop a positive attitude towards life; however,
terminally ill patients can only regain this strength if they understand the cause of the disease.
Culture plays a critical role in an individual’s healthcare; however, I urge individuals to shun
some cultures, which present more harm than good. Instead, individuals should embrace
complementary and alternative medicine because they have better medicinal values.
References
Berwick, D. M. (2020). The moral determinants of health. Jama, 324(3), 225-226.
Greaney, A. M., & O’Mathúna, D. P. (2017). Patient autonomy in nursing and healthcare contexts.
In Key concepts and issues in nursing ethics (pp. 83-99). Springer, Cham.
Jang, Y., Park, N. S., Yoon, H., Huang, Y. C., Rhee, M. K., Chiriboga, D. A., & Kim, M. T. (2018).
The risk typology of healthcare access and its association with unmet healthcare needs in Asian
Americans. Health & social care in the community, 26(1), 72-79.

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