Western bioethics on the Navajo reservation. Benefit or harm?
OBJECTIVE
To understand the Navajo perspective regarding the discussion of negative information and to consider the limitations of dominant Western bioethical perspectives.


METHODS
Focused ethnography.


METHODS
Navajo Indian reservation in northeast Arizona.


METHODS
Thirty-four Navajo informants, including patients, biomedical health care providers, and traditional healers.


RESULTS
Informants explained that patients and providers should think and speak in a positive way and avoid thinking or speaking in a negative way; 86% of those questioned considered advance care planning a dangerous violation of traditional Navajo values. These findings are consistent with hózhó, the most important concept in traditional Navajo culture, which combines the concepts of beauty, goodness, order, harmony, and everything that is positive or ideal.


CONCLUSIONS
Discussing negative information conflicts with the Navajo concept hózhó and was viewed as potentially harmful by these Navajo informants. Policies complying with the Patient Self-determination Act, which are intended to expose all hospitalized Navajo patients to advance care planning, are ethically troublesome and warrant reevaluation.
Carrese
J A
JA
Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.
Rhodes
L A
LA
D032722:Advance Care Planning; D000884:Anthropology, Cultural; D001130:Arizona; D001294:Attitude to Health / Q000208:ethnology; D026688:Bioethical Issues; D001675:Bioethics; D018864:Cultural Diversity; D030881:Disclosure; D006801:Humans; D007198:Indians, North American / Q000523:psychology; D009341:Negativism; D010817:Physician-Patient Relations; D012054:Reinforcement, Psychology; D012945:Social Values