Culturally Appropriate Geriatric Care: Delivery of Care

Decision Making and Disclosure

Pakistani culture emphasizes the individual as a part of a family unit, and decisions are made collectively. Pakistani elders will often involve family members in decision making, and an important health decision will commonly involve their conferring with and relying on a son or daughter.

When illness strikes a member of the Pakistani family, it is the family rather than the patient who takes center stage in this process. In the case of a conscious patient, the family and physician will generally protect the patient from the anxiety and distress associated with the knowledge of impending death. This is done by not disclosing the diagnosis or disclosing it in ambiguous terms. When faced with this situation, the clinician should verify that the patient is comfortable with letting the family make his/her health care decisions.

Saying something like: “Mr. Shiekh, I am told that you prefer to let your family make all health care decisions for you and that you would prefer not to know your diagnosis. Is this a correct assumption?” will help confirm the patient’s stance.

If the patient prefers not to know about his/her medical condition, this should be respected. Autonomy is the right to choose, and so patients have the right to choose to remain ignorant about their diagnosis. If the older adult has cancer, treatment options can be discussed with him or her, but it is recommended that the word “cancer” not be used.

It is also believed that the physician is the authority in matters relating to disease and medical interventions. She or he is often symbolically inducted into the family and is expected to direct rather than just facilitate medical management.