Case # 8: Bias & Culture
Leyla Ansari, 30, a recent immigrant from Afghanistan who is 22 weeks pregnant, is admitted to the hospital with severe cramping. She has only had 1 prenatal visit with a local OBGYN, not affiliated with the hospital. A preliminary ultrasound indicates brain abnormalities with her fetus.
Mrs. Ansari is accompanied by her husband of eight years (also an immigrant) and her mother, who speaks no English and lives with the couple. Mrs. Ansari (Leyla) also speaks very little English, though she does understand some; her husband speaks English better, though somewhat haltingly. Their primary language is Dari.
Mrs. Ansari is stabilized, and further scans are conducted on the fetus. The physicians soon discern that the fetus is afflicted with a relatively severe encephalocele; its size and location make survival outside the womb extremely unlikely. The attending physician, Dr. Fox, is not previously acquainted with the patient.
Mrs. Ansari’s other children (all girls, ages 2, 5, and 6) are in the outside waiting area, accompanied by an aunt. Noticing a look of deep concern on the doctor’s face, Mr. Ansari asserts that his wife is sick with fear and anxiety and that she herself would prefer that her husband handle any news of the situation. He requests that Dr. Fox meet separately with him first, outside of his wife’s room. Moreover, it is the traditional time for Muslims to offer prayers, and, since he and his family are devout Muslims, they would prefer to do so before any difficult conversations are had with the doctor. Mrs. Ansari, obviously upset but remaining silent, makes no visible objection to her husband’s wishes. Mr. Ansari repeats his request that the doctor meet separately with him.
Dr. Fox, unsure of how to proceed but not wanting to stress Mrs. Ansari further, agrees to meet the husband separately after they complete their prayers.
When they finish praying, Mr. Ansari meets separately with Dr. Fox. She discloses the most recent scan results to Mr. Ansari. Dr. Fox recommends termination of the pregnancy. Stunned, Mr. Ansari sits in silence for several minutes.
After several moments, there is a knock on the door from Mrs. Ansari’s mother. The patient’s mother immediately discerns from the husband’s face that something is terribly wrong and speaks in Dari to Mr. Ansari. Dr. Fox requests for Mr. Ansari to translate.
Mr. Ansari reports that his mother-in-law insists that the medical information from the scans may be faulty, and it would be bad luck for her daughter to learn the scan results at this point. In fact, she asserts, her daughter may “lose the baby” from stress over the results. She wishes for the hospital to keep her stable and let the fetus continue to grow inside her uterus in order to see “what God intends.” She herself firmly believes that this baby is the long-anticipated boy that the entire family has been hoping for, and that God would not visit such an unhappy result on such a devout family.
Mr. Ansari then turns back to Dr. Fox and insists that the doctor refrain from telling Mrs. Ansari the scan results, assuring Dr. Fox that he will tell his wife himself once she is emotionally ready for the news.
Dr. Fox submits an emergency request to the hospital ethics committee. Your group is this committee. What is your recommendation regarding what Dr. Fox should tell Ms. Ansari and what is the best way for him to deal with this family and this situation?
