Cultural relativism is the position that an act is right or wrong in so far as it is right or wrong for a particular culture. Here we suggest practical approaches to sensitively handling issues concerning different cultural backgrounds.
The affect of patients' cultural backgrounds on your decisions
Recognising that different cultures have different beliefs, many doctors and medical students express concern that the values underpinning medical ethics are exclusively western.
What authority, they ask, should these values have when treating patients whose values are different? Isn’t the moral importance given to patient autonomy, for example, an expression of the western emphasis on individual liberty?
If I am treating a patient from a culture that gives moral priority to the family, clan, or tribe, what am I to make of confidentiality and consent when it is clear that decisions are made collectively?
Although these questions touch on the vexed problem of cultural relativism – see below – in practice they can usually be addressed by sensitive and thoughtful handling.
What practical approach can you take?
A respect for patient autonomy can, for example, be thought of as an expression of a more primary ethical principle - respect for persons. By focussing on the needs, wants, and interests of individual patients, some of these apparently intractable difficulties can disappear.
If patients clearly indicate that they want others fully involved in their decision making, then where it is an autonomous choice, it is clearly deserving of respect. In this case, apparent cultural differences conceal deeper shared values.
Health and the relief of suffering are almost universally recognised as good things. When deeply held cultural values seem to impede their realisation, it is always worth exploring whether it is possible to find alternative ways to pursue them, ways that are more respectful of the values of the patient.
Although there can be a tendency in academic medical ethics to concentrate on extreme cases that throw moral principles into sharp relief, on a day-to-day basis, a great deal can be done to ensure that cultural differences do not impede the provision of appropriate person-centred care. A critical tool here is good communication.
Food for thought: cultural relativism
Cultural relativism is the position that an act is right or wrong in so far as it is right or wrong for a particular culture.
A cultural relativist would say, for example, that polygamy is neither absolutely right or wrong, merely right in some cultures and wrong in others. Expressions of cultural relativism often stem from the laudable desire to show sensitivity and respect to cultural differences and, in part, to atone for past episodes of cultural imperialism.
As a guide to action, cultural relativism is disappointing. It robs cultures of their ability to criticise themselves and to learn from others, nor is it very helpful where, as in most cultures, there are disagreements within the culture. On the health front, it also makes it difficult to criticise traditional practices that are widely regarded as harmful, such as female genital mutilation.