Although Western biomedical ethics emphasizes respect for autonomy, the medical decision-making of Muslim patients interacting with Western healthcare systems is more likely to be motivated by relational ethical and religious commitments that reflect the ideals of equity, reciprocity, and justice. Based on an in-depth cross-cultural comparison of Islamic and Western systems of biomedical ethics and an assessment of conceptual alignments and differences, we argue that, when working with Muslim patients, an ethics of respect extends to facilitating decision-making grounded in (...) the patient’s justice-related customs, beliefs, and obligations. We offer an overview of the philosophical contestations of autonomy-enhancing practices from the Islamic tradition of biomedical ethics, and examples that demonstrate a recommended shift of emphasis from an autonomy-centered to a justice-focused approach to culturally competent agency-promotion. (shrink)

Berger and Miller assert that race and ethnicity based cultural competence is a failure because medicine grounds its conceptualization of cultural competence on a “flawed” understanding of r...

This article explores the concept of cultural competence and its relevance as an organizational resource in ethical disputes. Empirically, we aim to reveal the cultural competences that a global forest industry company, StoraEnso, and a global environmental nongovernmental organization (NGO), Greenpeace, utilized in forestry conflicts during 1985–2001. Our study is based on data which were collected from corporate and NGO communication outlets and which have gone through a detailed discourse-semiotic analysis. Our reinterpretation of the discourses identified three (...) class='Hi'>cultural competences: (1) the ability to understand changing consumer preferences and values, (2) the ability to utilize culturally determined positions of expertise, and (3) the ability to maintain trust and credibility in the community through open communicative practices. We argue that these competences are relevant in industry–NGO disputes for both parties. However, maintaining them all simultaneously is a difficult task, since various discourses which aim at upholding them can sometimes have contradictory effects. (shrink)

Berger and Miller offer a strong argument for how cultural competence in medical education reinforces the racial structures that it purports to address. As social scientists with expertise i...

This paper discusses the Saudi Arabian case by Abdallah Adlan and Henk ten Have, published in a 2012 issue of the Journal of Bioethical Inquiry, regarding a congenitally disabled child enrolled in a research project examining the genetics of her condition. During the course of the study, her father was found not to be genetically related, and the case discussed the dilemma between disclosing to the family all findings as promised in consent documents or withholding paternity information because of the (...) likely severe social repercussions. Using Adlan and ten Have’s example, this paper proposes a framework to consider cases outside of the conventional bioethics frame of reference, splitting the bioethical task into three elements: understanding the problem from the patient’s and the clinician’s perspective and then engaging in dialogue to decide what to do next. The process of dialogue between affected parties is vital. Presuming that there is a common morality undermines the effectiveness of the dialogue needed to find a resolution. (shrink)

Berger and Miller argue that cultural competency as an educational tool for physicians-in-training fails to address structural inequality and systemic oppression. Instead, it focuses on “cul...

Taking seriously the value of cultural competence in healthcare requires at least three general commitments. First, it involves accepting the view that patients' health beliefs and behaviors are influenced to a significant degree by their own social and cultural practices. Second, it requires careful attention to how health professionals typically respond to patients' different social and cultural standards at various levels of the healthcare delivery system. And third, it calls for developing interventions that are sensitive to these (...) first two issues to assure the delivery of quality healthcare for culturally diverse patients. This much is plain, insofar as we are talking about the broadest of commitments necessary to support the value of cultural competence in healthcare. But what other, more specific commitments are implied in accepting the value of cultural competence? (shrink)

Terms such as ‘cultural competence’ and ‘transcultural nursing’ have comfortably taken their place in the lexicon of health care. Their high profile is a reflection of the diversity of western societies and health care’s commitment to provide care that is responsive to the values and beliefs of all who require treatment. However, the relationship between cultural competence and familiar ethical concepts such as patient autonomy has been an uneasy one. This article explores the moral foundations of cultural (...) competence, ultimately locating them in patient autonomy and patient good. The discussion of patient good raises questions about the moral relevance of a value’s rootedness in a particular culture. I argue that the moral justification for honoring cultural values has more to do with the fact that patients are strongly committed to them than it does with their cultural rootedness. Finally, I suggest an organizational approach to cultural competence that emphasizes overall organizational preparedness. (shrink)

In the United States, healthcare providers, institutions, and society have failed to ensure the conditions necessary for racial and ethnic minority communities to be in good health. Many scholars and federal government officials consider racial and ethnic disparities in health to be an injustice and have called for national attention and strategies to eliminate them. Several of these strategies, including cultural competency, focus on addressing deficiencies within the health care system. Cultural competency is the ability of (...) a healthcare provider to function effectively in the context of cultural differences with the clients they serve. Increasing cultural competency among healthcare providers has been shown to improve the quality of healthcare received by racial and ethnic minorities, which contributes to reducing health disparities. Achieving equity in the quality of healthcare received is a necessary strategy, but is insufficient for eliminating disparities in the health status of racial and ethnic minority populations. A growing body of literature reveals that health disparities are determined, not only by inequities in health care, but by social factors. The implication is that strategies that focus solely on healthcare perpetuate the misconception that health status is determined by access to or quality of healthcare. To eliminate racial and ethnic disparities in health status, the fundamental conditions for good health, which include but are not limited to healthcare equity, must be acknowledged and ensured for all people. (shrink)

BackgroundCultural competence is considered as one of the main skills of nurses enabling them to provide nursing care for those with different cultures. One of the cases related to nurses’ cultural competence is observance of ethical codes, but it has not been investigated sufficiently in studies.AimThis study has been conducted to determine the relationship between nurses’ cultural competence and observance of ethical codes in practice.Research designThis descriptive-correlational study was conducted in 2020. Sampling was done at several stages. The (...) data were collected using questionnaires of demographic information, cultural competence, and observance of ethical codes as self-report. The questionnaires were provided to the subjects by the corresponding researcher and the data were analyzed using Pearson correlation test.Participants and research contextThis study was done with participation of 267 nurses working in four training hospitals located in northwestern Iran and 16 head nurses of selected wards.Ethical considerationsThe study was approved by Human Ethics Committee of Hamadan University of Medical Sciences. Participation was voluntary. Consent was obtained and confidentiality kept.FindingsThe results of Pearson correlation coefficient test showed a positive and statistically significant relationship between cultural competence and observance of ethical codes (r = 0.524, p = 0.001). In addition, cultural competence and observance of ethical codes by most nurses were at a moderate level.ConclusionsThe results of the present study showed a significant relationship between nurses’ cultural competence and observance of ethical codes. Therefore, it can be concluded that by strengthening the level of nurses, the level of observing ethical codes by them can be increased. Cultural competency and observance of ethical codes are important components of nursing care, and their development can improve nursing care delivery to clients through academic training, hidden curriculum and in-service education. (shrink)

Research ethics guidelines grew out of several infamous episodes where research subjects were exploited. There is significant international synchronization of guidelines. However, indigenous groups in New Zealand, Canada and Australia have criticized these guidelines as being inadequate for research involving indigenous people and have developed guidelines from their own cultural perspectives. Whilst traditional research ethics guidelines place a lot of emphasis on informed consent, these indigenous guidelines put much greater emphasis on interdependence and trust. This article argues that traditional (...) guidelines are premised on relationships of equal power, and that often the researcher has more power that is not fully equalized by providing information. Where there is a relationship of unequal power, then focusing on interdependence and trust is more likely to achieve ethical safety. We illustrate this thesis by describing the detail of a research project looking at the use of interpreters, where we video-recorded live consultations and then interviewed the patient, interpreter and doctor. We conclude by suggesting that mainstream research ethics guidelines should pay more attention to the development of a trustworthy relationship between subject and researcher, and that, following the lead from clinical medicine, we should develop a culturally competent ethical framework for research on human subjects. (shrink)

Background: Transgender individuals experience discrimination, stigmatization, and unethical and insensitive attitudes in healthcare settings. Therefore, healthcare professionals must be knowledgeable about the ways to deliver ethical and culturally competent care. Ethical considerations: No formal ethical approval was required. Aim: To synthesize the literature and identify gaps about approaches to the provision of ethical and culturally competent care to transgender populations. Design: A Scoping Review Literature Search: Literature was searched within CINAHL, Science Direct, PubMed, Google Scholar, EMBASE, and Scopus databases using (...) indexed keywords such as “transgender,” “gender non-conforming,” “ethically sensitive care,” and “culturally sensitive care.” In total, 30 articles, which included transgender patients and their families and nurses, doctors, and health professionals who provided care to transgender patients, were selected for review. Data were extracted and synthesized using tabular and narrative summaries and thematic synthesis. Findings: Of 30 articles, 23 were discussion papers, 5 research articles, and 1 each case study and an integrative review. This indicates an apparent dearth of literature about ethical and culturally sensitive care of transgender individuals. The review identified that healthcare professionals should educate themselves about sensitive issues, become more self-aware, put transgender individual in charge during care interactions, and adhere to the principles of advocacy, confidentiality, autonomy, respect, and disclosure. Conclusions: The review identified broad approaches for the provision of ethical and culturally competent care. The identified approaches could be used as the baseline, and further research is warranted to develop and assess organizational and individual-level approaches. (shrink)

Ethical clinical practice requires cultural competency. In the United States, Hispanics report stronger attitudinal barriers to drug abuse treatment than any other racial/ethnic group. Hispanics report feeling that drug abuse treatment providers do not understand their unique cultural needs and are unfamiliar with their experiences of discrimination and immigration. Using this case study to explore broader ethical and policy issues, this study investigates the extent to which US universities train counselors to address the culturally specific needs of (...) Hispanic patients and how this is reflected in practice in Los Angeles County. Based on a content analysis of the required courses, syllabi, and course descriptions at 30 universities related to culture/race/racism/ethnicity/diversity at the undergraduate and graduate levels on the addiction therapist track, and thematic analysis of eight in-depth interviews with counselors working in outpatient rehabilitation centers in Los Angeles, I argue that cultural competency education for drug abuse counselors is too surface level and infrequent to adequately prepare students for a career in addiction counseling for Hispanic clients. Significant changes must be made to how cultural diversity is valued and prioritized in the field of psychology to provide better care for Hispanic people with a substance use disorder and fulfill the moral obligation to eliminate this health disparity. Although this study focuses on counselors in Los Angeles, these findings are relevant for professionals and healthcare systems across the United States and beyond who seek to provide equitable and effective care for Hispanic patients. (shrink)

Background:Forgiveness has the potential to resolve painful feelings arising from nurse–patient conflicts. It would be useful to evaluate direct and indirect important factors which are related to forgiveness in order to design interventions that try to facilitate forgiveness.Aim/objective:The purpose of this study was to evaluate the intermediating role of empathy in the cultural competence–forgiveness association among nurses using structural equation modeling.Research design:The research applied a cross-sectional correlational design.Participants and research context:The study included 380 nurses eight hospitals in southern Iran.Ethical (...) considerations:The Ethics and Research Committee of Birjand University of Medical Sciences approved the study protocol. The voluntary nature of participation was explained consent was obtained from participants, and anonymity was guaranteed.Findings:Most of the participants were married and female and fell in the 20- to 30-year-old category. Most of them (89.5%) had a working experience of 1–10 years. The proposed model showed that nurses’ empathy intermediated the association between nurses’ cultural competence and forgiveness which has fitted the data acceptably (root mean square error approximation = 0.070; comparative fit index = 0.993; goodness-of-fit index = 0.983; and χ2/df = 2.85).Conclusion:Empathy skills and cultural competence training were essential for interventions aimed at increasing the tendency to forgive patients. In such interventions, planners should aim at increasing nurses’ cultural competence in order to enhance their empathy toward patients, which can, in turn, lead to a greater wish to forgive patients. (shrink)

Crosscultural encounters are common in the delivery of healthcare, and cultural differences may contribute to misunderstandings and ethical conflict. Encounters between members of the Amish ethno-religious group and modern, science-based healthcare providers hold a high potential for misunderstanding and conflict because the Amish stridently maintain a countercultural outlook and they approach such encounters with suspicion and anxiety. This commentary on the case presented by Amy E. Caruso Brown, MD, involving a grandfather’s resistance to treating a child with leukemia commends (...) this physician for successfully managing the case and deriving important insights from reflection upon it. It argues, however, that the level of conflict most likely would have been reduced if the care team had made more of an effort to listen to the grandfather and acknowledge the emotional trauma he had suffered. (shrink)

Cultural competence has become a ubiquitous and unquestioned aspect of professional formation in medicine. It has been linked to efforts to eliminate race-based health disparities and to train more compassionate and sensitive providers. In this article, I question whether the field of cultural competence lives up to its promise. I argue that it does not because it fails to grapple with the ways that race and racism work in U.S. society today. Unless we change our theoretical apparatus for (...) dealing with diversity to one that more critically engages with the complexities of race, I suggest that unequal treatment and entrenched health disparities will remain. If the field of cultural competence incorporates the lessons of critical race scholarship, however, it would not only need to transform its theoretical foundation, it would also need to change its name. (shrink)

Due to a much more closely connected world, there is an accelerated interchange of cultures in the clinical setting. Alongside a pluralism of cultural beliefs for health and illness is a greater effort to value and respect freedoms for thoughts and belief pertaining to differing identities from legal, moral, societal and activist initiatives. When treating culture as part of the clinical consultation, there is a need for conceptual frameworks, communication skills, guidelines and policies to be implemented in a context (...) where there are certain dominant narratives such as scientific medicine and biomedical frameworks of the human body and mind that typically bracket out culture. The encounter of the clinic with culture is an ethical endeavour that requires expertise training and education; thus, the role of inter-culturality and cultural competence is significant for setting precedents in the translation from theory to practice. In this chapter, I discuss challenges for global bioethics in responding to culture in the clinic. (shrink)

Research ethics principles and regulations typically have been applied to the protection of individual human subjects. Yet, new paradigms of research that include the place-based community and cultural groups as partners or participants of environmental research interventions, in particular, require attention to place-based identities and geographical contexts. This paper argues the importance of respecting “place” within human subjects protections applied to communities and cultural groups as part of a critical need for research ethics and cultural competence training (...) for graduate research students. These protections and benefits are extensions of the Belmont Principles and have been included in recent recommendations from research regulatory committees. (shrink)

Hideo Kimura, a 46-year-old Japanese male patient in a Boston hospital, needs to undergo surgery to remove part of his lower intestine but resists signing the consent form and has little understanding of English. Discussing this with an interpreter, Hideo is puzzled, because he has already authorized his wife Sachiko to decide on his behalf. The interpreter points out to him that he has a right, a moral right, to give his informed consent to the surgery and that Hideo is (...) quite competent to decide for himself. Nonetheless, Hideo cannot grasp the meanings of “informed consent” and “moral right.” Hideo agrees to sign the consent form only after he is told that this is official hospital policy. (shrink)

The importance of developing cultural competence among healthcare professionals is well recognized. However, the widespread reports of insensitivity and deficiencies in care for culturally diverse patients illuminate the need to review how cultural competence development is taught, learnt and applied in practice. Unless we can alter the ‘hearts and minds’ of practising nurses to provide the care that they know they should, culturally insensitive care will continue operating in subtle ways. This paper explores the ideas behind nurses’ actions (...) and omissions when caring for culturally diverse patients and proposes the need to examine cultural competence development through a moral reasoning lens. Examining cultural competence development through a moral reasoning lens can help empower nurses, whilst nurturing commitment and courage to providing quality care that meets the needs of culturally diverse patients. The model of morality provides a framework that explores how moral motivation and behaviour occur and can provide a vehicle for critically examining the knowledge, skills and attitudes required to provide culturally responsive care. (shrink)

Health disparities are primarily driven by structural inequality including systemic racism. Medical educators, led by the AAMC, have tended to minimize these core drivers of health disparities. Ins...

Cultural competence literature and training aim to equip healthcare workers to better understand patients of different cultures and value systems, in an effort to ensure effective and equitable healthcare services for diverse patient populations. However, without nuanced awareness and contextual knowledge, the values embedded within cultural competence practice may cripple rather than empower the very people they mean to respect. A narrow cultural view can lessen cultural understanding rather than grow it. In its first part, this (...) paper argues that a hasty, unrestrained, and uneducated willingness to accept something as a cultural good, despite being well intentioned, can still cause significant harms—particularly when based on false, misinformed, and stereotypical conceptions—including the minimization of issues, the reinforcement of stereotypes, and the impediment of cultural change. The second part of this paper examines medical autonomy within the context of Saudi Arabian women. It pushes back on the common perception that Saudi women, by virtue of culture and religion, view dependency on and deference to male relatives as a cultural good. Through a historical examination and a presentation of the current women’s movement in Saudi Arabia, it is argued that the continued assumption that personal agency is a value external to Saudi women is false, misguided, and ethically problematic. Lastly, this paper considers some approaches to help providers navigate the narrow grounds between paternalism and patronization when caring for patients. (shrink)

Many cultural competency efforts in healthcare stress the importance of cultural diversity and difference. This emphasis is necessary and well justified. It has helped sensitize healthcare systems to the differences among people and their health-related attitudes, preferences, and behaviors. However, the emphasis on diversity and difference has, unfortunately, also detracted from serious consideration of the things that cultures have in common and the possibility that socioeconomic differences are today far more important than cultural ones in determining (...) healthcare outcomes. (shrink)

Research linking reading literary fiction to empathy supports health humanities programs in which reflective writing accompanies close readings of texts, both to explore principles of storytelling and to promote an examination of biases in care. Little attention has been paid to the possible contribution of guided fiction-writing in health humanities curricula toward enhancing cultural competence among health professionals, both clinical and community-based. Through an analysis of the short story “Pie Dance” by Molly Giles, juxtaposed with descriptions of specific writing (...) exercises, this paper explains how the demands of writing fiction promote cultural competency. (shrink)

An invaluable work especially for professionals and students in health care, bioethics, humanities, cultural studies, and for the educated lay reader, this volume offers a critical reflection on cultural competence and awareness in health care, an arena where world views and values often collide.

The health system is, in particular ways, a microcosm of society and both reflects and contributes to its ills of racism, inequities, and disparities. As such, the house of medicine is obligated to...

It is reported that medical students both in the U.S. and Poland have experience of interacting with pharmaceutical company representatives (pharma reps) during their school years. Studies have warned that the interaction typically initiated by the pharma reps’ general gift-giving eventually leads to the quid pro quo relationship between the pharma company and the future doctors, the result of which is that the doctors will prescribe their patients drugs in favor of the pharma company. Built upon the existing finding, this (...) research engages in analysis with three foci. The first is to compare attitudinal differences of the American and Polish medical students as they interact with pharma reps. Second, it investigates the role of the different economic and cultural elements (respectively in the U.S. and Poland) in the students’ attitudinal differences. Last, it suggests that the medical schools in both countries should have strict policies and effective education curriculum to help their students better prepare to interact ethically with pharma reps. Since there has been no direct comparative cultural analysis of this kind which is known in a published literature or report, the authors believe that the paper will serve as a catalyst for further research in the area. (shrink)

The contemporary operating environment for deployed United States military operations largely focuses on deployments to predominantly Islamic countries. The differences in cultural values between d...

The article is devoted to use of the principles of ‘Pedagogy of collective creative life‘, proposed I. P. Ivanov in the educational process of modern University. The mechanisms of development of intercultural competence of students, in particular, the ability to establish interaction with other actors in their professional activities, proposed a methodology for evaluation of the level of these competencies.

Cross-cultural competence is often studied as part of the foreigner's one-way adaptation to the host culture while ignoring the dynamic nature of adaptation at the discourse level of interactions. To address this issue, this article proposes a conceptual model to study cross-cultural discursive competence exhibited in individual interactions in business settings. The model is based on relational empathy and genre theories and, in particular, it develops the notional concepts of `cultural space' and `text reconstruction' that stress a (...) two-way cultural adaptation underpinned by building relational empathy and intercultural alliances. In addition, the study proposes that the triangulation of cultural, institutional and sociocognitive spaces is the key to understanding and interpreting text reconstruction as a dynamic process of two-way cultural adaptation. The three-space model is exemplified through an analysis of cross-cultural interactions that occurred at a business negotiation meeting. (shrink)

We live in an increasingly globalizing world, in which countries are closely linked by international trade and investment ties. Cross-cultural comparative studies of national values and ethics have attracted growing research interest in recent years, because shared practices, values and ethical standards depend on shared beliefs. However, the findings of such studies have been unable to reach a consensus on the impact of culture on ethics-related attitudes and behavior. Empirically, many "cross–cultural" differences reported by previous studies might actually (...) stem from cross-national differences. In order to partially fill this gap, this study advocates an analytical framework that isolates the role of cultural and national differences in order to test their relationship to individual level variables. Within this framework, we test competing hypotheses based on both cultural and national contexts by comparing groups of Chinese and American respondents together with a "bridging group" of Chinese Chinese-Americans. Theoretically, this contextual approach helps resolve the debate on the role of culture, by showing that culture plays a far more important role in shaping value orientations than the national background. Specifically, the two ethnic Chinese groups had many cultural values in common, and differed significantly from the Caucasian group. Implications are discussed. (shrink)

Using Chinese listed companies as research setting, this paper constructs a measure of corporate competing culture through textual analysis on firms’ management discussion and analysis disclosures, and examines the impact of corporate competing culture on environmental investment. The results show that competing culture has a significant and positive impact on firms’ environmental investment, and the results remain robust to a battery of robustness tests. Moreover, the mediating analysis indicates that competing culture promotes corporate environmental investment through enhancing firms’ internal control (...) quality. Furthermore, the heterogeneity results show that the positive impact of corporate competing culture on environmental investment is more pronounced in firms with larger size, stronger corporate governance, in high-polluting industry, and located in less developed regions. Our findings shed light on the importance of corporate competing culture and provide practical implications for corporate sustainable development. (shrink)

Globalisation has given rise to a new field of debate due to the growing mobility of the workers and the consequent cultural diversity inside companies. In this sense, a complex world like ours demands a review of the professional profile which should include the so called intercultural competences as a structuring element of companies’ policy and strategic plan. Subsequently it is suggested that, as the intercultural competences affect the cognitive, affective and behavioural aspects, they actually imply a transformation of (...) the person’s identity. (shrink)