Listening to the Whispers: Re-thinking Ethics in Healthcare

7. An Ethics of Diversity: Listening in Thin Places

7 An Ethics of Diversity Listening in Thin Places jeanne m. sorrell and christine s. dinkins Celtic traditions describe the concept of a “thin place,” an in-between place that merges the natural and sacred worlds, where the ordinary and non-ordinary mingle, where the seen and the unseen share common ground. Gomes (1996) suggests that these thin places are likely to be found where there is greatest suffering, among the marginalized and excluded. If one burrows down through the theoretical and philosophical perspectives of ethics, it may be argued that, at bottom, ethics is concerned with the suffering humans cause one another and the related capacity of humans to recognize and address this suffering through the empathetic virtues of sympathy, compassion, and caring (Roberts, 1996). Much suffering throughout history can be related to the problem of “unacceptable ” diversity among individuals or groups. Remembering the cruelties of the Nazi exterminations of Jews, slavery in the United States, and discrimination against homosexuals jolts us to awareness of the suffering of those who are “different.” A task of ethics, then, is to include, rather than exclude (Post, 1995). One approach to an ethics of diversity for healthcare professionals is a call for intimate listening to the stories of those who are different, who may be unseen, marginalized, and excluded in our healthcare systems. Unless we listen to these voices of diversity, we are likely to remain oblivious to the harm being done in healthcare through unwitting oppression of minorities. As reflected in stories in this volume, 21st-century healthcare has 310 fueled new questioning about how we want to live and interact with others. Cook (2003) notes that “diversity” has many definitions, including gender, cultural, spiritual, biological/physical, social, environmental, moral, ethical, economical, educational, political, and ethnic differences. All of these diversities affect healthcare practices and beliefs and may lead to further disparities in healthcare. Thus, it is important to explore diversity from an ethical perspective and come to know how to move through our worlds of differences so that we can grow, understand, and care. Listening to stories of diversity can help healthcare practitioners understand the potential for oppression built into the structure of our language, our social institutions, and, especially, our healthcare systems. These stories are all around us if we only choose to listen. As editors, we share a few personal stories with you: A young professional told of being humiliated by her female gynecologist when she wanted to discuss her lesbian sexual practices. A nursing student confided that her instructor did not allow her to miss clinical practicum to attend the funeral of a friend with AIDS because he was not “family.” A Saudi nursing student on the hospital elevator listened as a passenger told an acquaintance that Saudis should have no rights in American hospitals. An African American nursing student told how his patient assumed he was the maintenance man for the hospital. Those who dominate by class, ethnicity, age, or gender may be unaware of the invisibility of privilege within our society (Roberts, 1996). For members of a dominant group in society, their particular identity is transparent, in other words, not perceived by them as a specific identity. They may be oblivious to how they first attained membership in groups and the significance of group membership that is not “other.” For nondominant groups, however, their identity is always experienced as particular , as specific to them as members of the group. To help bridge these two worlds of the dominant and nondominant, we need to listen to narratives of those experiencing the lived realities of diversity so that the oftenmuf fled voices of these individuals are heard. Intimate Listening in Thin Places Thin places in the healthcare system may be found within stories of diversity. Stories embody a personal way of knowing that is unique, as An Ethics of Diversity 311 relationships between the narrative and narrated events uncover meaning . Harvey (1999) suggests that we need to learn to listen to stories of diverse places, landscapes, others, and ourselves as we explore new relationships . The sharing of stories opens up possibilities for new conversations and understandings between narrator and listener. As we listen, intimately , to someone’s story, we are drawn into the unique reality of that individual, helping us to see the world through experience, rather than through theorizing. An ethics of diversity can be developed not merely...