Healthcare without borders: Creating a shared medical decision-making model to support global patients at Northwestern Memorial Hospital

Individuals from across the globe increasingly elect to travel to the USA for the primary purpose of receiving healthcare. These border crossings create opportunities for rich cultural exchange, as well as for direct conflict between the basic values and preferences of global patients and their healthcare team(s). A series of ethics cases at Northwestern Memorial Hospital, where clinicians were morally distressed by the request of families of global patients to withhold medical information about life-threatening disease from the patient, led to a new partnership between the International Health and Medical Ethics teams. This paper describes the development, implementation and outcome of that creative collaboration: an innovative upstream preventive ethics initiative that honours the primary obligation of Western healthcare providers to uphold informed consent and patient autonomy while honouring a wide scope of preferences in communication and decision making identified among this patient population.