To the Editor.
—The interesting and informative study by Drs Carrese and Rhodes1 regarding the perspective of the Navajo peoples on the negative information provided by Western medicine—in this case, advance care planning and risk disclosure—actually brings up possibilities much more profound than the authors state. The authors nicely document that the Navajo tradition of hózhó, the concept of beauty, harmony, order, and general positiveness, is assaulted by the communication of possible adverse events (eg, risk of death from surgical procedures) that are normally disclosed to patients by modern (Western) physicians. The authors reason that the routine application of these accepted bioethical concepts to non-Western cultures might be unethical and perhaps should be reconsidered. The question arises, however, of whether they are too cavalierly applied to Western patients as well.The culture of "Western society" as it developed in Europe after the Roman Empire has been primarily Christian, and
Pastorek JG. Patient-Physician Communication: Respect for Culture, Religion, and Autonomy. JAMA. 1996;275(2):108-109. doi:10.1001/jama.1996.03530260021014