Over the past several decades, medicine has moved away from viewing the patient simply as a biological mechanism in need of "repair" and toward a more complete view of the patient as a person with a health need who is also part of a complex social system. A significant portion of who that patient "is" comes from the patient's religious and cultural background. Most of the time, religious and cultural considerations in patient care decisions seem invisible, indeed almost "hidden," in cases where the healthcare professionals, the patient, and his or her loved ones substantially agree about the appropriate therapy, treatment, or outcome to be sought ( Ellison, 1991). However, their presence may be more readily observed when the parties disagree because of differences in their religious beliefs and cultural values. It is easier to see these differences when they are succinctly stated by the participants. By understanding the more obvious cases, the physician will, it is hoped, become more attuned to the less obvious, but nonetheless significant, situations that involve differing views regarding what is "best" for a patient.
The following case illustrates the dilemma that can occur when differing religious beliefs and cultural values clash in the patient-physician relationship.
Case Study: What Should Leah Be Told? (Lantos, Offner, and Chambers, 1999).
Leah, an 18-year-old Israeli girl is diagnosed with clear cell adenocarcinoma of the vagina. Her family is ultra orthodox. She is being seen in a prominent American hospital because of its reputation as the best in the world at treating clear cell cancer. The prescribed treatment for her would be a course of radiation therapy to shrink her tumor and then a hysterectomy. Her father does not want her to be told that she will be sterile because she was recently engaged and the wedding will be...