Autonomy and shared decision-making in a multicultural world

Abstract

The delivery of palliative care is frequently a cross-cultural experience and, in many settings, it involves the care of patients from numerous different cultures and backgrounds. In the care of palliative care patients there are many challenging ethical issues around the issue of autonomy that may be influenced by the culture and traditions of either the patient or their family. Palliative care clinicians often find themselves challenged practically and ethically by issues arising around cross-cultural communication. Despite the input from philosophers, sociologists, psychologists, and communication experts, these issues continue to plague and often confuse individual clinicians as they confront challenging, and sometimes distressing, situations. This chapter aims to equip clinicians with a nuanced understanding of what a culture is and how it affects behaviours and expectations, a nuanced understanding of autonomy, and the role of paternalism when it may sometimes be appropriate and even justifiable to subvert patient autonomy.