A Cross-Cultural Dialogue on Health Care Ethics

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

Chapter 6 Health, Health Care, and Culture: Diverse Meanings, Shared Agendas Michael McDonald Introduction 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? - which raises questions about the training and legitimation of providers as well as recipients or patients. Three basic concepts - health, health care, and culture - are central to these questions. I will discuss these three concepts in the context of potential and actual conflicts between the multiple perspectives implied in the first question and the kind of shared social agenda implied in development of a cross-cultural approach to health care ethics. On the one hand, if multiple perspectives on health, disease, life, and death are ethically determinative, then it is reasonable to ask how people operating from diverse cultural, 92 Health, Health Care, and Culture 93 religious, and secular perspectives can find a common moral basis for social action, e.g. in the training and legitimation of health care providers or in the development of health care policy in a multicultural state. While prioritizing multiple perspectives lets participating individuals and groups remain true to their own deeply felt values, it seems to leave no principled way of resolving the inevitable differences that will arise in cross-cultural interchanges, particularly in multicultural societies. On the other hand, if the construction of shared moral agendas around health care prevails, then the multiple cultural, religious, and secular perspectives seem to be subordinated to an arbitrarily selected set of moral values. This achieves social co-ordination at the expense of downgrading deeply felt and even identifying differences (McDonald 1992). It acutely raises the question of whose values are to be regarded as dominant and whose values are to be relegated to subordinate status in drawing up shared social agendas around crucial health care choices. The central question I will address in this concluding chapter to Part I is: Can health, health care, and culture be construed in ways that allow us to construct an ethics of health care that is sensitive to cultural, religious, and other differences, but still allows for shared normative stances on pressing moral and political choices in and around health care? In other words, is there a way of avoiding an unhappy choice between either respect for cultural differences or the adoption of common moral agendas in health care? The sort of ethics I am seeking in this chapter would be sensitive to the cultural, religious, and other forms of diversity that mark us as socially situated human beings, e.g. as described by Hui in his chapter on Chinese medicine and Ratanakul in his discussion of Buddhism and health. Yet at the same time it would be an ethics that permits us to make progress on crosscultural issues. It would, for example, help us resist the misuses of cultural labelling that Stephenson describes in the story of Sandra Navarette and to address the issues of racism, sexism, and exploitation that Anderson and Reimer Kirkham explore in their chapter. Since I use the tools, language, and materials of analytical philosophy to explore the intersection of various conceptualizations of health, health care, and culture, this chapter may strike some readers as rather dry and abstract. Yet I am convinced that the concepts discussed in this chapter are important and need to be understood in order to develop a satisfactory response to the first two research questions. Fortunately, readers of this volume can find a counterbalance to this austere approach to developing a cross-cultural health care ethics in the richly contextualized approaches offered by my colleagues in this volume. Readers should use the chapters such as those offered in Parts II, III, and IV, to test the central ideas I advance in this chapter. Readers should also be cautioned that there are other ways than mine of 94 A Cross-Cultural Dialogue on Health CareEthics understanding health, health care, and culture. These are not eternal concepts fixed in a timeless platonic realm of ideas. Rather they must be contextually located.1 Health and its negative correlates My starting point is with a review of recent philosophical debates about the concept of health. In these debates, the main question...