In order to assure optimal care of patients with chronic illnesses, it is necessary to take into account the cultural factors that may influence health-related behaviors, health practices, and health-seeking behavior. Despite the increasing number of Romanian Roma, research regarding their beliefs and practices related to healthcare is rather poor. The aim of this paper is to present empirical evidence of specificities in the practice of healthcare among Romanian Roma patients and their caregivers. Using a qualitative exploratory descriptive design, this (...) study is based on data gathered through three focus groups with 30 health mediators in the counties of Iasi and Cluj (Romania). We identified various barriers to access to healthcare for Roma patients: lack of financial resources and health insurance coverage, lack of cognitive resources or lack of personal hygiene, but also important cultural issues, such as the shame of being ill, family function, disclosure of disease-related information, patient’s autonomy, attitudes towards illness and health practices, that should be considered in order to create a culturally sensitive environment in Romanian medical facilities:… The role of the health mediators within the context of cultural diversity is also discussed, as cultural brokers contributing to health care quality among Romanian Roma patients Bridging cultural differences may improve patient–healthcare provider relationships, but may have limited impact in reducing ethnic disparities, unless coupled with efforts of Roma communities to get involved in creating and implementing health policies. (shrink)

Background:There has been wide interest shown in the manner in which ethical dimensions in nursing practice are approached and addressed. As a result, a number of ethical decision-making models have been developed to tackle these problems. However, this study argued that the ethical dimensions of nursing practice are still not clearly understood and responded to in Brunei.Research aim:To explore how Bruneian nurses define ethical concerns they meet in everyday practice in the medical surgical wards of three Brunei hospitals.Research design:A qualitative (...) study was employed. Interviews were conducted with 28 practising and administrative nurses of three hospitals. Interview data were analysed via a constant comparative method.Ethical consideration:The study’s protocol was reviewed and approved by the Ethical Committee of the School of Health in Social Science at the University of Edinburgh and the Medical Health Research Ethics Committee of the Ministry of Health, Brunei.Findings:The nurses described three ethical dimensions in their practice, namely: ‘nurse at work‘ which illustrates the ethical dimensions within the work environment; ‘nurse and doctor’ which elucidates the ethical dimensions in the nurse and doctor relationship; and ‘nurse and patient’ which further examines ethical aspects in patient care. Nurses responded to the ethical dimensions in the ward setting with the aim of avoiding the conflict and maintaining ward harmony.Discussion:The data provide new insights into how nurses respond to ethical dimension in the ward settings where it puts strong emphasis on the nurses’ understanding of responsibility placed upon them as professional nurses.Conclusion:With these findings, it is recommended that further support is needed for nurses to be aware of the ethical dimension in their practice and to respond to ethical concerns accordingly. (shrink)

Background There are several psychosocial and ethical issues surrounding the decision to be a living kidney donor. The present study aimed to determine the perceptions of psychosocial and ethical issues that living kidney donors may have, and analyze their psychological characteristics.Methods Face-to-face semi-structured interviews were conducted with 15 donors. Thematic analysis was then performed to categorize the thematic elements of the transcripts. All procedures were approved by the relevant review board.Results Four main categories were identified: Awareness of family dynamics, barriers (...) to a proper understanding, contrasting psychological effects of recipient presence in clinical practice, insufficient information explained in informed consent.Conclusion Donors felt that they took on the “role as a care giver” for the recipient and were less aware of themselves as patients. This is a new concept that has not been shown in previous studies. Donors exist within the recipient and family, and the range of their autonomy may go beyond the traditional concept of autonomy and be rooted in relational autonomy. This study suggested that medical treatment in the presence of the recipient promotes the relational autonomy of the donor. (shrink)

Although the patient’s right to decide what they want for themselves, which is encompassed in the notion of ‘patient-centred medicine’ and ‘informed consent’, is widely recognised and emphasised in Japan, there remain grave problems when it comes to respecting the wishes of the no-longer-competent when death is imminent. In general, it is believed that the concepts above do not include the right to refuse treatment when treatment withdrawal inevitably results in death, even when the patient previously expressed the wish to (...) exercise this right when competent. In this paper, I first explain the current social and legal situation in Japan, where the lack of legal clarity regarding the right to reject treatment tends to result in doctors adopting the interpretation of patients’ words that is least conducive to treatment withdrawal. I then argue that the right to refuse treatment should be taken seriously, even when the patient is no longer competent, or the treatment refusal will result in death. I suggest that the concept of relational autonomy might have some practical and valuable implications in a country where individual autonomy is considered incompatible with societal values. Finally, I answer possible objections to relational autonomy and address the widespread societal concern about sliding down the slippery slope from allowing the right to refuse treatment to the obligation to die. (shrink)

Although parents are the default legal surrogate decision-makers for minor children in the U.S., shared decision making in a pluralistic society is often much more complicated, involving not just parents and pediatricians, but also grandparents, other relatives, and even community or religious elders. Parents may not only choose to involve others in their children’s healthcare decisions but choose to defer to another; such deference does not imply agreement with the decision being made and adds complexity when disagreements arise between surrogate (...) decision-makers for minor children and their physicians. I argue that clinicians and ethicists have a duty to consider voices marginalized by hierarchical structures, including but not limited to gender-based inequalities. This approach involves negotiating potential conflicts: between respecting differences of culture and religion, on one hand, and assuring that the wishes of those who are most invested in children’s lives are considered, on the other. (shrink)

Background: Dignified care is one of the main objectives of holistic care. Furthermore, paying attention to dignity as one of the fundamental rights of patients is extremely important. However, in many cases, the dignity of hospitalized patients is not considered. Dignity is an abstract concept, and comprehensive studies of the dignity of Iranian patients hospitalized in general hospital settings are limited. Objective: The aim of this study was to explore the concept of dignity from the perspective of patients hospitalized in (...) general hospital settings in Iran. Research design: This study takes a qualitative approach. Data were gathered using individual, semi-structured interviews. Qualitative content analysis was the method used to analyse and interpret the data. The criteria suggested by Guba and Lincoln were used ensure the trustworthiness of the study. Participants and research context: A total of 14 hospitalized patients in general hospital settings in Shiraz participated in this study. Ethical considerations: The Research Ethics Committee of the Shiraz University of Medical Sciences approved the protocol of the study and the ethical principles were followed throughout. Findings: The findings of this study revealed four main themes – ‘respectful atmosphere’, ‘patient privacy’, ‘preservation of authority’ and ‘receiving attention’ – and 10 categories. Discussion: Patients need to be hospitalized in a respectable environment in which their privacy is preserved and paid attention, providing them with sufficient authority in terms of medical decisions and their life-related issues. The dignity of hospitalized patients will be preserved under these conditions. Conclusion: Patients hospitalized in general hospital settings need to retain their dignity. This can contribute to the optimal therapeutic outcomes for them. Therefore, it is suggested that a cultural, professional and institutional background, in which all components of the patient’s dignity are protected and emphasized, should be provided. (shrink)

Although Chinese law imposes informed consent for medical treatments, the Chinese understanding of this requirement is very different from the European one, mostly due to the influence of Confucianism. Chinese doctors and relatives are primarily interested in protecting the patient, even from the truth; thus, patients are commonly uninformed of their medical conditions, often at the family’s request. The family plays an important role in health care decisions, even substituting their decisions for the patient’s. Accordingly, instead of personal informed consent, (...) what actually exists is ‘family informed consent’. From a Western perspective, these features of Chinese law and Chinese culture might seem strange, contradicting our understanding of doctor-patient relationship and even the very essence of self-determination and fundamental rights. However, we cannot forget the huge influence of cultural factors in these domains, and that ‘Western’ informed consent is grounded on the individualistic nature of Western culture. This article will underline the differences between the Western and the Chinese perspectives, clarifying how each of them must be understood in its own cultural environment. But, while still respecting Chinese particularities, this paper advocates that China adopt patient individual informed consent because this is the only solution compatible with human dignity and human rights. (shrink)

Medical communication in Western-oriented countries is dominated by concepts of shared decision-making and patient autonomy. In interactions with Roma patients, these behavioral patterns rarely seem to be achieved because the culture and ethnicity have often been shown as barriers in establishing an effective and satisfying doctor–patient relationship. The study aims to explore the Roma’s beliefs and experiences related to autonomy and decision-making process in the case of a disease with poor prognosis. Forty-eight Roma people from two Romanian counties participated in (...) semi-structured interviews, conducted by a research team from the University of Medicine and Pharmacy of Iasi. Participants were recruited among the chronically ill patients and caregivers. The Roma community opposes informing the terminal patients about their condition, the “silence conspiracy” being widely practiced. The family fully undertakes the right of decision making, thus minimizing the patient’s autonomy. We identified ethical dilemmas concerning autonomy, lack of patients’ real decision-making power, and paternalistic attitudes exerted firstly by the family and, on demand, by the physician. Instead, the Roma patient benefits from a very active support network, being accompanied at the hospital by numerous relatives. The patient’s right to make autonomous decisions promoted in the Western countries and stipulated by the Romanian law has diminished value in the Roma community. For the Roma, the understanding of dignity is not simply individual and personal, but it is closely related to their cultural particularities. Ignoring their cultural values could create conflicts between healthcare providers and community. (shrink)

Informed consent, decision-making styles and the role of patient–physician relationships are imperative aspects of clinical medicine worldwide. We present the case of a 74-year-old woman afflicted with advanced liver cancer whose attending physician, per request of the family, did not inform her of her true diagnosis. In our analysis, we explore the differences in informed-consent styles between patients who hold an “independent” and “interdependent” construal of the self and then highlight the possible implications maintained by this position in the context (...) of international clinical ethics. Finally, we discuss the need to reassess informed-consent styles suitable to the needs of each patient regardless of whether he or she resides in the United States or in Japan. (shrink)