Cross-cultural considerations in clinical ethics consultations

Cross-cultural encounters between patients and physicians are now commonplace. Although increasing attention has been given to cultural issues in clinical medicine, there has been little discussion of cultural differences presenting as ethical dilemmas. We report four cases in which such differences led to requests for ethics consultations. In analyzing these cases, we identify four elements that are essential for successful resolution of such dilemmas: (1) an ability to communicate effectively with patients and their families; (2) a sufficient understanding of the patient's cultural background; (3) identification of culturally relevant value conflicts; and (4) a willingness to pursue discussion of the ethical dilemma until a compromise is reached or an otherwise satisfactory resolution of the problem is achieved. We conclude with several practical guidelines for clinicians facing ethical dilemmas in cross-cultural interactions with patients.