Whether and How Normative Healthcare Ethics is Possible in a Multi-Cultural Society

Posted: December 22nd, 2022

Whether and How Normative Healthcare Ethics is Possible in a Multi-Cultural Society

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Whether and How Normative Healthcare Ethics is Possible in a Multi-Cultural Society

Healthcare has become a globalized issue as the ability to obtain healthcare services across national borders has improved with the advancements in technology. Healthcare services can now be provided in settings where people adhere to diverse beliefs related to medical conditions and curative approaches. Moreover, culturally-diverse patients who hold different moral values seek medical attention from healthcare facilities. As such, ethical considerations that used to be universally accepted are now being challenged by the different meanings of morality from diverse regions and cultures.[1] The diversity of ethical considerations has led to calls for the development of global bioethics, whose scope is broader than that of medical ethics and nursing ethics.[2] It is presumed that the existence of a globally-accepted view of the ethical issues in healthcare would enable healthcare services in a culturally-diverse society. However, doubts regarding the development of a global bioethics continue to exist because of the continued influence of the deeply-ingrained cultures in healthcare. What is morally acceptable in one culture may not be appropriate in another culture.

Consequently, the debate between universalism and cultural relativism, and between empiricism and subjectivism continues to feature in global bioethics. Emerging questions focus on whether it is possible to have normative healthcare ethics in a multicultural society that is globally accepted. Despite the lack of consensus on what bioethics should entail in a global community, the development for ethical principles that can be used in a multicultural society is important because it would help many people to benefit from healthcare services across the world. To this end, a normative analysis to determine the goals of global bioethics is performed to demonstrate the importance of healthcare-related ethical considerations in a multicultural society.

The Multicultural Society and Healthcare

The healthcare industry has undergone significant developments in the last few decades, which have influenced the access to and quality of healthcare across the world. Technological advancements have improved medical technologies while globalization has enabled people to access healthcare services from their facilities of choice around the globe. Besides, societies across the world have become increasingly multicultural as people travel widely and integrate more across different cultures.

The intermingling of culturally-diverse people presents challenges for the provision of healthcare in contemporary communities. Similarly, new and advanced medical knowledge and technologies are being shared across the healthcare institutions across the world. However, these developments have encountered diverse ethical views that challenge its acceptance by different healthcare stakeholders. Notably, the cultural differences between individualistic and collectivistic societies come with divergent notions about bioethics. In turn, the ethical dilemmas that are encountered in the healthcare sector differ across individualistic and collectivistic cultures.

Nonetheless, global healthcare challenges require global solutions regardless of the moral values held by people in different cultures in society. Indeed, healthcare practitioners and patients across the world experience similar ethical dilemmas presented by the new and advanced medical knowledge and practice. Therefore, the resolution of these dilemmas can begin with the accommodation of the different moral views across dissimilar cultures if healthcare services are to benefit contemporary society. In turn, the ethical dilemmas that are commonly experienced in the various cultural jurisdictions can be resolved through widely-accepted notions of what is considered as being the right and good action.

Universalism versus Cultural Relativism

Cultural diversity in modern societies has raised concerns regarding the existence of an ideal moral worldview, otherwise known as the universalistic view. Healthcare practitioners are continuously faced with ethical dilemmas because of the different perceptions about what the moral values in and an ideal world should be. Similarly, the different moral values held by patients and their families present ethical difficulties to healthcare professionals. Caregivers often have to choose medical interventions based on either their moral values or those of their patients. The current trend in the healthcare industry is the provision of patient-centered care because it delivers more health benefits to the patient, who is the client in healthcare services. In other words, healthcare should be provided in a culturally-sensitive manner. However, the moral values held by some patients may differ from those of the healthcare professionals, and as such, the health practitioner should be able to resolve the ethical dilemmas without compromising the quality of care.

Differences in ethical attitudes, boundaries, properties, and judgments can be argued from a universalistic or a relativistic angle. The universalistic perception of moral values advances the presence of an ideal worldview of ethics. In other words, there exists a body of knowledge related to health that has universal acceptance. Additionally, this precept comes with the belief that health is an objective science that cannot vary across geographical or cultural divides.[3] Universalism has been advanced by the concept of principlism, which is a methodology of approaching medical ethics that became well established in the West. Principlism applies a few principles to resolve ethical dilemmas by defining simply the right or the best course of action in a medical situation. As such, principlism presents a framework that guides medical ethics through concise moral standards, thus making them understood easily in the healthcare sector. In this regard, the four bioethical principles, namely beneficence, non-maleficence, autonomy, and justice, are accepted as standards in medical ethics.[4] These ethical principles continue to be widely accepted to date in jurisdictions that adhere to western culture. However, principlism disregards culturally-based moral values. As such, the four bioethical principles are conceived differently in different cultures.   

In contrast, a relativistic perspective explains moral values from a pragmatic view in which cultural differences can have different moral perceptions of the same action. Cultural relativism is a concept that makes normative claims about the importance of cultural considerations in ethical issues. Besides, normative moral relativism is acknowledged for recognizing the different moral demands placed by different people, and as such, no single true morality exists. Therefore, according to ethical relativism, morality should not be based on the ethical standards the western culture, which means that the western ethical standards should not be regarded universal.[5] However, arguments about the danger of equating of cultural relativism to ethical relativism have emerged. Cultural relativism is condemned for accepting various cultural beliefs and norms, even when they may lead to immorality or unethical actions. As such, normative claims cannot be equated to factual claims even when they gain cultural acceptance. Indeed, cultures differ in their perceptions of bioethics. Therefore, ethical relativism should be acceptable if it aids the accommodation of culture in healthcare practice, thus making healthcare services culturally relevant and acceptable.

The debate between universalism and relativism has interested bioethicists for a long time because it influences the ethical decisions taken by healthcare professionals and other stakeholders. In contemporary multicultural society, a healthy mix of ethical universalism and ethical relativism is paramount. However, some relativistic ethical views may be difficult to contend with in a healthcare environment. The moral values held by some cultures or individuals can lead to immorality or unethical behavior in the provision of healthcare services. As such, practices related to genital mutilation and abortion among many others should be guided by moral values that are accepted universally. Those performing such practices should be dissuaded using widely-accepted moral principles.

Empiricism versus Subjectivism

The scientific approach that underpins medical practice has facilitated the provision of high-quality healthcare services that are evidence-based and anchored on good medical practice. Advancements in research and technology have enabled the administering of previously unprecedented healthcare interventions. However, the acceptability of these interventions may be challenged when the facts underpinning the healthcare practice conflict with the moral values held by the practitioner or the patient.

Empiricism advocates for the inclusion of biomedical facts that have been proven through scientific rigor in bioethical considerations. As such empirical approaches to bioethics are commended for their ability to analyze and justify ethical decisions, and identify the ethical dilemmas that emerge from medical and technological advancements.[6] This has helped to bridge the disconnect between theory and practice in healthcare because healthcare practices can consider the moral differences across cultures. Subjectivism, on the other hand, contends that truth is subject to individual perceptions rather than the reality that is shared communally. Ethical subjectivism advances the belief that morality is determined and authenticated individually.

However, in healthcare, individual ethical considerations may hinder the provision and acceptance of healthcare services that run contrary to one’s moral values. In a multicultural society, bioethics should be considerate of empiricist and subjectivist perceptions of morality related to healthcare. Evidence-based practice should accommodate individualistic moral values so that healthcare services can be patient-centered.        

Global Bioethics

Global bioethics may facilitate the provision of healthcare services across the world because it would make bioethical values and principles applicable and acceptable globally. Therefore, global bioethics would make healthcare services acceptable and relevant in multicultural societies that populate the world. However, bioethics principles from the Western world are considered as the universal ethical standards. Because these ideas exclude those from other cultures, they hinder the advancement towards the development of bioethics that is truly global. Moreover, the healthcare injustices and inequalities experienced in developing countries and among ethnic minorities have intensified the calls for alternative ways of dealing with ethical dilemmas and underpinning ethical practice. Besides, many people in the contemporary world are multiracial, have multiethnic backgrounds while many others have multiple cultural experiences due to migration, communication and education. This can lead to norm conflict during clinical encounters because the diversity in enculturation and acculturation leads to different ethical understandings.[7]   

However, healthcare organizations and professionals across the world are subjected to training that exalts western-oriented ethical principles and practice. While the medical educational programs teach common ethical principles and advance the principlist model of ethical standards, they ignore the moral values of the patients and communities that receive the healthcare services. Therefore, mainstream bioethics has failed to accommodate the diverse moralities of patients and families seeking healthcare services from contemporary health facilities.   

Nonetheless, bioethics has progressed in recent times because of the realization of the interconnectedness of people across the world. Moreover, ethical dilemmas are increasingly being shared by people from diverse cultures as they are confronted with technological and medical advancements in healthcare. Besides, healthcare problems experienced worldwide require global solutions.[8] As such, the moral values held by ethnic minorities and collectivistic societies have gained prominence in mainstream bioethics. This has lead to the formulation of bioethical solutions that seek to resolve global bioethical dilemmas using local approaches.

Indeed, the four principles of bioethics that underpin the principlist model may be acceptable across diverse cultures if the moral inquiry in current practice is accommodative of cultural considerations. Normative analysis that is inclusive of the historical and comparative analysis of cultural norms can yield new interpretations of the core bioethical principles and facilitate the progress towards global bioethics.[9] Already, the bioethical scholarship is increasingly paying attention to the cultural frameworks related to health and illness, and the moral reasoning associated with healthcare practice. Care should be taken not to reduce cultural consideration to ethnic deliberations during normative analysis. Besides, the understanding of the socialization process of the healthcare professionals into their practice and organizations can help bioethicists progress towards the development of floral bioethics.  

Conclusion

What is right or considered as good action can govern the provision of healthcare services to a multicultural society provided that the ethical and moral standards used are widely accepted globally. The principlist model does not suit the multicultural environment so long as it is anchored in western bioethical perspectives and rejects alternative explanations that use cultural lenses. Moreover, the professional enculturation of healthcare practitioners during their training and practice makes them unprepared to deal with multicultural patients and communities. Besides, while bioethics has benefited from normative ethical analysis, the progress towards global bioethics is still challenged by the rejection of cultural considerations that do not fit into the mainstream ethical models.

Healthcare services continue to be administered discriminatively to the disadvantage of ethnical minorities and developing countries. Moreover, healthcare practices do not enjoy global acceptance because they are based on western ethical standards and ignore alternative moral foundations from nonwestern cultures. Therefore, resolving the existing and emerging ethical dilemmas and other healthcare challenges across the multicultural global society would benefit from concerted consideration of culturally-based ethical foundations.    

Notes

Bibliography

Beauchamp, Tom L., and James F. Childress. Principles of biomedical ethics. Oxford University Press, 2013.

Hellsten, Sirkku K. “Global bioethics: utopia or reality?” Developing World Bioethics 8, no. 2 (2008): 70-81.

Mbugua, Karori. “Respect for cultural diversity and the empirical turn in bioethics: a plea for caution.” Journal of medical ethics and history of medicine 5 (2012): 1-5.

Turner, Leigh. “Bioethics in a multicultural world: medicine and morality in pluralistic settings.” Health Care Analysis 11, no. 2 (2003): 99-117.

Turner, Leigh. “From the local to the global: Bioethics and the concept of culture.” The Journal of medicine and philosophy 30, no. 3 (2005): 305-320.

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[1] Leigh Turner, “From the local to the global: Bioethics and the concept of culture.” The Journal of medicine and philosophy 30, no. 3 (2005): 307.

[2] Sirkku K. Hellsten, “Global bioethics: utopia or reality?” Developing World Bioethics 8, no. 2 (2008): 71.

[3] Hellsten, “Global bioethics” 73.

[4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics (Oxford University Press, 2013), 10.

[5] Karori Mbugua, “Respect for cultural diversity and the empirical turn in bioethics: a plea for caution.” Journal of Medical Ethics and History of Medicine 5 (2012): 3.

[6] Mbugua, “Respect for cultural diversity,” 2.

[7] Leigh Turner, “Bioethics in a multicultural world: medicine and morality in pluralistic settings.” Health Care Analysis 11, no. 2 (2003): 103.

[8] Hellsten, “Global bioethics,” 80.

[9] Turner, “Bioethics in a multicultural world,” 100.