Culturally competent clinical ethics: Case study response: Response to case study: A family requests that their grandmother, who does not speak English, is not informed of her terminal diagnosis

The case study: a family requests that their grandmother, who does not speak English, is not informed of her terminal diagnosis focusses mostly on the issues of autonomy of patient and truth telling but fails to highlight the most ethically salient feature of the case; the clinician did not talk to the patient. The case study notes that the patient spoke a dialect of Cantonese and felt that translation services might not have been readily available. This is unacceptable practice given the easy availability of professional telephone interpreters. In addition, it rendered the rest of the discussion academic as without a professional interpreter the clinician had no idea exactly what the family member who was interpreting was saying to their grandmother. This is an excellent case to discuss the ethics of the care of culturally and linguistically diverse people and the importance of interpreter use in patients with limited English proficiency. This case is also a good illustration of a limitation of Clinical Ethics Committees. A common norm is that there is no patient involvement in the deliberations of the committee. Without any patient involvement, it is very difficult to understand the patient’s position (well illustrated in this case) and impossible to engage in dialogue to find an agreed management plan.

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