A Cross-Cultural Dialogue on Health Care Ethics

16. Conclusion

Chapter 16 Conclusion Robert Florida 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 academic disciplines, national and cultural backgrounds - notto mention temperaments - were barriers thatwe constantly tried to negotiate in order to understand the issues and to come up with some relevant cross-cultural insights and perhaps even some solutions to practical problems. Did we succeed? I believe that we did come to the point where individuals in the group actually did begin to see issues in new ways, ways that had been learned through cross-cultural insights. Some of this comes through very clearly in the book. For example, the suggestion that some sort of notion of interdependence or "we-self' should challenge the dominance of the singular autonomous "I" as the centre of value in modern Western biomedicine comes from our consideration of Thai Buddhist, Hutterian, First Nations, 263 Chinese, and other viewpoints. This idea has obvious applications in day-to-day clinical work in the multicultural Canadian context, but even at that level it is not always easy to apply. The Chinese and First Nations practice of families having the duty to take decisions about individual members' health care does not fit very well in practice with how Canadian hospitals deal with the problem of informed consent. Similarly the Chinese filial responsibility to conceal the knowledge of a terminal condition from parents conflicts with the biomedical ethical approach to informed consent and to the related issue of the patient's right or responsibility to know the full nature of his or her condition. In Parts III and IV there is also evidence that this cross-cultural venture was fruitful. The chapters in those sections, which build on the preceding theoretical discussions and expositions of individual cultural views, show the authors to have benefited from the cross-pollination that came from working with such a diverse group of participants. These chapters are perhaps the most original contributions of the book and could hardly have been written by scholars working in isolation. Our central themes of the study - that Western biomedicine is an imperialistic culture in itself and that social determinants of health are of primary importance even though too often shunted aside in health care ethical discourse - are not particularly crosscultural insights. Nonetheless, bringing them into the analytical foreground is a valuable contribution of this study. On the issue of effecting fundamental changes to the direction that biomedicine is taking around the globe, our study finds little reason for optimism . In the discussions of the status of traditionalmedicine in Thailand, of Chinese herbalism in Canada, and of corporate exploitation of "green" medicine, it is all too clear that biomedicine has very successfully taken the dominant position. The ancient naturalistic traditions must struggle to find a niche where they can be tolerated and allowed to survive. On the level of respecting First Nations' cultural values, the K'aila story suggests that biomedical technical views will simply sweep aside spiritual considerations. Similarly, we note that the issues concerning the social determinants of health, more honestly "ill health", in Canada's First Nations discussed in this book have not changed significantly for many decades and still seem of very little interest to our provincial and federal policy makers. In Canada, Thailand, and other countries today there is considerable public interest in health care policy issues. It is our hope that the insights and concerns found in this study will not be forgotten in the debates that continue. We believe that our cross-cultural approach shows the danger that would follow from uncritically continuing along the biomedical path which demands the technological domination of nature for the benefit of the individual while ignoring the interconnection of each of us to family, society, and nature. 264 A Cross-Cultural Dialogue on Health Care Ethics ...