Cross-cultural health care ethics

Cross-cultural health care brings together people who have different health beliefs and different health care ethics, that is, different health-related moral commitments, practices, and methods for evaluating right and wrong. Though there is an important lack of consensus on cross-cultural ethical issues, health care providers are routinely forced to decide whether to tolerate, accommodate, or override patients and families’ decisions and actions in health care settings. 
       We will offer health care providers and administrators the opportunity to advance their skills in identifying, assessing, and addressing cross-cultural ethical conflicts as well as resolving the conflicts by partnering with patients, families, community leaders, healers, and other health care team members. Using case studies, we will identify common sources of cross-cultural ethical differences, including deeply held Western biomedical beliefs not universally shared by persons with different cultural perspectives. For instance, we will consider culturally-based differences concerning: the proper roles, prerogatives and responsibilities of patients, families and health care providers; which types of risks are most important to avoid; and which types of benefits are most important to pursue.
       Participants will be invited to present their own clinical case studies for analysis and discussion, including cases involving serious cross-cultural ethical conflicts among family members (e.g., generational and faith-based conflicts) and between patients/families and health care providers. Participants will roll play case vignettes; engage in personal and small group reflection; and learn from providers, patients and families directly involved in cross-cultural ethical conflicts. Alternative methods for resolving cross-cultural ethical conflicts will be identified–including our recommended method– published in Healing by Heart: Clinical and Ethical Case Stories of Hmong Families and Western Providers (Vanderbilt University Press, 2003). Participants will practice applying several ethical tools in small groups, including distinguishing between challenges to a provider’s personal preferences, moral beliefs, and professional integrity. Which ethical commitments do they consider negotiable under some circumstances, which non-negotiable, and why? We will propose conditions under which the patient/family’s wishes should prevail and conditions when the provider’s perspective should prevail. Our tools evaluate ethical conflicts on a case-by-case basis and may be helpful to clinicians and administrators facing both cross-cultural ethical conflicts, and general ethical conflicts. Participants will have time to reflect upon and differentiate their cross-cultural health care ethics from their general health care ethics.