• J A Carrese and L A Rhodes.
• Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.
• JAMA. 1995 Sep 13; 274 (10): 826829826-9.

ObjectiveTo understand the Navajo perspective regarding the discussion of negative information and to consider the limitations of dominant Western bioethical perspectives.DesignFocused ethnography.SettingNavajo Indian reservation in northeast Arizona.ParticipantsThirty-four Navajo informants, including patients, biomedical health care providers, and traditional healers.ResultsInformants 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.ConclusionsDiscussing 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.

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