PHIL 222 Bryant and Stratton College Week 6 Cultural Competence Case Study

  

PART 1

Understanding culturally diverse populations and exercising cultural competencies are critical skills for anyone in the health care profession.

Initial Post:

Present a case study, news report, or other scenario that details an encounter in a health care setting that requires the use of cultural awareness and sensitivity on the part of the health care provider. Find one source in the Virtual Library that supports your ethical position on this case.

PART 2

Upload and submit your responses to the following questions:

Based on what you studied this week, think about situations in which you have been required to interact with people whose beliefs differed from yours. Now, put yourself in the role of a person working in the medical field. How would you handle a situation in which you were expected to deal with differing beliefs? Can you predict how you would react to the situation? How would you justify your actions and/or decisions?

PHIL222 – Ethics in Health & Human Services
Week 6 Lecture – Culturally Appropriate Healthcare and Cultural Relativism
Lesson #1
“Give as much as you receive and all is for the best.” -Maori Proverb (New Zealand)
“No arts; no letters; no society; and which is worst of all, continual fear, and danger of
violent death: and the life of man, solitary, poor, nasty, brutish and short.” (Thomas
Hobbes, Leviathan, Chapter 12)
In this famous quotation by Thomas Hobbes he is describing human life in the “state of
nature,” or outside of any human society. Hobbes’ point is that we trade many of our
natural freedoms to act as we choose in order to enjoy the projection of society so that
we may move beyond a bare animal existence and enjoy the finer things in life such as
education, cooperation among social institutions, and health. In other words, culture is
the bridge between a life that is “solitary, poor, nasty, brutish and short” and one that is
devoted to “life, liberty, and the pursuit of happiness.”
Up through and including a good part of the twentieth century we were not very
reflective about the diversity that existed within and among cultures. From within
Western Culture, there was a strong tenancy to see our own culture as the pinnacle of
development and to dismiss the wisdom of other cultures as folk wisdom or
“primitive.” Cultural competence is “the ability to understand, appreciate, and interact
with persons from cultures and/or belief systems other than one’s own, based on
various factors understand, appreciate, and interact with persons from cultures and/or
belief systems other than one’s own, based on various factors.” (Cultural Competence,
n.d.).
Define the “Patient”-Who are they?
We have been told that health care is collectively good, and the healthcare professionals
are supposed to be experts, but do we know who the patient is? To begin with, they are
strangers who know nothing about the medical world-not the often-difficult
terminology, not the procedures and certainly not the costs involved. How can we as
health professionals help these individuals? Well, first it should be known that patients
have rights. In 1948, the Universal Declaration of Human Rights recognized that
patients must be treated with “inherent dignity” with “equal and unalienable rights for
all members of the human family.” From this document the idea of patient’s rights was
born.
Knowing that patients have these rights, what does that mean when we treat their
medical problems? First, it means that the patient is to be treated with respect by
physicians and all medical staff working toward the common goal of good health.
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Patients’ rights vary from state to state, from country to country and even from
individual jurisdictions within a state or country. Understanding the cultural
differences will help you as the health provider to better treat your patient. There will
always be confusion and debate about how to best serve a patient with cultural
differences, but the bottom line for treatment should be the same….with respect and
dignity. Also, all patients have the right to privacy and confidentiality as per the
HIPAA doctrine. They must be given the right of consent in the language they can
understand and they must be allowed to refuse treatment. The most important part
here is that the patient must not only informed about their treatment, but must
understand it, as well.
The Universal Declaration of Human rights has also added clauses which outline
international law where there must be continuous improvement of patient care with
critical importance on social, legal and medical ethical issues (WHO, 2014).
Understanding Paternalism and Patient Autonomy
Years ago, when there was nowhere near the scientific evidence and treatment
available, the healthcare professionals had a greater and more important role in the
medical decision-making with a patient. Today, with so many medical advances, each
treatment is subject to scrutiny, the patient is more educated about their condition and
demands a greater role in their healthcare. The Internet, although a wonderful tool we
all could not live without, causes some distress to providers. Many times the patient
will “Google” their symptoms and come up with a diagnosis. When they visit the health
care providers they think they already know what is wrong with them and simply want
the doctor to give them a prescription. They are much more likely to self- diagnosis and
less likely to take the advice of their doctor. This is the autonomy of the patient.
This process from physician paternalism to patient autonomy is seen in two documents,
Code of Ethics of the American Medical Association (1848) and the American Hospital
Association’s A Patient’s Bill of Rights:
•
•
1848 Code, Section 6: The obedience of a patient to the prescriptions of his
physician should be prompt and implicit. He should never permit his own crude
opinions.
Patient’s Bill of Rights: The patient has the right to refuse treatment to the extent
permitted by law and to be informed of the medical consequences of his action.
(Edge, 2006)
Medical ethics is based on the philosophy written by many philosophers’ years ago.
One of the best examples of personal autonomy was written by the Utilitarian, John
Stuart Mill in his essay On Liberty. He says that the only purpose for which power can
b rightfully exercised over any other member of a civilized community (that could be a
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medical practice) against his will is to prevent harm to others. This could be very
representative of the doctor-patient relationship today (Edge, 2006).
Multiculturalism
Individuals in different cultures have their own perspectives on ethical issues
concerning health services and policy. It is important to consider the issue of whether
moral judgments are appropriate outside one’s own culture. Cross-cultural
communication has improved and knowledge of other cultures has increased.
Discussions of cultures and subcultures are affected by the movement known as
multiculturalism. It is necessary to understand how multiculturalism influences ethics.
It is important to understand different cultures as a healthcare professionalism
(Hinman, 2013).
The United States is a culturally diverse nation, with many residents who have grown
up within very different ethnic environments. Cultures differ in their ideas about what
is right and wrong and what is acceptable. These differences are not always small –
those in healthcare must be able to put aside their beliefs and ethically treat the patient,
not matter their differences.
For example, a Chinese medical student in the United States brings their unique set of
religious and social experiences and moral concepts to their class. In that same class
there may be individuals from Germany, the United States and other countries. As a
healthcare professional this is the variety of patients you may be asked to treat.
In order to have a dependable standard of ethical judgment, it is useful to consider
whether another person’s moral judgments are appropriate in our culture and vice
versa.
Differences among Cultures
Cultures differ in their ideas, sometimes in extreme ways from what is considered right
and wrong in the United States. However, as a healthcare worker you may come in
contact with cultural differences which cause you to critically think about the solution.
For example, one culture’s sin is another’s virtues. Think about the conception of
marriage in our country, one man-one wife or even gay marriage—joined for life.
However, this is not universal. In some cultures there is serial monogamy—marrying
several times. This is not just tolerated; it is regarded as a good thing. What if a patient
of yours has 3 wives—definitely different, but it is up to you to treat them with respect.
Our role as healthcare providers is to learn as much as we can about the cultures we
encounter and to be respectful of our patient’s desires. It is not always possible to meet
all of the requests but it is important to acknowledge their wishes, but if you are
familiar with the culture you can offer a compromise.
PHIL222 – Week 6 Lecture
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The Help Model
The HELP model is recommended when working with culturally diverse populations:
Hear what the patient perceives to be the problems. Encourage the patient and
healthcare professional to discuss the similarities and differences List treatment options
and make recommendations. Provide a chance to negotiate treatment.
Eastern vs. Western Medicine
It is important to understand when working with non-Western material –to be open
and sympathetic when you confront ideas that may seem odd at first. All Ethical views
are from the fundamental beliefs about human nature. For example, what it is to be a
person and how we relate to the world. The same is true of the ethics and ethical ideas
of Eastern Medicine (Ruggiero, 2012).
Traditional Chinese Medicine- the People’s Republic of China shows a rich history of
health care ethics. Another interesting fact is that China has recorded all of their cultural
history which extends back more than 40 centuries. Chinese medicine is a combination
of diagnosis and health care methods.
Difficulties seen in the healthcare provider- patient relationship result from many
sources and can post many challenges to the integrity of the visit. When these issues are
sensitive and vital to the patient’s health, it is important not to have a complete
breakdown of this relationship. Understanding that not everyone believes or thinks the
same is crucial to reach the healthcare goal for the patient. The goal for treating crosscultural patients must be to improve the healthcare professional’s ability to understand,
communicate and care for patients of diverse backgrounds.
A Chinese technique that many of us are familiar with is acupuncture. This practice
dates back to the eleventh century B.C.E. This, along with massage, diet, herbal
remedies, meditation and various exercises can be very effective. These can be used
together with the traditional Western techniques we are familiar with. Just as in
Western medicine tradition, doctors in China practice individual medicine where
healthcare is just as aggressively patient-centered. Traditional Chinese Medicine (TCM)
is recognized by many in the Western World, as well.
Indian Medicine
Another important culture that health care professionals will encounter are those
persons with an Indian background. Their culture is very different from ours, as are the
ethics. India is a country of many faiths such as Hinduism, Islam, Sikhism and
Christianity. The main religion of India is Hindu. Many of their healthcare techniques
have risen out of the Hindu faith. The medical tradition from India is known as
Ayurvedic. It is a very philosophical religion and is similar to our Virtue Ethics where
duty is relative to everything you do in life. (You read about this theory earlier in the
class). It also arranges society into distinct castes or stations in life. Although not as
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prevalent today, it is still practiced. A person is born into their caste station. Because the
Hindu also believe in reincarnation, what a person has done in past lives can signify
their caste in this life. Although a person’s caste is significant in India, you are not likely
to pay attention to this part of your patient. However, it is good to understand the
Hindu and their beliefs and ethics.
Abortion is debated in India much as it is in the United States. There are those who can
produce evidence from the scriptures that it is unethical and wrong; while others can do
the same showing that it is ethical. Abortions have been on the increase in India since
the early 1990’s (Stanford, 2014).
Perhaps the best value to considering non-Western beliefs in medicine are the insights
that show alternative approaches to health and to ethics. The approaches in other types
of culturally diverse medicine are not right or wrong, ethical or not ethical; they are
simply different. At all times, we should refrain from judging them unfairly but look at
what they have to offer. If we really want to have an encouraging impact on future
health care we should intertwine the concepts of cross-cultural health care into our own
ethics and then we will truly begin to have a positive impact on health care of diverse
populations.
Key Terms:
Autonomy
Provider
Western medicine
Eastern medicine
Cultural diversity
Hindu
Patient’s Bill of Rights
Career Connect Challenge:
You are employed at the ER of a local hospital as a medical assistant. A Native
American woman is brought by ambulance, injured as the result of a car accident. You
don’t know much about the culture of the American Indian except you have heard that
they may refuse treatment. Asking around, you find out that none of your co-workers
know much information about American Indians. When the woman regains
consciousness, she is very frightened and wants to go home. What should you do in this
case? How important is it to find out about her cultural heritage?
Think About These Questions: What should you do in this case? How important is it
to find out information about her culture and heritage? How can you contact her
relatives or emergency contact?
PHIL222 – Week 6 Lecture
Lesson #1 Completed!
Thank you! You have completed this lesson.
References
Cultural Competence. (n.d.). Medical Dictionary for the Health Professions and
Nursing. (2012).
Edge, R. S. & Groves, J. R. (2006). Ethics of health care: A guide for clinical practice. (3rd
ed). Clifton Park, NY: Delmar Cengage Learning.
Hinman, L. (2013). Contemporary moral issues: Diversity and Consensus. (4th ed).
Boston, MA: Pearson Education, Inc.
Ruggiero, V. (2014) Thinking critically about ethical issues. (9th ed). New York, NY:
McGraw-Hill.
Stanford, C. & Connor, V. (2014). Ethics for health professionals. Burlington, MA: Jones
& Bartlett Learning.
World Health Organization (2014). Patients’ rights. Retrieved from
http://www.who.int/genomics/public/patientrights/en/
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