Cultural Difference in Health Care
The following examples of ethical dilemmas that health care professionals face are the direct result of cultural differences within our society. They are just a few examples of cultural and ideological clashes that often occur in health care.
1. A couple from South Asia has requested an ultrasound. They want to know whether or not their unborn baby/fetus is a boy or a girl. If it is a girl, they wish to have an abortion. Their culture believes that males have more value than females.
2. A dying man from a Hutterite colony wishes to be home to die a slow death. His culture believes this is an important point in a person’s life where the ‘fortunate one’ can talk to the colony members, set things right, and pass on his knowledge before dying.
3. A patient consults a Chinese herbalist and is given powerful herbal remedies that dangerously mix with her doctor-prescribed pharmaceuticals. The patient refuses to stop the herbal remedies because of her belief that the herbs have the power to cure.
1. Now that you have read through the examples, think about what you would do in each of these scenarios.
2. As you are composing your response, consider the following questions:
a. Do you always have to ethically agree with the person in care?
b. What will you do if you do not agree?
c. Is it ok to stand up for your own beliefs in any of these situations?
Immigration trends in Saskatchewan
1. Please answer the following questions:
a. Explain why increased cultural diversity in Saskatchewan BC Canada will affect health care in the province.
b. As you read in the textbook, the mounting evidence from social research indicates that, more and more, “…we find support for the use of a population health perspective to examine the relationship between ethnicity, immigration, and health. Such a perspective recognizes that the socio-demographic, cultural and lifestyle characteristics of individuals and their interactions, rather than “medical care inputs and health behaviours” are the most important predictors of health status and health care utilization over the adult life course” (Strohschein/Bolaria, 2014, pp. 88).
Given this, explain why the population health perspective is an appropriate framework to use in order to try and understand how health care should respond to increasing diversity in Saskatchewan.
The Power of CAM
CAM is not widely taught in medical schools in Canada. Some treatments may be covered by health insurance, but many are not. An individual seeking out these treatments will typically have to pay for them out of pocket. CAM practitioners do not have the same level of social status as those trained in allopathic medicine and oftentimes the public is very skeptical of their practices. In many important ways this is because of cultural beliefs surrounding the medical model of illness.
Recall that according to the medical model of illness, the body should be viewed like a machine. When illness strikes, it means that one part of that machine is malfunctioning and needs to be fixed. The body is separate from the mind. It also asserts that bodies can be fixed in the same way- if a cure works for one person then it will work for everyone. The procedures, techniques, processes and medications are all carefully scrutinised from a scientific point of view.
Until the 1970s, allopathic doctors launched public and aggressive attacks against CAM practitioners. They used their position of domination in order to voice their skepticism as well as their objections to the state legalising and professionalising these practices. When they began to lose this battle, they changed tactics. They began to integrate some of the CAM methods into their practises – but only the ones that could ’scientifically’ be proven to be safe and effective. They condemned practices that could not be validated by science. Allopaths accepted CAM on their own terms and this allowed them to continue exercising their control.
1. Answer the following questions:
a. Why do you think CAM has recently gained more popularity in Canada?
b. How do you think CAM practitioners could gain more power and social status in Canadian society?
c. Does CAM gaining more public support actually represent a challenge to dominant, mainstream medicine? Why can the two not work together?
Health Care in Practice
According to your textbook, “health care providers commonly associated and anticipated violence with poor and racialized people, despite the fact that they were aware that violence crosses all socioeconomic levels and cultures. Paradoxically, although they were likely to assume abuse as an issue among poor and racialized women, they also tended to view poor and racialized women as less deserving of care and support” (Strohschein/Bolaria, 2014, pp. 364).
1. For this discussion exercise, answer the following questions:
a. Do you believe the paradox identified in quote above occurs and persists in health care practices. Remember to consider the power of stereotypes, prejudice and discrimination in Canadian society.
b. “In a disturbing example [of the use of power], nurses reported that a physician refused to call the sexual assault team to examine a First Nations woman who had been drinking, calling her a ‘social derelict’ (Strohschein/Bolaria, 2014, pp. 364). Discuss who had the power in this situation, and why you think the doctor could not call the sexual assault team.
c. Research findings have also shown that “support was often not offered or was withdrawn from women who were perceived as not making decisions that health care providers thought best” (Strohschein/Bolaria, 2014, pp.365). Explain why this occurs and how culturally safe nursing practices can assist in stopping this from happening.
Opposition to Cultural Safety
There are many barriers that health care practitioners face when trying to provide culturally safe care. One of the most powerful barriers is the dominance of bio-medicine. Cultural safety challenges the current power structures within the institution of medicine. It challenges some of the traditional teachings of nursing.
It requires that “culturally safe practitioners…move beyond the critical self-reflective to engage in actions that address the broader sociopolitical and economic determinants…of health and challenge the taken-for-granted processes and practices that continue to marginalize…this demands, therefore, advocacy and the creation of multiple clinical pathways for clients that extend beyond biomedical models” (Smye et al., 2010, pp. 15).
This is not an easy task. Challenging dominant power relations never is.
For this discussion, answer the following questions:
1. If it is possible to improve the wellbeing of a client by implementing the principles of cultural safety, why would anyone oppose doing so?
2. Culturally safe practices challenge existing power relations in many ways. Describe how.
3. Most of the burden (as well as the opportunities) involved with implementing cultural safety is currently being placed onto the shoulders of individual nurses. Explain why you think this is.
4. Given what you have learned, do you think it is possible to practice cultural safety in nursing at this moment in Canada? Why or why not?