A critical lens on patient decision-making: A cultural safety perspective

Document Type : Original Article


Background: Involving patients to make decision is a fundamental principle of patient's rights. It is also one of the components of cultural rights. Health professionals have undeniable role in this field through patient participation. “Power” is something that highlights this role.
This study aimed to explore the existing power imbalance between patients and practitioners and its influence on patient autonomy and cultural rights, based on cultural safety perspective.
Methods: A critical ethnography was conducted in a nephrology ward. Data collection was started by observation to build a primary record undertaken over 7 months and continued by interview about 6 months. Data were analyzed using the reconstructive analytical approach, developed by Carspecken.
Results: Two main themes from high-level coding were emerged one: suspense of uncertainty, information desperation, and alienation by the health care. Two: misunderstanding of patient participation, professional centrism, and abstract participation.
 Conclusion: The medical praxis has drawn a glass wall between patients and health professionals and divided them into two groups of “self” and “others”. The current dominant culture of medical centers could not provide an appropriate setting for ethical decision-making based on cultural right. This paternalistic view is a threat to the public discursive ethics and the cultural safety of patient as well in the medical and health-care settings.