AMERICAN medical practice is strongly influenced by the nation's historically dominant culture. Culturally based presuppositions of biomedical practice and its ethics, long neglected, are now under serious scholarly examination. For example, the primacy of individual patient autonomy is generally accepted as an enlightened perspective, particularly in the wake of earlier paternalism. However, this philosophy is not accepted by many ethnic groups in the United States and elsewhere who hold interpersonal and social responsibility in relatively higher regard.1,2 Assessments of good and harm are culturally mediated. Examples include general acceptance of euthanasia in the Netherlands, common use of fetal sonography for sex selection in India, African practices of female circumcision, and nondisclosure of cancer diagnoses in Italy and Japan.
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