Applying Bioethics Across Cultures

Abstract

In our multicultural society, as well as when working internationally, emergency physicians (EPs) frequently see patients from cultures with communitarian or hierarchal structures. These groups may rely on traditional medical practices and view health care decisions through a lens other than patient autonomy. This leads to uncertainty about who can legitimately make decisions for patients and how to apply basic ethical principles. Because the commonly taught ethical principles (autonomy, beneficence, nonmaleficence, and distributive justice) are loosely defined, they provide little help to EPs when working with cultures that de-emphasize Western individualism. The case illustrates this complexity by detailing how visiting EPs dealt with leaders from a communitarian culture who demanded that a preteen be treated for a femur fracture by a traditional bone healer rather than with modern techniques. The Western-trained clinicians struggled with their ethical responsibility to protect the child's welfare within the social setting: What should beneficence look like in this situation and to whom did it apply? More broadly, this paper examines the bases on which health care professionals might justify overruling parental decisions. It also asks whether the lack of clarity of the most used Western ethical principles suggests the need to broaden clinical ethics education to include issues from other cultures and settings. Despite principlism's shortcomings, the ease of teaching ethics to health care providers by grouping basic philosophical ideas suggests that we continue to use its structure. As educators and practitioners, we should, however, expand the concept of principlism to better address ethical values and issues found across different cultures.