This case narrative explores the ethical challenges that arise when culturally rooted surrogate decision-making conflicts with standard biomedical care. A 20-year-old Somali man presented with suspected autoimmune encephalitis requiring urgent immunosuppressive treatment to prevent permanent brain injury. Lacking decisional capacity due to encephalopathy, his mother served as his surrogate. Guided by religious and cultural beliefs, his family attributed his condition to demonic possession and declined medical treatment in favor of a spiritual healing ritual. This decision generated profound moral distress among the healthcare team and underscored the need for structured ethical support. This case illuminates the intersection of cultural pluralism, surrogate decision-making, and the moral boundaries of medical authority. The ethics consultation centered on the question of whose morality should guide care when a patient lacks capacity and cultural worldviews diverge. Drawing on Kleinman’s explanatory model, principles of cultural humility, and Fadiman’s framework of “collision of systems,” the ethics team reframed the conflict through cross-cultural moral negotiation (Kleinman, 1988; Fadiman, 1997). Ultimately, this case calls for a shift from moral certainty to moral accompaniment, an ethic of care that prioritizes understanding across differences when consensus cannot be reached.
Kristin Furfari (Sun,) studied this question.