Cross-cultural ethics

Question 1

Define Culture

Answer 1

the integrated pattern of thoughts, communications, actions, customs, beliefs, values, and institutions associated, wholly or partially, with racial, ethnic, or linguistic groups as well as religious, spiritual, biological, geographical, or sociological characteristics. Culture also includes but also gender, sexual orientation, age, disability, and socio-economic status. Culture is dynamic in nature, and individuals may identify with multiple cultures over the course of their lifetimes.
Culture is the myriad of factors that influence one’s self-identity

Culture molds a patient’s beliefs, values and expectations, shapes concerns, how they describe symptoms, how they weigh benefits and risks
Education, socioeconomic status and many other factors play roles in decision making
In some cultures, autonomy is less important than protecting patients from distress and fulfilling obligations to family members

Question 2

Essentialism

Answer 2

the belief that people have an underlying and unchanging “essence”
Example: She is a Muslim, therefore, she must cover her hair
This is stereotyping
Belief that ethics cannot change at all

Question 3

Relativism:

Answer 3

the belief that cognitive, ethical and aesthetic norms and values are independent of judgements and beliefs at particular times and places and that they are not absolute
Example: Who a person is can constantly change and you cannot say that just because a woman is Muslim that she therefore must believe that she needs to cover her hair
Belief that ethics must always change

Question 4

Disease:

Answer 4

a medical condition

Physiological and psychological process

Question 5

Illness:

Answer 5

the patients perception of his/her problem
Psychosocial meaning and experience of the perceived disease for the individual, the family, and those associated with the individual

Question 6

A culturally competent provider must address both a patient’s

Answer 6

disease and his/her illness.

Question 7

African Americans- cultural issues

Answer 7

Believe that God is responsible for health and that humans must preserve life until God determines its end.
Believe in prayer, divine intervention and miracles.
View illness as something to endure or as a test of their faith.
Desire life support.
Believe that DNR will lead to withholding of care.

Question 8

Haitians- cultural issues

Answer 8

Some believe that supernatural illnesses appear suddenly and are caused by evil spirits (may seek out a Voodoo priest)

Question 9

Mediterranean Cultures- issues

Answer 9

Believe in the “mal de ojo” or the evil eye, which can cause fitful sleep and sickness

Question 10

Traditional Chinese Culture:

Answer 10

Believe that advanced care planning is impractical and unnecessary.
Culture encourages people to avoid topics that make them feel negative and protect themselves against unnecessary worry.

Question 11

Muslims:

Answer 11

Often prefer a physician of the same gender and who is a Muslim (or non-Muslim of the same gender).
Modesty and privacy are highly valued.

Question 12

Ritual Genital Cutting of Females

Answer 12

Present in Africa and Middle East
Parents believe that it will integrate their daughters into their culture, protect her virginity and family honor and make her a wife
Complications: infection, dysmenorrhea, painful intercourse, infertility, childbirth complications

Question 13

Somalians, Ethiopians, Eritreans:

Answer 13

Consider it uncaring for a physician to tell a terminally ill patients about his/her condition; they prefer the physician to tell the family

Question 14

Hispanic and Haitian:

Answer 14

Respect parental authority even into adulthood; therefore, parents may be highly involved in decision making

Question 15

Navajo:

Answer 15

Pain is viewed as something that is to be endured; they may not request pain medication and might use herbal medicines without knowledge of the health care provider.
To suggest that a patient is dying could be interpreted as the provider wishing death upon the patient
Present the issue in 3rd person

Question 16

Examples of Traditional Health Care Methods

Answer 16

Healing rituals
Herbal medicine
Managing the balance of hot and cold foods
Acupuncture
Massage
Pinching
Cupping
Ingesting nonfood materials (dirt/clay)
Wearing objects to prevent illness (tight belts to keep gas from entering the body)

Question 17

Cultural and linguistic competency

Answer 17

is the capacity for individuals and organizations to work and communicate effectively in cross-cultural situations. Policies, structures, practices, procedures, and dedicated resources can support this capacity. Cultural and linguistic competence occurs through adopting and implementing strategies to ensure appropriate awareness of, attitudes toward, and actions about diverse populations’ cultures and languages.

Question 18

Culturally and linguistically appropriate services (CLAS)

Answer 18

are services that are respectful of and responsive to individual cultural health beliefs and practices, preferred languages, health literacy levels, and communication needs employed by all members of an organization (regardless of size) at every point of contact.

Question 19

Limited English proficiency

Answer 19

is a concept referring to a level of English proficiency that is insufficient to ensure equal access to public services without language assistance with respect to a particular type of service, benefit, or encounter.

Question 20

Health equity

Answer 20

is the attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally, with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.

Question 21

Cultural Competency

Answer 21

Helps to ensure effective, understandable and respectful care for all patients
Balance cultural facts that help guide interactions with each unique patient with acquiring sound skills
Fact-centered Approach: teaches cultural information about specific cultural groups
Attitude/Skill-centered Approach: enhance communication and emphasizes the socio-cultural context of individuals
Should balance with fact-centered
Cultural competency is a series of succeeding levels or stages of development, rather than a specific achievement, through review of frameworks that illustrate the development and characteristics of culturally competent care.

Question 22

The dimensions of developing cultural competency include:

Answer 22

Knowledge (understand meaning of culture and its importance in healthcare)
Attitude (have respect for variations in cultural norms)
Skills (eliciting patients’ explanatory models of illness)

Requires integrating or coordinating traditional care with conventional evidence-based medicine
EVERY encounter is a cross-cultural encounter! Apply the principles to EVERY patient, not just those belonging to minority groups

Question 23

Understandable Care vs Respectful Care

Answer 23

Understandable: focuses on the need for patients to comprehend fully questions, instructions and explanations
Respectful: considers the patients values and preferences and creates an environment in which patients from diverse backgrounds feel comfortable