Abraham Baca, the EMS program director at Glendale Community College and a paramedic with 30 years of experience, still remembers one emergency call that stuck with him. “We got called to a person with chest pain,” he said. “As paramedics, we have a protocol to follow: oxygen, medication and a 12-lead EKG that goes around the left breast to look at the heart.”

But that day, protocol collided with culture. “Unfortunately, this patient was a female, and in their culture, we weren’t allowed to touch her,” Abraham said. “We weren’t even allowed to speak directly to her. We had to talk to the male. We had to talk to her husband.”

He could see she was pale and sweating – all classic signs of a heart attack. Yet every question –  and even the administration of care had to go through her husband. “It was a little frustrating,” he admitted. “But at the same time, as clinicians, we have to respect that.”

These moments, where deeply held beliefs clash with life-saving care, don’t just happen on the occasional 911 call. In hospitals and in-home care settings too, health care workers face these dilemmas every day.

A cancer surgeon on the East Coast, who asked not to be named to maintain privacy, described the challenges he’s faced with patients who refuse blood transfusions. “As a surgeon, it’s very difficult to plan a surgery knowing the patient won’t consider life-saving blood products if there are complications,” he said. “Yet, I respect the decision of their family. I have lost patients who could have survived due to this reason.”

Dr. Maria Knobel, a general practitioner specializing in lifestyle and sports medicine and the founder of Medical Cerk UK, has found that open, respectful communication can sometimes bridge the gap.

“I have had instances where strongly held religious or cultural convictions have caused problems in administering medical care,” she said. “One patient who declined a blood transfusion on religious grounds is one that I recall vividly. It’s tough because you want to be understanding of their beliefs, yet administering the treatment can save their lives.”

Knobel emphasized a patient-centered approach. “I adopt the patience based, respectful style rather than rigid protocol,” she said. “It is a path of open communication, listening to what the patient has to say, and guiding them gently with clear information.”

Kyle Sobko, CEO of SonderCare, an in-home health care equipment company, shared a similar experience from his work coordinating in-home care.

“I’ve been engaged in lots of discussions with physicians, nurses, and families who are making tough health decisions for their loved ones,” he said. “Sometimes these discussions happen when their beliefs are in conflict with their needs of care.”

He described one case where a parent refused a hospital bed for their child, feeling it looked “like giving up.”

A hospital social worker was brought in to help talk through the concerns with the family and provide some additional support.

“Eventually, when she understood it would alleviate her child’s pressure sores, she was comfortable with it,” Sobko said. “It was a tense situation but it did reflect how sometimes patience and understanding can be more changing than policy or script.”

However, knowing what’s right and wrong in these cases – especially when minors are involved – can be murky at best. And while philosophy doesn’t offer a single answer, it can help clarify what’s at stake.

Theo Morgan-Arnold, an adjunct philosophy professor at Glendale Community College, emphasized that even without formal bioethics training, rights-based frameworks can help frame these conflicts and the ethics that surround them.

“It’s generally uncontroversial that a sufficiently autonomous adult has the right to deny life-saving medical treatment if it does not infringe on the rights of others,” he explained. But the situation becomes murkier when minors are involved. “Children are thought to have a limited sort of autonomy,” he said. “The line is much harder to draw when a parent wants to deny the autonomy of a child in seeking life-saving medical care.”

Morgan-Arnold acknowledged that some might argue a parent’s right to guide their child’s faith is critical, but others see the child’s right to life as overriding that. “Just because a parent has a right to their religious beliefs does not mean that they have the right to deny medical care to their child in such a way that infringes on that child’s right to life,” he said.

The emotional toll on clinicians can be heavy as well. “It’s very difficult to see a patient choose not to receive life-saving therapies,” the surgeon on the East Coast said. “I had a hard time reconciling it personally because I felt conflicted over his decision to die rather than allow me to save his life.”

Sobko noted that for nurses in home care, the emotional burden can linger. “I have seen nurses who have decades of experience cry after shifts and come back the next day with even greater commitment to do what it takes,” he said.

There’s no single answer, but many clinicians agree that compassion, communication, and strong patient support are what matter the most.

Dr. Knobel highlighted the importance of listening to patients and involving family members or spiritual guides. Sobko pointed to the role of hospital ethics teams, as well as the need for careful documentation, especially when decisions for minors can lead to conflict between parents and medical staff.

For Abraham, the paramedic who had to communicate through his patient’s husband, the takeaway on religious and cultural boundaries is clear. “We have to respect that,” he said. “Even if it’s life or death.”

In the case of his heart attack patient, patience and collaboration paid off. “She survived,” Abraham said. “We worked with her husband, explaining what we needed to do and why. He ended up helping us, and we got her to the hospital.”

But Abraham knows not every story ends that way. “It was frustrating,” he said. “But at the same time, that’s the job – we do what we can within the boundaries we’re given. Sometimes you wish you could do more.”

Jenny Beres can be reached at [email protected].