To promote so-called cultural competence in work of direct-care providers and other health professionals among diverse peoples, cross-cultural training is now widely advised. However, in ethically assessing aims and content of CCT, and surrounding issues and concerns, what should guide us? And if we can elaborate satisfactory moral touchstones, what do they imply for healthcare professionals, overarching structures, and bioethicists? Building on prior work, this paper tries to help answer these questions.

In lieu of an abstract, here is a brief excerpt of the content:Books ReceivedThe Ambitions of Curiosity: Understanding the World in Ancient Greece and China. By G.E.R. Lloyd. Cambridge: Cambridge University Press, 2002. Pp. xvi + 175. Price not given.The Art of the Han Essay: Wang Fu's Ch'ien-Fu Lun. By Anne Behnke Kinney. Tempe: Center for Asian Studies, Arizona State University, 1990. Pp. xi + 154. Paper $10.00.The Autobiography of Jamgön Kongtrul: A Gem of Many Colors. By Jamgön Kongtrul Lodrön (...) Thayé and translated by Richard Barron (Chökyi Nyima). Ithaca, New York: Snow Lion Publications, 2003. Pp. xxii + 549. Price not given.Awesome Nightfall: The Life, Times, and Poetry of Saigyō. By William R. LaFleur. Boston: Wisdom Publications, 2003. Pp. xiii + 173. Paper $14.95.Becoming the Compassion Buddha: Tantric Mahamudra for Everyday Life. By Lama Thubten Yeshe, edited by Robina Courtin, and foreword by Geshe Lhundub Sopa. Boston: Wisdom Publications, 2003. Pp. xi + 194. Paper $14.95.Between Two Worlds East and West: An Autobiography. By J. N. Mohanty. New Delhi: Oxford University Press, 2002. Pp. ix + 134. Hardcover RS 525.00.The Chinese Face of Jesus Christ. Edited by Roman Malek, S.V.D. Sankt Augustin, Germany: Institut Monumenta Serica and China-Zentrum; and Nettetal, Germany: Steyler Verlag, 2002. Pp. 391. EUR 40.00.Chinese Medicine in Contemporary China: Plurality and Synthesis. By Volker Scheid. Durham and London: Duke University Press, 2002. Pp. xiv + 407. Hardcover $69.95. Paper $23.95.Confucian Feminist: Memoirs of Zeng Baosun (1893-1978). Translated and adapted by Thomas L. Kennedy. Philadelphia: American Philosophical Society, 2002. Pp. xxi + 170. Price not given.Consciousness Studies: Cross-Cultural Perspectives. By K. Ramakrishna Rao. Jefferson (North Carolina) and London: McFarland and Company, 2002. Pp. 367. Hardcover $65.00.Constituting Communities: Theravāda Buddhism and the Religious Cultures of South and Southeast Asia. Edited by John Clifford Holt, Jacob N. Kinnard, and Jonathan S. Walters. Albany: State University of New York Press, 2003. Pp. viii + 224. Hardcover $65.50. Paper $21.95.Developments in Indian Philosophy from Eighteenth Century Onwards: Classical and Western. By Daya Krishna. Volume X Part 1 of History of Science, Philosophy and Culture in Indian Civilization, edited by D. P. Chattopadhyaya. New [End Page 110] Delhi: Centre for Studies in Civilizations, 2001. Pp. xxiii + 417. Hardcover RS 1200.East and West: Identità e dialogo interculturale. By Giangiorgio Pasqualotto. Venezia: Marsilo Editori, 2003. Pp. 210. EUR 16.00.Effortless Action: Wu-wei as Conceptual Metaphor and Spiritual Ideal in Early China. By Edward Slingerland. New York: Oxford University Press, 2003. Pp. xii + 352. Price not given.Encountering Kā lī: In the Margins, at the Center, in the West. Edited by Rachel Fell McDermott and Jeffrey J. Kripal. Berkeley and Los Angeles: University of California Press, 2003. Pp. xviii + 321. Hardcover $55.00, £37.95. Paper $21.95, £15.95.Encyclopedia of Chinese Philosophy. Edited by Antonio S. Cua. New York and London: Routledge, 2003. Pp. xx + 1020. Hardcover $150.00.Essays on Indian Philosophy. By J. N. Mohanty and edited by Purushottama Bilimoria. New Delhi: Oxford University Press, 2002. Pp. xxxvii + 347. Paper RS 525.00.Faith, Humor, and Paradox. By Ignacio L. Götz. Westport, Connecticut: Praeger Publishers, 2002. Pp. 136. Hardcover $61.95.Four Illusions: Candrakīrti's Advice for Travelers on the Bodhisattva Path. Translated by Karen C. Lang. New York: Oxford University Press, 2003. Pp. xv + 240. Price not given.The Great Awakening: A Buddhist Social Theory. By David R. Loy. Boston: Wisdom Publications, 2003. Pp. 223. Paper $16.95.The Hidden History of The Tibetan Book of the Dead. By Bryan J. Cuevas. New York: Oxford University Press, 2003. Pp. xi + 328. Price not given.Huang Di nei jing su wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text. By Paul U. Unschuld. Berkeley and Los Angeles: University of California Press, 2003. Pp. xii + 520. Hardcover $75.00, £52.00.In Dewey's Wake: Unfinished Work of Pragmatic Reconstruction. Edited by William J. Gavin. Albany: State University of New York Press, 2003. Pp. vi + 249. Hardcover $71.50. Paper $23.95.Knowledge and Freedom in Indian Philosophy. By Tara Chatterjea. Lanham, Maryland: Lexington Books, 2002. Pp. xvi + 159. Hardcover... (shrink)

Tоday there is a strong tendency to incorporate the bioethical principle of social justice in healthcare in cross-cultural communication. Considering cultural differences makes it possible to ensure that the human right to medical care and wellbeing is fully respected. Several types of most vulnerable populations were identified – immigrants and social minorities. When seeking medical care they face a number of problems such as culture and language barriers, lower socio-economic status, lack of literacy, which impede effective (...) communication and care provision. The most promising ways of coping with the problem are developing cultural competence and practicing a patient-centered approach. New curricula aiming at raising cultural awareness have been elaborated for practical use in medical schools. (shrink)

BackgroundThe global COVID-19 pandemic confronts people with their fragility, vulnerability, and mortality. To date, scales to measure death awareness mainly focus on the anxiety-provoking aspect of mortality cues. This study aims to cross-culturally adapt and validate the Death Reflection Scale, a scale for measuring positive, growth-oriented cognitions of life reflection and prosocial behavior following confrontation with the finiteness of life.Materials and MethodsThe Death Reflection Scale was translated and adapted in a multi-step process to the German language. In this anonymous, (...) cross-sectional, online survey at a large university in Germany, students, healthcare professionals and other staff completed the DRS alongside comparison measures. Multi-group confirmatory factor analysis was used to assess configural, metric, and scalar measurement equivalence across four age and occupational groups. Convergent/divergent validity testing was done via Spearman correlations.Results1,703 participants provided data for a response rate of ∼5%. 24% of respondents were HCP, 22% students. Confirmatory factor analysis showed a higher-order structure of the DRS with a strong general factor and the originally proposed five subscales. Multi-group CFA showed partial metric equivalence across age groups and partial scalar invariance across occupational groups. Non-invariant scales were the Motivation to live, Putting life into perspective, and Legacy subscales. In the convergent validity testing, two hypotheses were fully confirmed, two partially and four were not confirmed. Experiencing a propensity for increased contemplation and life reflection during the pandemic together with spirituality showed correlations of moderate to large size to the DRS and its subscales.ConclusionFurther conceptual work for death awareness to explore the construct’s stability in different population groups needs to be undertaken. However, the DRS can be mostly used to assess positive and growth-oriented aspects of death awareness and death reflection which may be an important avenue when developing counseling and support interventions for groups experiencing a high burden during the pandemic. (shrink)

This book explores the challenges of informed consent in medical intervention and research ethics, considering the global reality of multiculturalism and religious diversity. Even though informed consent is a gold standard in research ethics, its theoretical foundation is based on the conception of individual subjects making autonomous decisions. There is a need to reconsider autonomy as relational-where family members, community and religious leaders can play an important part in the consent process. The volume re-evaluates informed consent in multicultural contexts and (...) features perspectives from Buddhism, Confucianism, Hinduism, Christianity, Judaism and Islam. It is valuable reading for scholars interested in bioethics, healthcare ethics, research ethics, comparative religions, theology, human rights, law and sociology. (shrink)

Ethical beliefs may vary across cultures but there are things that must be valued as preconditions to any cultural practice. Physical and mental abilities vital to believing, valuing and practising a culture are such preconditions and it is always important to protect them. If one is to practise a distinct culture, she must at least have these basic abilities. Access to basic healthcare is one way to ensure that vital abilities are protected. John Rawls argued that access to (...) all-purpose primary goods must be ensured. Amartya Sen and Martha Nussbaum claim that universal capabilities are what resources are meant to enable. Len Doyal and Ian Gough identify physical health and autonomy as basic needs of every person in every culture. When we disagree on what to prioritize, when resources to satisfy competing demands are scarce, our common needs can provide a point of normative convergence. Need-based rationing, however, has been criticized for being too indeterminate to give guidance for deciding which healthcare services to prioritize and for tending to create a bottomless-pit problem. But there is a difference between needing something (first-order need) and needing to have the ability to need (second-order need). Even if we disagree about which first-order need to prioritize, we must accept the importance of satisfying our second-order need to have the ability to value things. We all have a second-order need for basic healthcare as a means to protect our vital abilities even if we differ in what our cultures consider to be particular first-order needs. (shrink)

ABSTRACT Ethical beliefs may vary across cultures but there are things that must be valued as preconditions to any cultural practice. Physical and mental abilities vital to believing, valuing and practising a culture are such preconditions and it is always important to protect them. If one is to practise a distinct culture, she must at least have these basic abilities. Access to basic healthcare is one way to ensure that vital abilities are protected. John Rawls argued that access (...) to all‐purpose primary goods must be ensured. Amartya Sen and Martha Nussbaum claim that universal capabilities are what resources are meant to enable. Len Doyal and Ian Gough identify physical health and autonomy as basic needs of every person in every culture. When we disagree on what to prioritize, when resources to satisfy competing demands are scarce, our common needs can provide a point of normative convergence. Need‐based rationing, however, has been criticized for being too indeterminate to give guidance for deciding which healthcare services to prioritize and for tending to create a bottomless‐pit problem. But there is a difference between needing something (first‐order need) and needing to have the ability to need (second‐order need). Even if we disagree about which first‐order need to prioritize, we must accept the importance of satisfying our second‐order need to have the ability to value things. We all have a second‐order need for basic healthcare as a means to protect our vital abilities even if we differ in what our cultures consider to be particular first‐order needs. (shrink)

The rapid growth of pharmaceutical markets in the 20th century has increased the demand for human research participants in clinical trials. However, with the globalization of clinical research, most clinical trials are conducted in low-income countries (LICs) with political and economic instability, and lack of basic healthcare, but easy access to human subjects. This paper explores the unique ethical challenges faced during the pre-enrollment phase of cross-cultural research in a country like Pakistan, and how these challenges make (...) the Pakistani population vulnerable to exploitation. It also outlines recommendations regarding conducting research in Pakistan within ethical parameters adopted according to local culture. This discussion is important because researchers must focus on the pre-enrollment phase of the research process for it’s cultural suitability and acceptability so that the research conducted is credible and valid and has social value for the research population. (shrink)

Culture creates the context within which individuals experience life and comprehend moral meaning of illness, suffering and death. The ways the patient, family and the physician communicate and make decisions in the end-of-life care are profoundly influenced by culture. What is considered as right or wrong in the healthcare setting may depend on the socio-cultural context. The present article is intended to delve into the cross-cultural perspectives in ethical decision making in the end-of-life scenario. We attempt (...) to address the dynamics of the roles of patient, family and physician therein across two countries from East and West, namely, India and Germany. In India, where illness is more a shared family affair than an individual incident, a physician is likely to respect the family’s wishes and may withhold the ‹naked truth’ about the diagnosis of a fatal disease to the patient. In Germany, a physician is legally required to inform the patient about the disease. In India, advance directive being virtually non-existent, the family acts as the locus of the decision-making process, taking into account the economic cost of available medical care. In Germany, advance directive is regarded as mandatory and healthcare is covered by insurance. Family and the physician appear to play larger roles in ethical decision making for patients in India than for those in Germany, who place greater emphasis on autonomy of the individual patient. Our study explicates how culture matters in ethical decision-making and why the bioethical discourse is necessary in the concrete realities of the socio-cultural context. To explore the possibility of finding a common ground of morality across different cultures while acknowledging and respecting cultural diversity, thus remains a formidable challenge for the bioethicists. (shrink)

The case of Mrs. J is interesting not only because of the difficult questions that the clinical ethicist must confront but also because of the intriguing way in which such cases make Western clinicians and ethicists confront their own oft-unspoken cultural ethical norms and presuppositions.

BackgroundAlthough, moral distress presents a serious problem among critical care nurses in many countries, limited research has been conducted on it. A validated scale has been developed to evaluate moral distress and has enabled cross-cultural comparison for seeking its root causes.Research aimsThis study aimed to (1) clarify the current status of moral distress among nurses who worked in critical care areas in Japan, (2) compare the moral distress levels among nurses in Japan with previously reported results from the (...) United States (US), and (3) explore the factors associated with moral distress.Research designA nationwide cross-sectional study was conducted.Participants and research contextWe conducted a self-administered questionnaire survey using the Measure of Moral Distress–Healthcare Professionals (MMD-HP) among critical care nurses who were randomly selected from hospitals across Japan. The mean differences between the two countries were compared using a Student's t-test with summary statistics. The factors associated with higher levels of moral distress were examined using a multiple regression analysis.Ethical considerationsThe study was approved by the Ethics Committee of the Tokyo Medical and Dental University (approval nos. M2018-214 and M2019-045).ResultsWe obtained 955 valid responses from 94 facilities. In Japan, the items with the highest moral distress scores were those related to aggressive/inappropriate treatment. The total MMD-HP score was significantly higher in Japanese nurses compared to US nurses (122.8 ± 70.8 vs 112.3 ± 73.2). Some factors, such as leadership experience, were associated with higher moral distress.DiscussionThe top root causes of moral distress were similar to potentially inappropriate treatments in both countries.ConclusionThis study revealed the factors associated with higher moral distress and its characteristics in each country. These results can be used for reducing moral distress in the future. (shrink)

In todays’ super-diverse societies, communication and interaction in clinical encounters are increasingly shaped by linguistic, cultural, social and ethnic complexities. It is crucial to better understand the difficulties patients with migration background and healthcare professionals experience in their shared clinical encounters and to explore ethical aspects involved. We accompanied 32 migrant patients during their medical encounters at two outpatient clinics using an ethnographic approach. Overall, data of 34 interviews with patients and physicians on how they perceived their encounter (...) and which difficulties they experienced are presented. We contrasted the perspectives on the difficult aspects and explore ethical questions surrounding the involved issues. Patients and physicians describe similar problem areas, but they have diverging perspectives on them. Two main themes were identified by both patients and physicians: >patients’ behaviour in relation to doctors’ advice relationship issues<. A deeper understanding of the difficulties and challenges that can arise in cross-cultural settings could be provided by bringing together healthcare professionals’ and patients’ perspectives on how a cross- cultural clinical encounter is perceived. Ethical aspects surrounding some of the difficulties could be highlighted and should get more attention in clinical practice and research. (shrink)

The concept of ‘accounts’ (Scott and Lyman, 1968) – or linguistic strategies for neutralizing the negative social meanings of norm violation – has a long history in sociology. This work examines British and American women's accounts of cosmetic surgery. In the medical literature, feminist writings and the popular press, aesthetic plastic surgery has been associated with narcissism, psychological instability and self-hatred. Given these negative connotations, cosmetic surgery remains a practice requiring justification even as its popularity increases. Drawing on interview data, (...) I argue that respondents' efforts to account for cosmetic surgery vary according to the ‘repertoires of evaluation’ (Lamont and Thévenot, 2000) made available by their own nation and, particularly, by its healthcare culture. In the market-based US healthcare system, women justify cosmetic surgery by referring to their personal and financial ‘investments’ in physical attractiveness and well-being. Such explanations are less legitimate in Britain, where healthcare is considered a social right rather than a consumer good. In the latter context, women employ narratives that medicalize the pre-surgical body by stressing the physical pain and emotional distress that it caused. (shrink)

The vast majority of experimental studies of music to date have explored music in terms of the processes involved in the perception and cognition of complex sonic patterns that can elicit emotion. This paper argues that this conception of music is at odds both with recent Western musical scholarship and with ethnomusicological models, and that it presents a partial and culture‐specific representation of what may be a generic human capacity. It argues that the cognitive sciences must actively engage with the (...) problems of exploring music as manifested and conceived in the broad spectrum of world cultures, not only to elucidate the diversity of music in mind but also to identify potential commonalities that could illuminate the relationships between music and other domains of thought and behavior. (shrink)

Moral distress is a complex phenomenon experienced by individuals across multiple healthcare professions, teams, organizations, and educational settings. It arises when any healthcare professional...

Transgender and gender diverse (TGD) youth are currently being targeted by global anti-trans legislation that would prevent their access to gender-affirming care even by healthcare providers willing to deliver it and who understand the importance of this support. It has been suggested in some studies that transness in young people is a result of peer contagion. As such their free will, authenticity and autonomy could be brought into question when accessing gender-affirming care. It is important to explore the relevance (...) of these concepts concerning the provision of gender-affirming care to TGD youth by nurses and other healthcare professionals. Nurses should challenge the notion held by some that these young people are not capable of knowing themselves or the level of treatment they require. They can do this by practising gender-affirming care determined by aspirational ethical values of beneficence, non-maleficence, autonomy and justice. (shrink)

This article analyzes the complex relation of phenomenology and literature in the work of Husserl and Derrida. In the first part, I show that the limited ideality of the literary object necessarily situates it in a derivative region of phenomenology. In the second part, however, I problematize the regional status of literature by elaborating a brief but important footnote in which Husserl broadens the concept of literature to embrace all cultural products whatsoever. Yet, because even this broadened concept of (...) literature ultimately remains secondary for the phenomenologist, it only redoubles and ratifies the submission of literature to the more ideal objectivities of mathematical disciplines like geometry. The third part, finally, mobilizes Derrida’s notion of “dissemination,” prepared in and unintelligible apart from his early engagement with Husserlian phenomenology, in order to broach a notion of literature that the phenomenologist can neither circumscribe nor describe. (shrink)

Corporate gifts – from philanthropic donations to individual reward schemes – attract considerable attention from scholars for the kinds of moral, economic and political logics that motivate them. This article considers the gifts that transnational corporations give to producers and draws from Marilyn Strathern’s writings on exchange and personhood in order to reverse dominant analyses. Focused on the gifting of gold coins to industrial workers at a global manufacturing unit in India, it brings together field-based observations with a diverse field (...) of literature on the gift in anthropology. Against an analysis that sees the corporate gift harnessed directly to a corporate bottom line, this article proposes an alternative accounting that uses Strathern’s notions of ‘elicitation’, ‘revelation’ and ‘detachment’ to explore the contours of knowledge, personhood and relationality in the transaction. If corporate gifts have powerful effects, the article argues, it is because they establish difference between the person of the giver and the person of the recipient and because they materialize actions, desires and capacities that accrue to and transform the recipients rather than simply because they are vessels for the interests of global capital. As social theory confronts the political economy of corporate giving, Strathern’s writings prompt provocative questions about agency and power that challenge the hegemonic status of the modern corporation. (shrink)

Digital systems are reshaping how we engage with music as a sounding dimension of cultural life that is capable of being transformed into a commodity. At the same time, as we increasingly engage through digital media with each other and with virtual others, attributes of music that underpin our capacity to interact communicatively are disregarded or overlooked within those media. Even before the advent of technologies of music reproduction, music was susceptible to assimilation into economic acts of exchange. What (...) is new in the digital world is the way in which modes of engagement with music are themselves being absorbed into an economy built on the datafication of virtual acts and the digital shadows of casual preferences. But music is more than just sounds that are culturally sanctioned as musical. Music is manifested as behaviours, and in interactive behaviour. Music is participatory as well as presentational, and in the participatory mode—involving collective, non-specialist, interactive real-time music-making—has significant individual and social consequences. Yet music as real-time participation is largely absent from the virtual world, with potential social costs that remain to be understood. Moreover, our everyday, face-to-face communicative—conversational—interactions are imbued with patterns between interlocutors that are musical, in that they share features with what we are happy to describe as “music”. These features are presently lacking in digital systems designed to subserve communicative functions, and this paper will consider the significant implications for our interactions with machines to which their successful incorporation into voice–user interfaces would give rise. (shrink)

If a critique of everyday life is to become a serious undertaking, virtually everything we experience needs to be subjected to careful and critical scrutiny. Even fairy tales. Like so much else in modern culture, these tales may not be as innocuous as they appear. To the extent that the culture industry has appropriated them and uses their motifs to manipulate consciousness or shape behavior, especially in children, fairy tales may be more effective as instruments of social control than one (...) would think. Perhaps for this reason the study of these tales is too important to be left to folklore aficionados or specialists in children's literature. (shrink)

SummaryThe importation of Spencerism and Social Darwinism into Japan in the early Meiji era (from 1868 to the early 1880s) occurred against a background of rapid economic and industrial change which provoked widespread political unrest. This accelerated modernization was forced by Western demands for trade liberalization and the threat of Western imperialism. In this context, selected elements of Western scientific naturalism and liberalism could provide a prestigious ratification of élite agendas for the management of change, provided they could be made (...) culturally recognizable. It is suggested that traditional and Western knowledge claims were combined by key Meiji intellectuals in such a way that the product, Meiji Social Darwinism, supplied both the prestige of Western scientific positivism and the familiarity conferred by traditional resources. The clear differentiation between the constituents which made up Meiji Social Darwinism enables us to identify the distinct cultural functions performed by each of these sets of resources. In this study, these cultural functions emerge as elements in an élite class strategy. (shrink)

Throughout history, dance has maintained a critical presence across all human cultures, defying barriers of class, race, and status. How dance has synergistically co-evolved with humans has fueled a rich debate on the function of art and the essence of aesthetic experience, engaging numerous artists, historians, philosophers, and scientists. While dance shares many features with other art forms, one attribute unique to dance is that it is most commonly expressed with the human body. Because of this, social scientists and neuroscientists (...) are turning to dance and dancers to help answer questions of how the brain coordinates the body to perform complex, precise, and beautiful movements. In the present paper, we discuss how recent advances in neuroscientific methods provide the tools to advance our understanding of not only the cerebral phenomena associated with dance learning and observation but also the neural underpinnings of aesthetic appreciation associated with watching dance. We suggest that future work within the fields of dance neuroscience and neuroaesthetics have the potential to provide mutual benefits to both the scientific and artistic communities. (shrink)

The target paper shows how cultural adaptations to ecological problems can underpin “paradoxical” patterns of phenotypic variation. We argue: (1) Gendered social learning is a cultural adaptation to an ecological problem. (2) In evolutionarily novel environments, this adaptation generates arbitrary-gendered outcomes, leading to the paradoxical case of larger sex differences in more gender equal societies.

This article reviews some of the ethical aspects of collaborative research. Scientific collaboration has known potential benefits but it’s a challenging task to successfully accomplish a collaborative venture on ethically sound grounds. Current trends in international healthcare research collaboration reflect limited benefits for the majority of world population. Research collaboration between scientists of academia and industry usually has financial considerations. Successful cross-cultural and international collaborations have to overcome many regional and global barriers. Despite these difficulties, many scientific (...) collaborations usually begin with an informal meeting or contact. With advancement in global communications, scientists have greater responsibility towards the world community while considering the impact of their collaborative partnerships. I review the basic factors that are required for forging a collaborative partnership and responsible attitudes to sustain the relationship. Finally I conclude that scientists in healthcare research can play important roles beyond collaborations and contribute to bringing harmony, resolving differences across the nations and countries in today’s troubled world. (shrink)

The movement to respect culturaldiversity, known as multiculturalism, poses a dauntingchallenge to healthcare ethics. Can we construct adefensible passage from the fact of culturaldifferences to any claims regarding morality? Or doesmulticulturalism lead to ethical relativism? Macklinargues that, in view of a leading distinction betweenuniversalism in ethics and moral absolutism, the onlyreasonable passage avoids both absolutism andrelativism. She presents a strong case againstethical relativism and its pernicious consequences forcross-cultural issues in healthcare. She alsoprovides sound criteria for the assessment (...) of aculture's moral progress. (shrink)

BackgroundThe issue of stigma is very important in the battle against HIV/aids in Africa since it may affect patient attendance at healthcare centres for obtaining antiretroviral medications and regular medical check-ups. Stigmatization creates an unnecessary culture of secrecy and silence based on ignorance and fear of victimization. This study was designed to determine if there is external stigmatization of people living with HIV and AIDS by health care workers at a tertiary hospital in KwaZulu-Natal province, South Africa. The study (...) investigated the impact of knowledge of HIV/aids by HCWs on treatment of patients, as well as the comfort level and attitude of HCWs when rendering care to PLWHA.MethodsA descriptive cross sectional study was designed to collect data using an anonymous self-administered structured questionnaire from 334 HCWs. The study was conducted in clinical departments of a large multidisciplinary 922-bed tertiary care teaching hospital in Durban, KZN.ResultsOverall HCWs had an above average knowledge about HIV/aids although some gaps in knowledge were identified. Tests of statistical significance showed that there was association between level of education and knowledge of HIV/aids ; occupation and knowledge of HIV/aids ; and gender and knowledge of HIV/aids. Test for comfort level was only significant for gender, with males showing more comfort and empathy when dealing with PLWHA. The study also revealed that patients were sometimes tested for HIV without informed consent before surgery, due to fear of being infected, and there was some gossiping about patients' HIV status by HCWs, thereby compromising patient confidentiality. The majority of HCWs showed a willingness to report incidents of stigmatization and discrimination to higher authorities, for better monitoring and control.ConclusionsAlthough knowledge, attitude and comfort level of HCWs taking care of PLWHA was above average, enforcement of existing antidiscrimination laws and continuing education in medical ethics and healthcare law, would greatly improve the performance of HCWs taking care of PLWHAs. More psychological support and counselling should be provided to HCWs, to further reduce the impact of stigmatization and discrimination against PLWHA. (shrink)

There is a dire need today to create spaces in which people can make meaning of their existence in the world, abiding by cultural frameworks and practices that acknowledge and validate a meaningful existence for all. People are not just isolated individuals but are connected in diverse ways with other persons within our natural and social environment which is part of the whole universe. The African philosophy of uBuntu or humaneness is re-emerging for its timely relevance and potential as (...) indispensable in our quest for global citizenship, peace, and mutual understanding in securing sustainable human development in the broader ecosystem. Comparative educationists have the challenge to devise theoretical frameworks, epistemological and pedagogical constructs as well as pragmatic, useful and effective ways of promoting the virtues of compassion and recognition of our common humanity in eliminating the ills of domination and control that are guided by greed, hatred, jealousy, and intolerance. Comparative Education for Global Citizenship, Peace and Shared Living through Ubuntu paves the way for a better understanding of the critical importance of the collective search and endeavor towards achieving the virtues of nonviolence, peace, shared values of living together, global citizenship, improved quality of life for all and a better appreciation of the positive implications of interdependence. (shrink)

The decline of empathy among health professional students, highlighted in the literature on health education, is a concern for medical educators. The evidence suggests that empathy decline is likely to stem more from structural problems in the healthcare system rather than from individual deficits of empathy. In this paper, we argue that a focus on direct empathy development is not effective and possibly detrimental to justice-oriented aims. Drawing on critical and narrative theory, we propose an interpersonal approach to enhance (...) empathic capacities that is centered on constructive and transformative interactions which integrates the participatory arts and involves both patients and health professional students. We describe and evaluate a program where patients and students create collaborative, original songs. Interviews and a focus group revealed interactional processes summarized in four themes: reciprocal relationships, interactions in the community, joint goal, and varied collaboration. There was a significant enhancement of positive attitudes about care post-program amongst health professional students. The interpersonal approach may be a preliminary framework for the medical humanities to shift away from a focus on direct empathy development and further towards participatory, co-creative, and justice-oriented approaches to enhance health and thereby empathic capabilities. (shrink)

This essay argues that service-learning pedagogy is an important tool in pre-health humanities education that provides benefits to the community and produces more compassionate, culturally competent, and community-responsive future healthcare professionals. Further, beginning this approach at the baccalaureate level instills democratic and collaborative values at an earlier, crucial time in the career socialization process. The discussion focuses on learning outcomes and reciprocity between the university and community in a Medical Humanities course for junior and senior premedical students, an elective (...) in the premedical curriculum. The course includes an experiential learning element in which students shadow physicians and a service-learning component in which students complete medically-relevant service work, working with partners such as the veteran’s hospital, a hospice home, and organizations that serve individuals with disabilities. We cover topics such as narrative medicine, ethics, cross-cultural medicine, patient/practitioner relationships, the human life cycle, and the illness experience, and the writing, discussion, and reflection we engage in is enriched by the real-world experiences from which the students are able to draw. The shadowing and service experiences and the classroom texts and topics combine to form a symbiosis that leads to especially meaningful teaching and learning outcomes. (shrink)

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)

Gaining ethical approval for qualitative health research and implementing all the planned research processes in a proposed study are not straightforward endeavours. The situation becomes more complex when qualitative research is conducted in a cross-national healthcare and academic context. Also, it is even exhausting when the study is student-based, as student researchers may be considered novices and inexperienced researchers, especially for field-based research. Our aim in this reflective paper is to present, reflect, and discuss the experiences of a (...) doctoral researcher in dealing with two independent institutional review boards in Canada and Ghana during an interdisciplinary Ph.D. project and the ethical dilemmas encountered while collecting data in Ghana. Based on the researcher’s experiences, it became apparent that consent and its documentation can have cultural implications in different settings; hence, institutional review boards must exercise reflexivity in their protocol review practice. Also, sharing research data with participants and institutional leaders while maintaining participant confidentiality and privacy in institutional ethnographic research requires sensitivity to bi-lateral ethical values. With the experiences shared in this paper, we advocate for a dialogic ethical review process in qualitative research where researchers and research ethics boards engage in ongoing dialogue rather than the usual prescriptive format research ethics reviews often assume. (shrink)

We provide new findings that add to the growing body of empirical evidence that important epistemic intuitions converge across cultures. Specifically, we selected three recent studies conducted in the US that reported surprising effects of knowledge attribution among English speakers. We translated the vignettes used in those studies into Mandarin Chinese and Korean and then ran the studies with participants in Mainland China, Taiwan, and South Korea. We found that, strikingly, all three of the effects first obtained in the US (...) also emerged in the East Asian cultures we studied. Our findings not only cohere with but also provide—at least moderate—support for the existence of extensive convergences of important epistemic intuitions across cultures. (shrink)

The goal of this paper is two-fold. First, I begin by reviewing several of themajor points of emphasis among health educatorsas they begin to incorporate multiculturalissues into healthcare education. I thenconsider the role of moral relativism, which iscurrently being endorsed by some healtheducators, as the foundation for resolvingcross-cultural conflicts in healthcare. Iargue that moral relativism is ultimatelyinconsistent with the stated goals inmulticultural curricular proposals and fails toprovide an effective framework for consideringmoral conflicts in cross-cultural settings. (...) Instead, I propose that those methods seekingto establish a common morality, built uponmutually shared values, offer the mostpromising means of resolving cross-culturalconflicts. This leads to my second goal, tocompare recent work in moral pragmatism withwhat is now widely known in bioethics as moral``principlism.'' I argue that while proponentsof principlism and pragmatism each seek toestablish a common foundation for moraldeliberation, they fail to appreciatesignificant similarities between theirrespective approaches. Instead of offeringtwo completely unique and independent methodsof moral deliberation, I suggest thatprinciplism and pragmatism embrace commonthemes that point us in a positive direction,providing an effective framework useful forconsidering cross-cultural conflicts inhealthcare. (shrink)

The increasing demographic changes of populations in many countries require an approach for managing the complexity of sociocultural differences. Such an approach could help healthcare organizations to address healthcare disparities and inequities, and promote cultural safety for healthcare providers and patients alike. Almutairi's critical cultural competence (CCC) is a comprehensive approach that holds great promise for managing difficulties arising from sociocultural and linguistic issues during cross‐cultural interactions. CCC has addressed the limitations of many (...) other cultural competence approaches that have been discussed in the literature. Therefore, the purpose of this study is to define the construct of CCC and the theoretical components of the CCC. (shrink)

For years, violence against doctors and healthcare workers has been a growing social issue in China. In a recent series of studies, we provided evidence for a motivated scapegoating account of this violence. Specifically, individuals who feel that the course of their (or their family member's) illness is a threat to their sense of control are more likely to express motivation to aggress against healthcare providers. Drawing on existential theory, we propose that blaming and aggressing against a single (...) individual represents a culturally afforded scapegoating mechanism in China. However, in an era of healthcare crisis (i.e., the global COVID-19 pandemic), it is essential to understand cultural variation in scapegoating in the context of healthcare. We therefore undertook two cross-cultural studies examining how people in the United States and China use different scapegoating responses to re-assert a sense of control during medical uncertainty. One study was conducted prior to the pandemic and allowed us to make an initial validating and exploratory investigation of the constructs of interest. The second study, conducted during the pandemic, was confirmatory and investigated mediation path models. Across the two studies, consistent evidence emerged that, both in response to COVID-related and non-COVID-related illness scenarios, Chinese (relative to U.S.) individuals are more likely to respond by aggressing against an individual doctor, while U.S. (relative to Chinese) individuals are more likely to respond by scapegoating the medical industry/system. Further, Study 2 suggests these culture effects are mediated by differential patterns of primary and secondary control-seeking. (shrink)

As physicians encounter an increasingly diverse patient population, socioeconomic circumstances, religious values and cultural practices may present barriers to the delivery of quality care. Increasing cultural competence is often cited as a way to reduce healthcare disparities arising from value and cultural differences between patients and providers. Cultural competence entails not only a knowledge base of cultural practices of disparate patient populations, but also an attitude of adapting one's practice style to meet patient needs (...) and values. Gender roles, relationship dynamics and boundaries are culture specific, and are frequently shaped by religious teachings. Consequently, religion may be conceptualised as a cultural repertoire, or dynamic tool-kit, by which members of a faith adapt and negotiate their identity in multicultural societies. The manner in which Islamic beliefs and values inform Muslim healthcare behaviours is relatively under-investigated. In an effort to explore the impact of Islam on the relationship between patients and providers, we present an Islamic bioethical perspective on cross-gender relations in the patient-doctor relationship. We will begin with a clinical scenario highlighting three areas of gender interaction that bear clinical relevance: dress code, seclusion of members of the opposite sex and physical contact. Next, we provide a brief overview of the foundations of Islamic law and ethical deliberation and then proceed to develop ethicolegal guidelines pertaining to gender relations within the medical context. At the end of this reflection, we offer some practice recommendations that are attuned to the cultural sensitivities of Muslim patient populations. (shrink)

As physicians encounter an increasingly diverse patient population, socioeconomic circumstances, religious values and cultural practices may present barriers to the delivery of quality care. Increasing cultural competence is often cited as a way to reduce healthcare disparities arising from value and cultural differences between patients and providers. Cultural competence entails not only a knowledge base of cultural practices of disparate patient populations, but also an attitude of adapting one's practice style to meet patient needs (...) and values. Gender roles, relationship dynamics and boundaries are culture specific, and are frequently shaped by religious teachings. Consequently, religion may be conceptualised as a cultural repertoire, or dynamic tool-kit, by which members of a faith adapt and negotiate their identity in multicultural societies. The manner in which Islamic beliefs and values inform Muslim healthcare behaviours is relatively under-investigated. In an effort to explore the impact of Islam on the relationship between patients and providers, we present an Islamic bioethical perspective on cross-gender relations in the patient-doctor relationship. We will begin with a clinical scenario highlighting three areas of gender interaction that bear clinical relevance: dress code, seclusion of members of the opposite sex and physical contact. Next, we provide a brief overview of the foundations of Islamic law and ethical deliberation and then proceed to develop ethicolegal guidelines pertaining to gender relations within the medical context. At the end of this reflection, we offer some practice recommendations that are attuned to the cultural sensitivities of Muslim patient populations. (shrink)

ABSTRACT The paper explores the ethical aspects of introducing cultural circumcision of children into the EU public health system. We reject commonplace arguments against circumcision: considerations of good medical practice, justice, bodily integrity, autonomy and the analogy from female genital mutilation. From the unique structure of patient‐medicine interaction, we argue that the incorporation of cultural circumcision into EU public health services is a kind of medicalization, which does not fit the ethos of universal healthcare. However, we support (...) a utilitarian argument that finds hospital‐based circumcision safer than non‐medicalized alternatives. The argument concerning medicalization and the utilitarian argument both rely on preliminary empirical data, which depend on future validation. (shrink)