Carrese J A, Rhodes L A
Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.
JAMA. 1995 Sep 13;274(10):826-9.
To understand the Navajo perspective regarding the discussion of negative information and to consider the limitations of dominant Western bioethical perspectives.
Focused ethnography.
Navajo Indian reservation in northeast Arizona.
Thirty-four Navajo informants, including patients, biomedical health care providers, and traditional healers.
Informants explained that patients and providers should think and speak in a positive way and avoid thinking or speaking in a negative way; 86% of those questioned considered advance care planning a dangerous violation of traditional Navajo values. These findings are consistent with hózhó, the most important concept in traditional Navajo culture, which combines the concepts of beauty, goodness, order, harmony, and everything that is positive or ideal.
Discussing negative information conflicts with the Navajo concept hózhó and was viewed as potentially harmful by these Navajo informants. Policies complying with the Patient Self-determination Act, which are intended to expose all hospitalized Navajo patients to advance care planning, are ethically troublesome and warrant reevaluation.
了解纳瓦霍人对于负面信息讨论的观点，并思考主流西方生物伦理观点的局限性。
聚焦民族志研究。
亚利桑那州东北部的纳瓦霍印第安保留地。
34名纳瓦霍受访者，包括患者、生物医学医护人员和传统治疗师。
受访者解释说，患者和医护人员应以积极的方式思考和交谈，避免以消极的方式思考或交谈；86%的受访者认为预先护理计划严重违背了传统纳瓦霍价值观。这些发现与hózhó一致，hózhó是传统纳瓦霍文化中最重要的概念，它融合了美、善、秩序、和谐以及所有积极或理想的事物的概念。
讨论负面信息与纳瓦霍人的hózhó概念相冲突，这些纳瓦霍受访者认为这可能有害。旨在让所有住院的纳瓦霍患者接受预先护理计划的符合《患者自主决定法案》的政策在伦理上存在问题，值得重新评估。
