Society of Bioethics and Medicine
INFORMED CONSENT FOR ELDERLY IMMIGRANTS AND THEIR FAMILIES
Updated: Sep 21, 2020
By- Razna Ahmed, Edited by - Nadia Addasi April 19, 2020
Informed consent ensures that a patient and, if appropriate, the patient’s family, has an understanding of their health problems, and treatment options and their consequences so that they may knowingly consent to treatment. Its role is to protect the patient and respect patient autonomy, or their right to make their own decision. In Western medicine, it is the patient’s right to consent to their treatment without outside interference. However, Eastern and South Asian medicine focus on the will of the family as the dominant decision-making source. This stems from the strict family structures characteristic to many Eastern and South Asian cultures. This policy can be helpful in circumstances where a patient may lack the mental capacity to decide a course of treatment for themselves. However, delegating decision-making solely to the family risks violating the patient’s wishes if the family has contradicting wishes or interests.
Nonetheless, patient-exclusive decisions may also have a negative effect on treatment because it leaves out family members from the same support and informative decision-making process which can cause great anxiety. This comprises the mental wellbeing of the patients’ support system, which can, in turn, make the patient feel equally anxious. Furthermore, immigrant families in the US may struggle with this loss of power and feel unprepared for the implications of patient autonomy in the course of medical treatment. Situations like this can be greatly confusing for elderly patients, who may not speak English and are unable to communicate with their medical team.
Imagine an immigrant family visiting a doctor for the treatment of an ill grandmother. The family is stressed because of the grandmother’s pain, and the financial burden posed by potential medical costs is further stressful. The medical team is focused on helping the grandmother understand her situation; they provide a translator, illustrated diagrams, and emotional support. While these resources may be helpful, it does not ensure that they will be an effective means of communication, especially considering how words and concepts can be lost in translation. In this case, the family who may be the best resource in treating the ill is left out of the discussion, only being informed of decisions after they are, correctly or erroneously, made. This can present itself as an out of control situation which only adds to the stress, creating a very harrowing situation for the family, and in extension the patient.