A Cross-Cultural Dialogue on Health Care Ethics

1. Introduction

Chapter 1 Introduction Harold Coward and Pinit Ratanakul 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 of cultural and religious assumptions regarding human nature, health and illness, life and death, and the status of the individual suggested to us that a cross-cultural study of health care ethics is needed. This is especially evident in the engagement of modern Western biomedical ethics with Asian cultures and Aboriginal traditions. On the one hand, there is the multicultural context in which health care operates in Canadian and American cities - think of Vancouver, Toronto, Montreal, Chicago, or San Francisco. On the other, there is the export of modern Western biomedicine (with its European scientific worldview) to other cultures (with their very different worldviews) in a colonizing fashion - "colonizing" because aspiring young people from Thailand, China, India, or Aboriginal cultures are brought to medical schools or ethics departments in 1 2 A Cross-Cultural Dialogue on Health Care Ethics European or North American universities, trained in modern biomedicine or ethics, with little or no reference to their own cultures and traditional medicines, and sent home to establish and practise modem biomedicine and its associated ethics in their home cultures. Often this has been done in an insensitive and imperialistic fashion - hence the use of the term "colonizing ". Sometimes, however, both in distant home cultures and in the multicultural contexts of North American cities, the interaction of modern and traditional medicine (and their very different worldviews) has occurred with a sensitivity that is not at all imperialistic or one-sided but betrays an understanding of the complementary strengths each approach has to offer. Members of our research team, both individually and as a group, have learned from such experiences. Let us consider a couple of examples. Our research team was composed of mixed backgrounds: Christian, secular, Aboriginal, Chinese - faculty members all from medicine, nursing, biology, anthropology, philosophy, law, or religion - and Thai Buddhists (also faculty members from philosophy, nursing, and sociology). Our team meetings were held in both Canada and Thailand. During a visit to Thailand we made a field trip to a village about 90 kilometres outside Bangkok. There we found two medical units serving the community: a modern biomedical clinic and a monk-healer practising in the nearby Buddhist Temple. The monk-healer specialized in treating simple fractures without casts or splints but with daily hot herbal oil massage and Buddhist chanting. The patients slept in the Temple on simple cots and ate food provided by their families. The Temple and the monk-healer depended on freewill offerings from the village and treated patients free of charge. The cure of the fractured limbs was very rapid and successful, partly because the leg or arm was not immobilized. Recognition of this was given by the nearby biomedical clinic which referred simple fracture cases to the monk-healer for treatment. In their view, his treatment was better and certainly more cost-effective than they could offer. The monk-healer, however, recognized that his technique was not suitable for compound fractures, which he referred to the biomedical clinic for treatment. In this way, the wisdom and skills of both cultures modern Western biomedicine and traditional Buddhist monk-healers - with their very different worldviews and approaches, functioned together in a cooperative and complementary way. To us this seemed a good example of what can happen when modern Western biomedicine sees itself to be one cultural approach to health care alongside others. In such a context, ethical questions can be resolved by examining the ethical principles present in each culture, critically assessing each other's values, and identifying common values found within all traditions. This example points up the most fundamental finding of our research. In response to our initial question, "How does one train doctors, nurses, social Introduction 3 workers, chaplains, medical ethicists, pharmacists, and hospital administrators to be sensitive to other cultures?", our research led us to a surprising conclusion - namely, that modern Western biomedicine andits health care system is itself a culture with its own belief system, social structure, initiation ritu?!s, language, dress, and educational system. Modern Western medicine does not occupy a neutral position from which to relate itself sensitively to other...