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A Cross-Cultural Dialogue on Health Care Ethics

Harold Coward

Publication Year: 1999

The ethical theories employed in health care today assume, in the main, a modern Western philosophical framework. Yet the diversity of cultural and religious assumptions regarding human nature, health and illness, life and death, and the status of the individual suggest that a cross-cultural study of health care ethics is needed.

A Cross-Cultural Dialogue on Health Care Ethics provides this study. It shows that ethical questions can be resolved by examining the ethical principles present in each culture, critically assessing each value, and identifying common values found within all traditions, It encourages the development of global awareness and sensitivity to and respect for the diversity of peoples and their values and will advance understanding as well as help to foster a greater balance and a fuller truth in consideration of the human condition and what makes for health and wholeness.

Published by: Wilfrid Laurier University Press

Table of Contents

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pp. vii-viii

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pp. xi-xii

This book is the result of the work of a Canada-Thailand interdisciplinary research team of the Centre for Studies in Religion and Society at the University of Victoria in Canada. The research team is interdisciplinary, composed of medical scientists, sociologists, anthropologists, psychologists, philosophers, and nursing, law, and...

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1. Introduction

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pp. 1-14

The ethical theories employed in health care today assume, in the main, a modem Western philosophical framework which is then applied to issues such as abortion, euthanasia, consent, and organ transplantation. The application of this approach to non-Western and traditional cultures needs critical examination. The diversity...

Part I: Culture, Health, and Illness

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Part I, Introduction

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pp. 17-33

Many writers in each section of this book take multiple perspectives on cross-cultural health care issues. These perspectives have been shaped and enriched by a process of dialogue that extended over three years. While cross-cultural dialogue is not an easy process, it can be a rewarding one. We are thus a diverse group involved...

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2. Buddhism, Health, Disease, and Thai Culture

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pp. 34-46

Therevada Buddhism, also known as the Hinayana tradition, has been considered the core of Thai national identity since the establishment of the first Kingdom of Sukhodhaya in the thirteenth century. Though the present constitution does not make it compulsory for every Thai to follow the Buddhist beliefs and practices, it requires...

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3. Concepts of Health and Disease in Traditional Chinese Medicine

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pp. 47-67

Prior to 1840, "traditional Chinese medicine"1 was the only medical system being practised in China for both acute and chronic diseases. Grounded on traditional philosophy, especially cosmology, traditional Chinese medicine was developed into a highly sophisticated theoretical...

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4. Discourses on Health: A Critical Perspective

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pp. 68-91

We begin our inquiry into the discourses on health by recognizing that we too bring multiple perspectives and interpretations to the materials that we draw upon. As nurses and as academics, we share the "culture of health" (biomedicine as a culture itself) constructed...

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5. Expanding Notions of Culture for Cross-Cultural Ethics in Health and Medicine

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pp. 92-112

It has recently become regarded as useful by persons doing "health promotion" to include "culture" among a cluster of variables to be taken into account in the decisions people make when they become ill. Likewise, the term culture has found its way into the manifold clinical concerns of medical ethicists, health administrators, nurses...

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6. Health, Health Care, and Culture: Diverse Meanings, Shared Agendas

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pp. 113-114

In this chapter I focus on two important questions that were basic to the investigation of cross-cultural approaches to health care ethics represented in this volume. First of all: What are health, disease, life, and death from the viewpoints of various cultural, religious, and secular perspectives? Secondly: What is it to be a health care provider...

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Part I, Conclusion

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pp. 115-116

The above chapters have presented a conceptual analysis of the ways in which "culture", "health", and "illness" may be understood as establishing a basic foundation for cross-cultural health care ethics. After being introduced to the quite different basic assumptions underlying these concepts in Thai Buddhist and Chinese thought, we were sensitized to the multiple meanings of health provided by various social contexts -

Part II: Culture and Health Care Ethics

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Part II, Introduction

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pp. 117-118

As people from diverse cultural and ethnic backgrounds mingle and interact more and more, opportunities for conflict among their beliefs, values, and ways of life proliferate. One emotion-laden example is the use of corporal punishment in child rearing. A reporter observes: "At a time when immigrants make up nearly twenty percent...

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7. Buddhist Health Care Ethics

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pp. 119-127

Buddhism has over 2500 years of involvement in medical theory and practice. Its health care ethics is based on its teachings concerning life, suffering, death, and compassion. The following explanation is written within the context of...

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8. Chinese Health Care Ethics

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pp. 128-138

In all schools of traditional Chinese philosophy, the universe is regarded as a unity which consists of three interacting and interdependent members: heaven, earth, and man. 1The ultimate basis of this unity of nature is provided by the Dao which as the first indeterminate principle is the primal origin from which all things become determinate....

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9. Secular Health Care Ethics

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pp. 139-145

The early, formative contributions to contemporary health care ethics in North America came principally from theologians. Reflecting on "the birth of bioethics", Robert Veatch observes: It is striking how many of the scholars and leaders in those early years were trained in theology, especially Protestant theology ... Important...

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Part II, Conclusion

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pp. 146-154

Despite a surge of writing about pluralism, multiculturalism, and the need for cultural sensitivity, the kinds of challenges that these sorts of cultural differences pose for health care ethics and health care public policies remain vaguely and imperfectly understood...

Part III: Ethical Issues in the Delivery of Health Care Services

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Part III, Introduction

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pp. 157-159

The chapters in Part III connect the earlier conceptual discussions with some issues that arise in the delivery of health care in biomedical institutions. These examples are selected to reflect various stages of life in which health care practitioners and members of the community are likely to encounter issues of cross-cultural health care...

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10. Pediatric Care: Judgments about Best Interests at the Onset of Life

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pp. 160-175

This chapter turns to one of the most contentious issues in pediatric ethics: parental refusal of life-saving treatment for children. Although cultural considerations enter at all levels of pediatric care, it is in the refusal of lifesaving treatment that the conflict is most obvious....Edward Keyserlingk

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11. Comparing the Participation of Native North American and Euro-North American Patients in Health Care Decisions

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pp. 176-189

This chapter compares the relevance of the notions of autonomy, informed consent, and personal choice in the attitudes and expectations of contemporary Euro-North American patients and Native North American patients. The comparison intended...

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12. End-of-Life Decisions: Clinical Decisions About Dying and Perspectives on Life and Death

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pp. 190-206

This chapter applies the discussions of cross-cultural health care ethics to health care institutions' efforts to support persons in end-of-life decisions through the provision of advance directives and perhaps physician-assisted suicide. The clinical innovations of advance directives and physicianassisted suicide are based on...

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Part III, Conclusion

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pp. 207-209

Cultural background contributes to the meanings of various activities and roles. Participation in health care by any patient or family member ought to be focused on how clinical services serve these meanings. Part III has discussed examples of how health care services might serve meaning in the context of birth and caring for children...

Part IV: Health Policy: A Cross-Cultural Dialogue

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Part IV, Introduction

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pp. 213-214

In Part III, it was argued that health care services and health care ethics have complex internal assumptions that are often taken for granted. In other words, those of us delivering health care and debating its ethics are as embedded in our culture as those who are the recipients. The authors in Part III therefore claimed that successful...

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13. A Critical View of North American Health Policy

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pp. 215-225

this chapter, the authors explicate a number of issues in North American health policy. First, the various forms of health policy are explored, with a discussion of the limitations of North America's predominantly legalistic approach. Next, the authors address a number of systemic inequities in the application of health policy. Public participation in health...

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14. Threats from the Western Biomedical Paradigm: Implications for Chinese Herbology and Traditional Thai Medicine

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pp. 226-235

two authors explore some of the threats to traditional and folk medicine posed by contemporary Western biomedical policy. Hui articulates these threats in terms of Canadian attempts to regulate Chinese herbology, while Tangkanasingh warns of the difficulties that traditional Thai medicine will have to transcend if it is to survive into the future. The...

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15. Global Challenges: Ethical Implications of the Greening of Modern Western Medicine

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pp. 236-256

The past two decades have seen a dramatic increase in interest in alternative health care options. This probably reflects both demographic and social factors. As the population ages, the inability of conventional Western medicine to deal effectively with chronic illness leads many to seek medical alternatives. Similarly, the...

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Part IV, Conclusion

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pp. 257-262

At the outset of Part IV, it was claimed that health policy must aim for public participation that is sufficiently diverse to represent a wide range of meanings. It was further claimed that achieving this would require critical self-reflection on the part of those who develop and implement health policy. Chapter 13 by Blue, Keyserlingk...

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16. Conclusion

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pp. 262-264

When we started this project some five years ago, none of us really knew how challenging it would be. Perhaps if we had, we might not have volunteered so readily. As scholars we often found it hard to operate at the level of cross-cultural sensitivity and intercultural dialogue that we call for in health care ethics. Our different...

About the Authors

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pp. 265-270

Subject Index

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pp. 271-274

E-ISBN-13: 9780889208551
Print-ISBN-13: 9780889203259
Print-ISBN-10: 0889203253

Page Count: 288
Publication Year: 1999