International Bioethics: West Learns from East

A Cross-Cultural Dialogue on Health Care Ethics (Harold Coward & Pinit Ratanakul eds., 1999)

Since its beginning, America has been known as a melting pot, a country welcoming immigrants from the world over. Nonetheless, cultural diversity has an ever-changing face. The United States has seen large numbers of immigrants of European descent through the years, but this is not the current trend. Sometime around 2050, non-Hispanic white Americans will make up only a little over half of the population, down from the current rate of around 82 percent. ¹ As diversity continues to increase and immigrants bring with them more varied backgrounds, they will bring to medicine, as both physicians and providers, different perspectives on bioethics.

A Cross-Cultural Dialogue on Health Care Ethics is the work of an interdisciplinary team of medical scientists, sociologists, anthropologists, psychologists, philosophers, nurses, lawyers, and religious scholars in both Canada and Thailand for the Centre for Studies in Religion and Society in Victoria, British Columbia. ² Through their research, this group has compiled a compelling dialogue that centers on health care, life, living, and dying in various societies around the globe. The end result is to advocate a shared vision of health care for the future that is responsive to the mores and demands of every culture.

The essays attempt to distinguish the ways in which various cultures characterize health, disease, life, and death. Several chapters analyze the differing ways the Thai Buddhist and Chinese cultures view health as compared to the Western view of biomedicine, focusing on the clashes between science and spirituality.

The contributors reject the argument that there can be a vision of health and medicine that is value-free and culture-free. ³ The authors are firm in their commitment to a vision of health that respects the needs of the various cultures comprising our global society, yet still allows for shared values and approaches to various political policies. Furthermore, the authors are insistent that we not place the blame for certain health decisions on culture, when deeper issues are at fault. ⁴ The contributors emphasize a complete view of health that considers not just being physically free from illness, but also the ramifications of various socioeconomic factors, such as racism and poverty, that influence health.

The view that socioeconomic factors influence the health of those who suffer the effects of racism and poverty is not new. In fact, this year, the National Forum for Health Care Quality Measurement and Reporting (NQF) released a report outlining ten priority actions to be taken to help remedy the disparity in health care given to minorities and whites. ⁵ NQF represents health care consumers, purchasers, providers, health plans, and experts in health services research, and two federal agencies, the Center for Medicaid and Medicare Services and the Agency for Health Care Research and Quality. ⁶ Clearly, the health care profession has taken notice of this issue. However, the focus of the remedy is on improving the quality of the health care provided to minorities, rather than attempting to improve the quality of their lives. ⁷ As the contributors point out, "the issue is not just the allocation of resources within health care, but rather, the allocation of resources between health care and health—for example, the pressing need to address poverty." ⁸

The contributors analyze health care ethics from a Thai Buddhist, Chinese, and secular perspective. Issues such as fertility, infant care, informed consent, pain control, and assisted suicide are highlighted, as well as the cultural implications for end of life decisionmaking and the differing views of death across cultures.

One section of the book focuses on patient participation in health care decisions as compared from an Aboriginal perspective, a Thai Buddhist perspective, a Hindu perspective, and a Euro-North American perspective. For instance, in Chinese society "patients are not to be told of a terminal illness because from a Confucian point of view . . . it is considered morally inexcusable to disclose terminal illness which may...