Native Americans have views on health or strong spiritual beliefs that should be acknowledged, respected, and safely integrated into the plan for anesthesia care. The cultural effects of Native American beliefs in the medical workplace serve to illustrate problems common to the care of patients whose cultural beliefs are significantly different from that of the traditional healthcare culture with regard to autonomy, beneficence and informed consent. Native American cultures are far more communitarian than mainstream American cultures. Native Americans have historical spiritual belief systems that should not be confused with our understandings about pre-historic early human social organization. Scientific research supports the connections between spiritual and mental states and the outcomes of stressful healthcare procedures. Verbalizing respect for the concerns and spiritual needs of Native American patients and their families should be a normal part of ethical anesthesia care for these patients.