Ethics Consultation and Cultural Diversity

Anthropologists have been at the forefront in advocating for ethical clinical practice and decision-making that takes into account the cultural values and beliefs of all involved parties. Much of this work describes the kinds of cross-cultural ethics cases (predominantly end-of-life issues) that can occur and provide guidance to health care professionals and bioethicists to resolve ethical dilemmas in a culturally respectful manner (Carter & Klugman, 2001; Crawley et al., 2001; Hern et al., 1998; Jecker, Carrese, & Pearlman, 1995; Kaufert & Putsch, 1997; Koenig & Gates-Williams, 1995; Marshall, Thomasma, & Bergsma, 1994; Orr, Marshall, & Osborn, 1995). This process has come to be referred to as "cultural competency." Such attention and guidance is essential because respecting patient and family cultural and moral values and practices can conflict with U.S. law. For example, the U.S. Patient Self-determination Act mandating that hospitals ask all admitting patients whether they have an advance directive can disrespect Navajo values of balance and beauty by forcing them to discuss future health problems (Carrese & Rhodes, 1995). Similarly, health care professionals and bioethicists may wonder what they should tell a patient with terminal cancer when their family members request that no information be disclosed in order to respect traditional Chinese or Latino/a values of respect for the elderly and/or protection from the harm of the truth of the diagnosis and prognosis. Should health care providers disclose this information because they are bound by U.S. legal imperatives requiring informed consent so as to respect an individual's autonomous self-determination? Contributors to this discourse have suggested helpful steps to engage in cross-cultural ethical dialogue as well as a variety of techniques for enhancing cross-cultural communication, including making reference to a hypothetical third party, reframing a clinical problem in terms of benefits instead of poor outcomes, and acknowledging that individuals have the right to relegate decision-making authority to others as an expression of their own autonomy (Hern et al., 1998; Jecker et al., 1995; Orona et al., 1994).

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