You are the oncology nurse caring for Maria, who has been diagnosed with non-small cell lung cancer (NSCLC). She says she doesn’t understand how she developed lung cancer because she has always lived a clean lifestyle according to her religious practices. You notice that although Maria is initially conversant with you, she allows her husband to speak for her whenever he is present. When you mention your observation to Maria, she tells you that in her religious culture, medical decisions are deferred to the high elders of the church.
What Would You Do?
Culture is a broad term encompassing the beliefs, social norms, and ways of life in a large group of people. Autonomy is a core nursing value acknowledging others’ rights to make decisions about their lives. In health care, sometimes a practitioner must reserve their personal beliefs to fully honor another’s autonomy.
In Maria’s scenario, you feel that her religious culture is compromising her autonomy. You struggle to understand how Maria could turn over her healthcare decisions to someone else. You also recognize that you have less conflict when patients defer their choices to a medical professional.
The International Council of Nurses instructs nurses in its Code of Ethics to “provide people-focused, culturally appropriate care that respects human rights and is sensitive to the values, customs, and beliefs of people without prejudice or unjust discrimination” (p. 8). You understand the need to value Maria’s self-determination; however, you question whether Maria is truly using her agency or, as you see it, transferring her rights to her religious leaders.
You ask Maria to tell you more about her beliefs so you can better understand how to provide her with patient-centered care. She tells you that her religion believes in not taking harmful, non-natural substances into one’s body. She says she has been faithful to that practice for more than 30 years. You listen attentively, and over time, Maria opens up and tells you she is scared of not treating the lung cancer and dying in pain.
You explain to Maria and her husband that the oncologist is recommending treatment with a monoclonal antibody, which enhances the body’s ability to use its immune system to fight the harmful cancer cells. You are careful just to state the facts and not push the couple toward a decision. Maria and her husband come back the following week. She agrees to have the recommended treatment. When you ask Maria what changed her mind, she says her husband discussed the treatment with other religious leaders and they made the decision to allow her to use a monoclonal antibody.
You feel confident that you honored Maria’s religious edicts while reducing your ethical conflict by providing education in a nonthreatening way. This is one of several strategies (see sidebar) for managing internal ethical conflicts.