Informed consent, medications and procedures

Informed consent

Confucianism in healthcare dictates that the family has the responsibility and authority to make healthcare decisions. So for traditional families, and elderly clients in particular families are usually involved in decisions about medication and procedures. The exception to this is sexual health issues, (see Reproductive Health below). In contrast to Western practices diagnosis disclosure is not considered an individual issue, but a family issue. In New Zealand however, informed consent is required from a client for medical information to be disclosed to family members, making the issue complicated. Practitioners need to approach disclosures sensitively whilst complying with New Zealand code of practice. (More information on how to handle this issue, and a related video on best practice, is provided in CALD 2 training programme, 'Working with Migrants').

Medications and procedures

• Blood samples
  Those who subscribe to harmony principles and TCM may resist having blood drawn as blood loss has consequences for yin/yang balance and chi. The procedure may also be unfamiliar to some clients because it is not a common practice in TCM. The reason for blood samples may need explanation.
• Western medicine for some conditions
  As noted above, many East Asian and Southeast Asian clients regard Western medicine as not as useful for them as for Westerners. Some believe that Western medicine is best for acute diseases and some chronic conditions (e.g. tuberculosis), but that TCM is better for most other chronic problems such as cardiovascular and skin disorders (Kleinman cited in Shih, 1996). Clients may therefore accept some procedures and treatments and not others.
  Medical procedures such as chemotherapy, radiotherapy, and surgical interventions are considered as both treatments and interruptions of body harmony. Pluralistic practices may result in order to counterbalance the effects of treatments and interventions.
• Pain management
  Confucian and Buddhist principles can encourage stoicism in pain. Both systems teach that pain and suffering is an inevitable part of life. Confucianism in particular advises that the sensation of pain is an assurance of being alive, and that it can heighten sensitivity and reminds one of one's humanness. So pain as a trial or sacrifice is profoundly meaningful. Consequently some clients may refuse pain medication until it becomes unbearable, or not report pain to clinicians. Others may tell a family member and ask them to report to the clinician since they feel embarrassed about not bearing the pain (Chen et al, 2008). Buddhists may also refuse medication for similar reasons, particularly if the medication was to affect the state of consciousness since maintaining awareness, particularly during dying, is considered paramount.