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January 10, 1996

Patient-Physician Communication: Respect for Culture, Religion, and Autonomy

Author Affiliations

MacGregor Medical Association Houston, Tex

JAMA. 1996;275(2):108. doi:10.1001/jama.1996.03530260021012

To the Editor.  —Drs Carrese and Rhodes1 offer us a detailed exposition of the Navajo view that bad outcomes can be avoided by not speaking or even thinking of them, a view refuted by the Navajos' own rate of morbidity and death from treatable and preventable diseases. The physicians find it "ethically troublesome" to discuss advance directives with hospitalized Navajos, a group who have already broken with that view by consenting to hospitalization.It is time for a reality check when contributors to JAMA start asking physicians to avoid discussions of sickness, injury, and death, the very reasons our profession exists. Are we to withhold the facts about possible operative complications from Navajos faced with surgery? Or prescribe antibiotics without mentioning the infection they are supposed to treat?Respecting our patients' views is both noble and necessary. But refusing to give them the facts about their condition and possible