1. Starr, Kristopher T. JD, MSN, RN, FNP-C, CEN, CPEN

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AS A HEALTHCARE professional dedicated to ushering patients from the state of illness to wellness, the unsuspecting nurse may be shocked when patients place restrictions on what he or she can do for them based on their cultural or religious beliefs. Our profession's commitment to cultural competence and, by extension, religious or ethno-religious competence, can push the limits of our personal and professional acceptance of the medical decisions of others.

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Any seasoned clinician has probably run into this situation at least once. If you work in healthcare near a large urban center, patients with various ethnic and religious beliefs come under your care; this could be a weekly or even daily event for you.


Imagine what different ethnic groups one might encounter. Those from certain Middle Eastern, Asian, and some other cultures might believe in treatments such as cupping, in which suction is applied to a part of the body to extract illness.1 In some Asian cultures, a dermabrasive technique called coining is used to treat fever, headache, and chills.2 In my neck of the woods, the Old Order Amish eschew the use of electric power in their lives and generally aren't into preventive medicine in the purest sense of the term. You might experience the entire world of cultures and beliefs right within your facility.


So, where is the legal interface with those who come into the facility seeking medical care but, due to their ethnic or religious ideology, refuse what one would consider standard medical care? Enter the law, the federal constitution, about 100 years of personal freedom jurisprudence, and the boundless and tricky questions of culture and faith.


The legal question to ponder here is whether a competent person can refuse standard medical care or limit the medical care provided based on religious or cultural beliefs. The legal answer is, generally, yes.


The U.S. Supreme Court has found that the right of self-determination, which includes the right to refuse medical care, is inherent in the liberty interests protected by the federal constitution.3 But the highest Court in our land hasn't indicated that this is a guaranteed privacy right, but rather is better considered a right of liberty.4


What's the difference for the clinician? The constitutional guarantee that permits a patient to refuse otherwise standard medical treatment flows from an individual right to be free from unwanted touch, which is also the basis for the concept of informed consent. Where does this leave us? Simply, if an adult under your care is mentally competent and refuses a treatment, including blood transfusions, surgery, or standard medical care, based on a held religious or cultural belief, the law generally grants this right of choice-even if the consequences of refusal are dire.


If you question the competence of the person you're caring for, that leads you down a much different path that can include surrogate decision making, medical powers of attorney, conservatorships, guardianships, and the like. But let's leave that discussion for another time. For now, remember that our role is to care, educate, support, and heal-not to preach, convert, or cajole.


Until next time, stay safe and keep it legal.




1. WebMd. Health & Balance. Cupping therapy. [Context Link]


2. Pich L. CAO GIO (coin rubbing or coining). Vanderbilt University Health Psychology Home Page. [Context Link]


3. Cruzan v. Director, Missouri Dept. of Health, 497 U.S. 261 (1990). [Context Link]


4. Standler R. Legal right to refuse medical treatment in the USA. 2012. [Context Link]