Ethical Challenges in Short-Term Global Health Training

Later in the day, Jeffrey observes his local supervisor, Dr. Zao, informing a patient of her blood status. Click image to start video.

CASE 8: Telling the "Truth"

Vignette 2: Jeffrey proceeds to ask his local advisor about what to do. Dr. Zao informs Jeffrey that, in this cultural setting, telling an individual that he or she is "not a match" is interpreted as being informed of an HIV and/or hepatitis B diagnosis. Speaking about these diseases is often not done in public. Individuals do know, however, to return to the local clinic to pursue further testing and treatment.

Later in the day, Jeffrey observes Dr. Zao from a distance sitting with an individual, telling her about her HIV diagnosis.

Jeffrey is surprised. He just learned that the truth can be expressed differently in different cultures. Now, however, he has just witnessed Dr. Zao directly tell an individual of her diagnosis.

What might explain the situation Jeffrey has just witnessed?

A. Sometimes, "who" delivers the news can matter. In this situation, Dr. Zao is a trusted local and thus might be able to deliver news that a trainee ought not.
Although this is correct, it is not the only explanation. Choose a different answer.
B. Not everyone in a community necessarily holds the same belief about speaking the "truth" directly. Dr. Zao knows that this woman accepts speaking about "HIV" directly.
Importantly, generalizing about a culture’s or community’s orientation to the "truth" can be difficult. This underscores the importance of close collaboration with locals and others who know the community and its members well. However, this is not the only correct explanation. Choose a different answer.
C. HIV is such an important diagnosis that Dr. Zao probably had some reason for violating the general norm she just discussed with Jeffrey.
This might be true, but Jeffrey should not jump to this explanation. Choose a different answer.
A and C.
Only one of these is correct. Choose a different answer.
A and B.
This is correct. Not only does the messenger matter (in this case, a local), but also generalizing about “the” community or cultural orientation to the truth can be difficult. In both instances, in depth knowledge and collaboration within the community is critical.
© Stanford University Center for Global Health and the Johns Hopkins University Berman Institute of Bioethics.

Project funding provided by Doris Duke Charitable Foundation (DDCF)