Whose autonomy is it anyway? Drawing back the curtain

A few weeks ago our first year students were thinking about patient confidentiality and it was my task to facilitate the process. The group I was with were from diverse cultural backgrounds and from several different countries, including the UK. Whilst they all readily grasped the idea of respecting  confidentiality as a way of respecting autonomy, some came from cultures where doing so was less important than it is for the average UK patient. Last weekend, visiting an elderly relative in hospital in Germany, I was reminded of that conversation.

Perhaps going to another country is always, on some level, a culture shock. Sometimes the shocks are big but often, when you’re going to a country that is in many ways familiar, the shocks are so small as to barely register. And sometimes they’re all the more profound because they’re unexpected and cause you to change the way in which you understand things that are important to you. What shocked me on this visit, and apologies to you heartier folk for being rather easy to shock, was the lack of curtains or screens between the three elderly woman sharing the hospital room I visited. Or rather what shocked me was the complete lack of care these three otherwise dignified woman paid to the fact that nothing, and I mean nothing, that they did or was done to them or said to or about them could in any way be kept private from each other.

Which brings me back to my students and the earnest and concerned discussion we had as they grappled with the practical challenges involved in trying to hold a confidential conversation with a patient in a four bedded room with only the curtains and little space to aid them in their endeavour. The curtain and the small space between beds had seemed daunting enough until I saw those three beds tightly packed and with nothing to shield their occupants’ modesty.

Like a dazzled tourist in an exotic land I quizzed my relative and her healthier and younger family to try to ascertain if they too felt this lack and if not why not. They didn’t, one and all. Instead they smiled at me, bemused but indulgent, and attempted to placate me by suggesting that it’s all a matter of what you’re used to. And yet patients in the UK were once used to less privacy, expected less respect for their autonomy. But gradually things changed. Expectations evolved, ethicists debated, the profession responded and sometimes led. And suddenly it’s hard to imagine it any other way.

In some ways of course my reaction is just so very English, and perhaps my shock results as much from the way in which the attitudes of these very down to earth Germans challenge my own. What it has done is remind me how easy it is to write for international audiences whilst glibly assuming we’re all lying in the same proverbial hospital bed surrounded by the same thin excuse for a veil of privacy. Clearly we’re not.

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