A Cross-Cultural Dialogue on Health Care Ethics

Part II, Introduction

Part II, Introduction Barry Hoffmaster 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 of the Canadian population, one of the biggest cultural confrontations between ethnic minority communities and mainstream culture is about where spanking ends and child abuse begins."1 Immigrants to this country who were subjected to stern discipline and sometimes spanked or whacked with a stick when they misbehaved and who are now parents themselves can regard the Canadian approach to child rearing as too liberal and too permissive. For many Canadians however corporal punishment is intolerable, not only because it is ineffective but because it teaches children to solve problems by resorting to violence. How should this conflict between minority and mainstream cultures be handled? Should parents who belong to cultures in which corporal punishment is approved and encouraged be allowed to use it on their children or should they be required to conform to the Canadian way? If 117 118 A Cross-Cultural Dialogue on Health Care Ethics respect for cultural diversity is the proper response, what are the limits of this tolerance or cultural sensitivity? If, on the contrary, deference to the views of the majority may legitimately be demanded, what justifies this "cultural imperialism"? Health care is also rife with cultural differences and potential for conflicts. The most intimate events of our lives - reproduction, birth, death - draw people into the health care system and expose their most fundamental attitudes, values, and beliefs. More generally, concepts of health and disease and expectations about how those who are ill or suffering should behave are suffused with assumptions and values that reflect culturally distinctive views of the nature of persons and their relationships with others, with the world, and with a transcendent order. Health care ethics now faces the increasingly important challenge of figuring out how conflicts that can be deeply embedded in different cultural and religious understandings of life and the world should be handled. Obviously that is not an easy task. The aim of Part II is to provide some background in terms of how the moral and policy issues raised in the following chapters can be addressed. Buddhist and Chinese approaches to health care ethics relating to the boundary conditions of birth and death are reviewed, along with the secular health care ethics that has evolved in North America over the last several decades. The concluding section then outlines the general questions that need to be asked in order to understand cultural conflicts in health care ethics. As with the other parts of this book, the dialogue between cultures and religions over health care ethics is focused on Buddhist and Chinese traditions as examples but not as exhaustive of the field of study. Note 1. I. Vincent, "Rather spank than spoil", Globe and Mail, 24 April 1996,Al,A10. ...