The other day, I had a family tell me to not tell their grandmother that she had cancer and was going to die soon. I am not sure what to do. I want to be culturally respectful but I also have to make sure that I am doing right by the patient. It is her life, not the families. What should I do?
Great question. If it was 40 years ago, a doctor could keep information from a patient. Now the rules are different. Here is what you need to do to respect the patient and the culture.
1. Speak directly to the grandmother, hopefully without her family in the room. Ask her, “Do you want the results from the tests we are doing or should I be talking to somebody else? Do you want to make your own decisions or would you prefer that someone else make those decisions for you?”
2. If she says, “Yes, I want to know the results and make my own decisions”, then you will know what to do. Tell her the information. You may also want to check with her if she would prefer to have these conversations in private or with her family present. Sometimes it is just as important to the patient to protect their loved ones as well. Respect the patient’s wishes while you show respect for this family’s culture.
If she says, “No, I would rather focus on getting better and let someone else deal with all of the decisions”, you also know what to do. You now must ask her, “Who should I talk to?” Once she tells you who is in charge, and it might be a 2-3 people, then talk to them. This is called a waiver of informed consent. Patients can act autonomously and waive their right to information. You may want to have her to fill out an advance directive or living will ahead of time and check the box on the form that says, “Starting now, I want _____ to make my decisions for me even though I still have capacity.” If she changes her mind later on, then you can follow her new instructions and begin having her give her own informed consent.
Have a kind and respectful day.