A Cross-Cultural Dialogue on Health Care Ethics

Part I, Conclusion

Part I, Conclusion Harold Coward 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 - including the cultural context of biomedicine itself. Anderson and Reimer Kirkham's feminist and postcolonial analysis revealed the powerful influence of race, gender, and class relations upon health and health care in various historical and cultural contexts. These influences were poignantly illustrated in the voices of their community respondents - for example in the need to address poverty, sexism, and the exploitation of the underclasses, when the allocation of resources between health care and the social conditions needed for health is discussed as an ethical issue. Stephenson continued this critique by examining the different assumptions that lie behind the uses of the term "culture" and the implications for ethics. Stephenson demonstrated that biomedicine falsely assumes that it is a privileged or neutral site where 113 114 A Cross-Cultural Dialogue on Health Care Ethics culture does not play a role. He calls for (and attempts to provide) an expanded self-awareness on the part of practitioners and researchers that biomedical science is itself a culture. McDonald concluded Part I by further testing this thesis. He conducted a careful philosophical analysis of Boorse's argument that there can be a value-free and culture-neutral concept of health and medicine. Finding Boorse's argument flawed in key respects, McDonald then showed how one could develop a philosophical basis that would respect fundamental cultural and religious differences and yet allow for shared values of the sort needed for the development of cross-cultural health care ethics. In line with the other authors in Part I, McDonald warns against the dangers, for ethics, of overemphasizing the needs and rights of individuals at the expense of collective identities and minority communities. Here we are taken back to the ethics of the Chinese and Buddhist perspectives in which not only other human individuals and groups but also our respectful relationship with the natural environment must be considered in order for health to be realized. By dealing with the major conceptual questions, Part I sets the stage for our examination of three culturally contextualized examples of health care ethics in Part II, before we move on to applied ethical examples in health care delivery (Part III) and policy issues (Part IV). ...