We read with great interest the article, “Teaching ethics: when respect for autonomy and cultural sensitivity collide,” by Minkoff in the April 2014 issue of the Journal.

Such ethical conflicts are regularly dealt with by the clinicians in Eastern countries like India. We just want to add our own experience in dealing with this problem. Minkoff rightly highlighted the importance of differentiation between the patient’s deferral (to her husband’s decision) because of her cultural priorities and deferral because of fear of retribution.

We believe that this differentiation can be successfully achieved only by understanding the patient’s point of view; therefore, building a good rapport with the patient appears to be the first and foremost step in the right direction. Good communication and convincing skills are apparently the preliminary requirements for building a good rapport with the patient. But, unfortunately, there are no separate dedicated teachings for the development of these interpersonal skills in the medical curriculum of the countries/places where these skills are needed the most. Furthermore, the local administration/government should provide an environment in which a healthy and trustful doctor-patient relationship can flare so that the patient should not consider herself as merely a consumer of the doctor/hospital. Only under such circumstances, it can be expected that the patient will communicate unhesitantly with the clinician, thereby helping the clinician to understand the ethical issues and the cultural differences comprehensively.

At this point, the clinician may advocate for the ethical as well as medical issues and may show the right path, giving due consideration to the will/desires and values of the patient. This process of positive interaction with the patient (and also with her relatives, if needed) may sometimes be very time consuming, but usually it gives encouraging results. However, if the patient’s true choice/autonomy conflicts with her own interest, the clinician may execute his/her (clinician’s) right to refuse to provide inappropriate care, thereby minimizing negative consequences of cultural differences.