In the United States, the health care system is guided towards promoting autonomy in individuals (Hammoud, White & Fetters, 2005). Even though the United States strive for autonomy, can we really consider this true for every culture and ethnicity that populates the U.S.? Even though this approach may seem appropriate, it can cause a lot of friction based on a person’s culture and family structure. With this in mind, I would like to look at the views of informed consent in married women from the Middle East.
So, what is informed consent? Informed consent is when a health care provider (doctor, physician, etc.) discloses information to the patient about a procedure or treatment. The information disclosed includes potential risks, benefits, alternative treatments, etc. (Neff, 2008). Before the treatment or procedure begins, the health care provider must obtain a signature or, informed consent, in order to proceed.
“Informed consent is always provided by the subject, under optimal conditions, without any sense of time or pressure” (Neff, 2008).Even though this is ideal, it’s not always possible. In some cases, where there’s an emergency or when a patient is incompetent, another person will have to provide informed consent. This is called surrogate consent, which “means consent from someone other than the subject (the legally authorized representative, sometimes called the legal next of kin) (Neff, 2008). Consent authority can be given by the guardian, the power of attorney, spouse, adult children, parents, and adult siblings (Neff, 2008). Even though anyone on that list can consent, the person highest on the list always has the final say and must be approached about new or ongoing consent when available (Neff, 2008).
I chose this topic because it’s important to be culturally competent and aware of how culture can influence decisions such as informed consent. In 2002, the Institute of Medicine reported that “racial and ethnic minorities tend to receive lower quality of health care than non- minorities, even when access related factors, such as patient’s insurance status and income are controlled” (Hammoud, White & Fetters, 2005). As a result of this report, it suggested that all providers be cross culturally trained because “evidence indicated that stereotyping , biases, and uncertainty on the part of the health care providers all contribute to unequal treatment” (Hammoud, White & Fetters, 2005). This strengthens the fact that not only case managers, but also people working in health care must build knowledge about the different cultures. This way, proper care is given and barriers that are cause from stereotyping, biases, and uncertainty are broken.
As a health care professional, it’s important that we provide the highest quality of care and to do so, we must know the basics of cultural knowledge and how to apply it. Another reason why I chose this topic is because I’m taking a Sociology class, which studies the structure of family in different eras and parts of the world. After learning about the Middle Eastern culture and beliefs, I was curious in learning their views on informed consent.
Informed consent can be influenced by culture. In some cultures, when making a decision, the person can either make an decision as an individual, or as a family. The Middle Eastern culture and health practice beliefs are very different when compared to the United States. In the Middle Eastern culture, women define themselves as part of a family rather than as an individual (Hammoud, White & Fetters, 2005). Major decision, especially informed consent, usually involves all member of the family, specifically men (Hammoud, White & Fetters, 2005). Therefore, patient autonomy and next of kin have very little meaning for these patients.
In 2010, a study was done by El- Azab and Shaaban, to look at the barriers preventing women from seeking care for urinary incontinence (El-Azab & Shaaban, 2010). They found that one of the barriers was family but more specifically, the husbands of the women who were affected (El-Azab & Shaaban, 2010). Only 8.8 percent of women reported that their husband encouraged them to seek health care. While 77.3 percent stated that their husbands didn’t find it a good idea. The other 13.9 percent stated that their husbands were neutral. Based on the statistics, it can be concluded that men have a say in what their wives do in terms of treatment and procedures.
As a health care provider, cultural competence will help in communication, planning and knowing what to do when obtaining informed consent. For example, the way you approach a women at the bedside. In the Middle East culture, it’s important to announce your arrival by knocking on the door, before entering (Hammoud, White & Fetters, 2005). Women from the middle east, dress modestly. They wear head covering, which are called hijabs and are dressed in non-transparent, nor shape revealing clothes (Hammoud, White & Fetters, 2005). It is important to give them time to cover up to avoid any issues of disrespect.
Another thing you have to consider is staff gender. Middle Eastern women prefer women doctors, nurses, etc. (Hammoud, White & Fetters, 2005). If this is not possible, then the patient should be informed and asked for suggestion that will make her feel comfortable, such as having a women present during an examination. In addition to this, patting a patients back or giving a hug should be avoided unless if the health care provider is of the same gender (Hammoud, White & Fetters, 2005).
The family structure and women’s role in the Middle Eastern society can affect informed consent. In the Middle East women are subordinate to men. Men have authority over women and it’s usually the eldest man that has the most power. Like mentioned before, when it comes to informed consent, the family, particularly the men, might want to take part in the final decision. As a health care provider it’s important to know the customs, this way conflicts are avoided. Considering the family structure, it’s important that we assess the patient and document her wants and needs. If she’s okay with her family being involved in the treatment, then we should document it and involve the family.
Informed consent is a very sensitive subject. It involves legal, ethical and cultural aspects. Many issues can arise from this topic that we need to be aware of. Since family is involved in the process of healing and support, it’s important that we consider them. But most importantly, we have to consider what the patient needs. What it basically comes down to is assessing. What does the patient want? Does the patient want the family to be involved and who should be the person we consult in any situation. This information needs to be documented, not only to protect the individual’s beliefs and practices, but also to protect us, as health care providers from the law.
El-Azab, A., & Shaaban, O. (2010). Measuring the barriers against seeking consultation for urinary incontinence among Middle Eastern women. BMC Women’s Health, 103. doi:10.1186/1472-6874-10-3
Hammoud, M., White, C., & Fetters, M. (2005). Opening cultural doors: providing culturally sensitive healthcare to Arab American and American Muslim patients. American Journal Of Obstetrics & Gynecology, 193(4), 1307-1311.
Neff, M. (2008). Informed consent: what is it? Who can give it? How do we improve it?. Respiratory Care, 53(10), 1337-1341.