A Cross-Cultural Dialogue on Health Care Ethics

Part I, Introduction

Part I, Introduction Michael McDonald Many writers in each section of this book take multiple perspectives on cross-cultural health care issues. These perspectives have been shaped and enriched by a process of dialogue that extended over three years. While cross-cultural dialogue is not an easy process, it can be a rewarding one. We are thus a diverse group involved in a dialogue about diversity itself. Part I is a discussion about a multiplicity of problems that confront society, health care professionals, and clients. Key concepts such as culture, religion, health, and illness are often contested in plural societies comprised of many different kinds of people. Even when they are not contested and taken for granted, understanding the assumptions that lie behind them can be crucial for dealing with major ethical issues in health care. For example, health may well be defined and understood as a positive state of being in societies, while in others illness is the defining category and health becomes a residual concept defined in a negative way as people who are not sick. The meanings of health and illness are often constructed in religious and philosophical terms, and the treatment of people predicated on existential terms 15 16 A Cross-Cultural Dialogue on Health Care Ethics that are the essence of cultural configurations of living. We recognize that cultures are expressed in beliefs and practices. In our work, we try to explore the assumptions that lie behind these beliefs and practices, recognizing that we must begin by trying to unmask our own assumptions. We are acutely aware that our interpretations of other people's belief systems and practices are refracted through the lenses of our own systems ofmeaning. Belief systems and practices can be explored along a variety of axes: theological, economic, philosophical, political, legal, and so forth. These explorations can also be conducted in a variety of ways using the diverse methodologies and tools of different disciplines. All of these are important for understanding the quality of interpersonal connections that are at the core of ethical decision making. In Part I, we examine different ways of talking about culture, health, and illness, which themselves reflect values and choices, not only within the "Western" or modern context but also in the Chinese and Thai contexts. In doing this, we recognize that how we construct these central but contested concepts has implications not only for the practice of health care, but also for various discourses on health care ethics and how issues of social justice are ultimately addressed. Without essentializing the notion of health as a good with a single meaning for all people at all times and places, we believe that a powerful case can be made for a decent minimum of the material conditions that contribute to health and well-being. This has profound implications for the provision and distribution not only of the various elements of health care, but also for those factors like wealth and power that have such a profound impact on health status. In his chapter, Pinit Ratanakul weaves together the Buddhist account of health and disease and delivery of health care in both traditional and modern forms in Thailand. In his chapter, Edwin Hui takes a similar perspective by first examining the concepts of health and disease in Traditional Chinese Medicine and then considering actual processes of health delivery in contemporary China. Anderson and Reimer Kirkham, in their critical perspective on discourses on health, examine negative and positive concepts of health and the ways in which the theoretical and practical uses of these concepts often reflect unequal social relationships, based on race, gender, and class. Peter Stephenson then discusses and deconstructs various understandings of culture particularly as they are embodied in Western health care and medical ethics. These are explored through a series of examples in which culture appears in various guises, some universalistic in their claims and others particularistic. Finally, in Michael McDonald's examination of health and culture, there is a discussion of whether the recognition of the diversity of perspectives on health and illness undermines the possibility of cross-cultural agreement on major social choices with respect to health care. ...