One Size Fits All? On Patient Autonomy, Medical Decision-Making, and the Impact of Culture

Gilbar, Roy; Miola, José

doi:10.1093/medlaw/fwu032

Cited by 46 publications

(62 citation statements)

References 15 publications

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“…Autonomy implies the capacity to think, decide and act on one's own free initiative (British Medical Association., 2013). In the Western culture, this is highly valued by both healthcare providers and patients, who are usually well informed about this topic, which ultimately lead to gradual attenuation of medical paternalism (Gilbar & Miola, 2015;Gillon, 1994;Khoury & Khoury, 2015;Surbone, 2006;Tuckett, 2004). However, in some Middle Eastern cultures, beneficence usually precedes autonomy.…”

Section: Introductionmentioning

confidence: 99%

Practice and Attitudes of Physicians Regarding Disclosure of Information to Patients With Serious Illness

Jassim¹,

Alakri²,

Alsayegh³

et al. 2019

GJHS

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BACKGROUND: Health Information disclosure is the cornerstone in respecting the patients’ autonomy and beneficence, particularly in the context of serious illness. Some Middle Eastern cultures prioritise beneficence over patient autonomy. This may be used as a justification when patient’s family takes over the decision-making process. Although guidelines and protocols regarding information disclosure are fast evolving, there are no sufficient data regarding the application of these guidelines in the clinical context. The objective of this study is to explore the truth disclosure practices of physicians in Bahrain. METHOD: In this cross sectional study, a random sample of 234 physicians was obtained from the database of Salmaniya Medical Complex (the largest public hospital in Bahrain). We used self-administered 21-item questionnaire to assess the practices and attitudes of physicians regarding disclosure of information to patients with serious illnesses. RESULTS: A total of 200 physicians completed the questionnaire with a response rate of 69.6%. The question about the usual policy of disclosure revealed that 62.5% (125) of the doctors would always disclose the diagnosis to the patients, 26% (52) would often disclose the diagnosis and only 1% would never disclose the real diagnosis to a competent adult. Only 15% of the physicians would never make exceptions to their policy of “telling the patient” while all remaining physicians (85%) made exceptions to their policy either often, occasionally or rarely. The most common reason for not disclosing the diagnosis was family request (39.5%). About 64.5% of the physicians were not aware of any existing protocol or policy for diagnosis disclosure to patients. There was no statistically significant association between doctors’ policy of disclosure and other demographic variables. CONCLUSION: Most physicians opt to disclose the truth; however, the majority would make exceptions at some point particularly upon family request. Regional truth disclosure policies should take into consideration the interplay and balance between patient autonomy and the role played by the family in the decision-making process.

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Section: Introductionmentioning

confidence: 99%

Practice and Attitudes of Physicians Regarding Disclosure of Information to Patients With Serious Illness

Jassim¹,

Alakri²,

Alsayegh³

et al. 2019

GJHS

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“…7,16 In certain Middle Eastern, North African and South Asian societies, the family has final authority in TDM, as often the patient is inseparably linked to the family as a whole. 17 For example, the majority of cancer patients in South Korea preferred shared TDM with their family members, although it was noted that there may be disagreements between family members and patients. 7 In a study from Pakistan, family members sometimes met the physician independently and gave consent for treatment on the patient's behalf.…”

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confidence: 99%

“…Indeed, medical law in many Western countries states that, in the majority of circumstances, the patients themselves have the final decision with regards to TDM. 17 However, the cultural background of the physicians may influence their response to involving family members in the TDM process. One study conducted in the USA showed that the majority of physicians of Japanese heritage would obey a family's request not to involve the cancer patient in TDM while very few North American physicians would consent to this request.…”

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confidence: 99%

“…24 In Western countries, the concept of relational autonomy, which considers the individualistic perception of autonomy within a larger social framework, allows for the inclusion of family members in the TDM process. 17 Thus, physicians are requested to abide by their patients' expressed wishes with regards to family involvement in TDM and to consider the family's opinions during care, in the absence of any evidence of abuse or neglect. 23 Nevertheless, research conducted in the UK indicated that while the relatives of cancer patients influenced the decision-making process itself, the final decision was ultimately left to the patient.…”

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confidence: 99%

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The Role of Patients’ Families in Cancer Treatment Decision-Making: Perspectives among Eastern and Western families

Al-Bahri

Al-Moundhri

Al-Azri

2018

Sultan Qaboos Univ Med J

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“…Looking at the English legal context in healthcare, for instance, Gilbar and Miola observe that ‘the emergence of relational autonomy has not yet yielded a meaningful legal response to the impact of the patient’s cultural background on the decision-making process, thus creating difficulties for clinicians and some patients to make decisions about treatment’. 25 Similarly, McLean notes the law’s ongoing strong focus on the individual’s decision-making capacity and her individual right thereof to exercise in decision-making. 26 Despite her criticisms of the law’s extant approach, however, McLean is equally concerned that emphasising ‘the importance of inter-relatedness can result in an undue focus on the interest of others and this is evident, for example, when the decisions of pregnant women are disregarded in the interests of a future child’.…”

Section: Introductionmentioning

confidence: 99%

Beyond individualism: Is there a place for relational autonomy in clinical practice and research?

et al. 2017

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The dominant, individualistic understanding of autonomy that features in clinical practice and research is underpinned by the idea that people are, in their ideal form, independent, self-interested and rational gain-maximising decision-makers. In recent decades, this paradigm has been challenged from various disciplinary and intellectual directions. Proponents of ‘relational autonomy’ in particular have argued that people’s identities, needs, interests – and indeed autonomy – are always also shaped by their relations to others. Yet, despite the pronounced and nuanced critique directed at an individualistic understanding of autonomy, this critique has had very little effect on ethical and legal instruments in clinical practice and research so far. In this article, we use four case studies to explore to what extent, if at all, relational autonomy can provide solutions to ethical and practical problems in clinical practice and research. We conclude that certain forms of relational autonomy can have a tangible and positive impact on clinical practice and research. These solutions leave the ultimate decision to the person most affected, but encourage and facilitate the consideration of this person’s care and responsibility for connected others.

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One Size Fits All? On Patient Autonomy, Medical Decision-Making, and the Impact of Culture

Cited by 46 publications

References 15 publications

Practice and Attitudes of Physicians Regarding Disclosure of Information to Patients With Serious Illness

Practice and Attitudes of Physicians Regarding Disclosure of Information to Patients With Serious Illness

The Role of Patients’ Families in Cancer Treatment Decision-Making: Perspectives among Eastern and Western families

Beyond individualism: Is there a place for relational autonomy in clinical practice and research?

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