Markkula Center of Applied Ethics

Cancer: A Failure to Communicate - Reflections by Abdelmalek Yamani

The relationship between a Western-style physician in and outside the West and a patient from a non-Western tradition is most often characterized by a sense of hope and trust; but it may also be very fragile and sensitive. In fact, this relationship usually starts with the patient's (and his or her relatives') firm trust in the knowledge and the "magic touch" of the Western doctors. As a result, sometimes a simple medicine prescribed by the doctor can accomplish miracles. Once the doctor starts speaking about a specific length of time before the death of the patient, however, this patient and his or her relatives, regardless of their intellectual or Western upbringing, will likely start losing that respect and instead come to view the doctor as someone who is playing the role of God. Thus will the patient probably reject the doctor's suggestions and even come to a position of complete mistrust.

Dr. Looke and Mr. Tabrizi

Dr. Looke does act in an ethical and professional manner until he talks about the death of the patient in a short period of time. This sends an overwhelmingly negative message to Mr. Tabrizi, who now most likely thinks that Dr. Looke is interfering with the will of Allah and as such should no longer be trusted. At this stage, Mr. Tabrizi and his son and wife probably believe Dr. Looke does not know what he is talking about and may even want to do harm to the patient.

Of course, Mr. Tabrizi's son doubtless agrees with the patient and hence does not want to bother translating word for word the doctor's message about Mr. Tabrizi's hopeless future. Moreover, he must know that, by this time, Mr. Tabrizi himself understands, through the doctor's facial expression and tone of voice, that he is offering a negative prognosis.

In fact, even if the son believes the doctor, there is no way for him to convey exactly what the doctor says, since he would not want to be the bearer of such negative news. That is Dr. Looke's second major mistake. And, in addition to his harsh and rude approach (in the eyes of the patient and his visitors), the son may have never heard of words such as extensive small cell lung cancer, chemotherapy and radiation. Hence, Dr. Looke may as well be speaking French to him; he very likely has no idea what to make of the doctor's complex medical vocabulary. To overcome this, Dr. Looke, could and should have sought the help of a professional translator.

As for feeding Mr. Tabrizi, it is widely understood and well accepted by all Muslims living in the West that, if they have any doubt about whether or not meat is Halal (Kosher), they can eat vegetables. Muslims are allowed to eat the food of the people of the book, in this case Jews and Christians, as the son alluded to. However, Muslims are not allowed to eat pork except in extreme circumstances where there is nothing else to eat. Yet in this case, the rules of that which is unlawful do not apply, for the life of the individual is more important than anything else, according to Islam.

Mr. Tabrizi's extreme reluctance to offer up any information about his own or his family's health-causing high levels of frustration among the medical staff-is a very natural attitude. The reason, no doubt, is that Mr. Tabrizi considers that information to be part of his private life, not something he would reveal to any stranger. To obtain the information needed, the medical staff could have asked the son. At first, he might have shown some resistance, but if he had been made aware of the danger to his father's health and well-being, he would most likely have provided all that was necessary to save his father's life.

Conclusion



Like a smile, the effects of language are powerful and reach deep into a person's psyche. Many Westerners would have done anything to get well here, including complete submission to the will of the doctor. This is not true of many Muslim patients, particularly when:

  1. the doctor speaks of death within a specific period of time.

  2. the doctor uses unfamiliar vocabulary. (In this case, unfamiliar language is automatically translated into something negative.)

  3. the translator is a relative. (There are a number of family and traditional structures that prohibit a close relative, such as a son, from disclosing very negative news to someone like a father or a dear friend.)

In this case, a professional translator should have been engaged to help bridge the communication gaps and convey the doctor's news in a more effective and sensitive manner. This small step would very likely have helped to prevent the vast cultural communication gap that prevailed.

Return to the case
Introduction to Culturally Competent Care
Introduction to Culturally Competent Care for Muslim Patients

Abdelmalek Yamani holds an M.S.E.E., an M.A. in psychology, a Ph.D. in linguistics, and is a PhD. candidate in psychology. Currently, he is working as a software engineer at Cisco Systems and is a professor of Arabic at the University of San Francisco.
January 2008