Cross-cultural communication

Part 2

  • Consent revisited, A

  • Dr. Riel: Alright, so tell her that her back pain will return unless we treat her. Now there are two ways of doing that but we’re not sure which one is the best. So, we are going to do a trial to figure that out. Now, as I said there are two possibilities. The first one is through medication but there are side effects to that which we will go through. The other method requires that we begin to treat her locally with radiation. Both treatments are effective but we just don’t know which one is best. So… However, before we do anything else I really would like to examine her again. Would you kindly step out for a few minutes please?

    Mado: Sure.

    Dr. Riel: Thank you. (Mado, Betsy and Dani converse in Creole)

    Mado: Momma, the doctor says your back will continue to hurt if they do nothing. The doctor wants to examine you and wants us to leave for a few minutes.

    Betsy: Ok. Go for a coffee and then you can come back.

    Dani: We will be right back. I love you. (Mado and Dani leave)

    Dr. Riel: Thank you.

    Betsy: Doctor, best treatment.

    Dr. Riel: Oh… So, you do speak English?

    Betsy: A little bit.

    Dr. Riel: Well that’s good to know Mrs. Exantus. I don’t know if you understood, but I would like to examine you again. Is that ok with you?

    Betsynods yes.

    Dr. Riel: Alright, so we’ll take this easily and slowly in order not to hurt you. Alright?

  • Consent revisited, B

  • Dr. Riel: Well, it’s not quite that simple Mrs. Exantus. You see, these treatments are effective, but we just don’t know which one is best for someone with… well, someone in your condition. So, what we are suggesting is to put you into what’s called a clinical trial; it means that you will be put into this trial randomly, and so, you will undergo either one or the other treatment… understand? Okay. Now, given one of the treatment options in this case is radiation, we would know which treatment you are getting. You’ve said yes and agreed to the radiation approach, and we’ve discussed all the possible complications, the different things that could happen, right? Alright, now the other arm of this trial, the other treatment option in this case is chemotherapy. Now with that approach you would have to take pills but these have side effects that I…

    Betsy: Home, home, restaurant, home.

    Dr. Riel: I understand but I don’t think you’re going to be strong enough Mrs. Exantus. You see, these treatments are very effective but also very demanding.

    Betsy: Home, restaurant, home, customers…

    Dr. Riel: Yes, I understand Mrs. Exantus but you need to take this one step at a time. Let’s start with the trial, and then we’ll see. Alright?

  • Consent revisited, C

  • Dr. Tyson: I’m afraid it isn’t good news… Listen, there’s… there’s no easy way for me to tell you this, but your mother has lung cancer that has metastasized to her bones. The bone in her spine has been affected, and that’s the reason why she is getting all that back pain. I’m surprised she didn’t have urinary symptoms because…

    Elsi: She’s not one to complain, she never complains, but are you sure? I mean, couldn’t it be something else?

    Dr. Tyson: Well, we don’t have the results from the biopsy back yet, but we found a mass in her lung in keeping with cancer. There are some things we can do to help her…

    Elsi: Just one thing… she can’t find out, ok? She can’t find out about having cancer. My dad, okay, but she can’t find out.

    Dr. Tyson: Well… there could be a problem with that…

    Elsi: Why?…

Breaking — or not — bad news

Please also see “Breaking bad news” in the Communication Skills module.

Reflective exercise 5

In this encounter between Betsy and Dr. Riel, the oncologist, we revisit some of the issues around the consent process. In “Consent and confidentiality,” we saw the basics at work: voluntary, informed, and (not required here) capacity. We will now see that many of the issues that arise in the daily work of physicians are not quite so clear-cut. Being informed, understanding and appreciating consequences is just the beginning of a process called “shared decision-making.” This is an area of bioethics in which consent, paternalism and autonomy interact in an ongoing process.

Before considering further the situation of Betsy and the physicians, read the following articles:

After reading the literature on decision-making, complete the following exercise. Remember that there are no right or wrong answers, but you should be able to support your responses with a reasoned argument. This is a good exercise for group discussion.


Next: Conclusion