Implications for Bioethics

Why is it important for bioethics to understand that health, illness, and disease are socially shaped, culturally constructed, and historically situated? Basically, those ethnomedical beliefs and values inform people's health-related behavior. More specifically, culture shapes the ways in which people make decisions in the context of morally charged healthcare situations. Culture also shapes the kinds of ethical situations that can arise in a particular healthcare or healing setting and the frameworks for understanding and models for responding to those ethical dilemmas. Anthropology's cross-cultural or comparative perspective, combined with ethnographic methodological approaches, helps people (1) recognize that moral norms vary cross-culturally and (2) challenge tacitly held cultural assumptions in biomedicine and bioethics about what counts as human, self and other, normal and abnormal, life and death, right and wrong, and other key moral concepts (Marshall and Koenig, 1996, 2001; Haimes).

Anthropological investigation into contemporary debates about bioethics raises new questions, provides insights into the ways in which people experience ethical issues, and broadens the scope of inquiry. Anthropological research on genetics, for example, shows that women's decisions to undergo prenatal genetic testing are informed by cultural definitions of risk, perceived acceptable forms of disability, and social dynamics between women and genetics counselors (Browner et al.; Rapp). These factors may come as a surprise to bioethicists, who may expect attitudes toward abortion to take a primary role in women's prenatal decisions. With regard to examining the genetic basis of medical conditions such as Alzheimer's disease and sickle-cell anemia among African Americans, anthropologists have been at the forefront in pointing out the problems with using the term race. For instance, using that term risks perpetuating essen-tialism about clinical phenomena. They also have identified how notions of heredity hinge on cultural ideas of kinship and the implications of genetics research for defining claims to group identity (Koenig and Silverberg; Brodwin, 2002; Gordon; Wailoo, 1997).

The ability to explicitly recognize the cultural basis of bioethical constructs, such as the concept of autonomy, can help bioethics scholars rethink the premises of moral arguments. Furthermore, by recognizing that medical systems maintain their own logic, bioethicists and biomedical practitioners are more likely to attempt to understand patients rather than label them as irrational or incompetent. Patients' perceived levels of competency—from both legal and ethical perspectives—can affect their involvement in medical decision making.

As an example one might consider the case in which a Mien mother from Laos brings her daughter to a pediatrician for her four-month immunizations (Crigger). The pediatrician observes a number of burns on the child's stomach and considers whether to call the Department of Child and Family Services, thinking that the mother has abused her child. The burns actually were the result of a healing ritual designed to ameliorate the child's symptoms that were identified as meaningful to Mien culture. Understanding that the burns are a result of a therapeutic regimen can help the pediatrician realize that the mother was not abusive or neglectful; instead, she was attentive to improving the health of her child (Brown and Jameton ). In contrast, one might consider the physician's attempt to pierce skin with a needle as unnecessarily harmful even though it is intended to improve health. Different cultures have different conceptions of what therapeutic interventions constitute acceptable harms or risks and benefits. This case illuminates how culturally shaped ethical notions of risk and benefit are. With a cultural perspective in mind bioethicists can reconstruct arguments regarding risk-benefit ratios. Biomedical healthcare practitioners who recognize these cultural dynamics can better provide not just culturally competent care but also high-quality care.

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