Informed Consent- What Role Should Gender and Religion Play?

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I teach a number of courses, including Health Care Law and Patient’s Rights, at Barry University School of Law in Orlando, Florida.  Last week, I led a discussion about Informed Consent to first year medical students at the University of Central Florida School of Medicine.  Although my main purpose was to discuss the legal standard regarding informed consent (community standard versus the reasonable patient standard), I wanted to give some practical advice as to how to ensure that a patient really knows all that is relevant to that particular patient about a proposed treatment or procedure.  I was struck by the difficulties of obtaining informed consent from certain patient populations due to language barriers and cultural preferences.  Certain cultures traditionally “protect” their family members from the knowledge that they may be suffering from a terminal illness.  When faced with a request to hide such information from a patient, however, American tort law does not seem to allow it.

What about when the patient is a Muslim woman who needs to undergo surgery but is worried about “modesty” in the operating room? There was an interesting article (here) entitled “Respecting Muslim Patients’ Needs” in the New York Times yesterday that addresses this issue.   The article discusses cross cultural bioethics and specifically how male physicians should deal with interactions with those female Muslim patients who observe traditional Muslim rules about interactions with unrelated males.  The article is based on a Journal of Medical Ethics paper, “Muslim patients and cross-gender interactions in medicine: an Islamic bioethical perspective,” by Aasim Padela, an emergency room physician and Robert Wood Johnson Clinical Scholar and Pablo Rodriguez del Pozo.

While it does seem laudable to respect the religious preferences of patients when they do not directly affect patient care, I wonder about the limits of this.  If a female patient does not consent to a procedure by a male physician, and no female physician is available, what options does a physician have?  What are the problems of a physician making assumptions about a patient’s preferences based on a patient’s gender, religious background or appearance (in this case, presence or lack of presence of a head covering)? There are some interesting issues raised here and the answers are not all that clear.

-Seema Mohapatra

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