Transcript Document

SASOM CONGRESS
PRESENTATION:
CULTURE
&
ETHICS
Dr Blanche Pretorius
November 2013
Brief for & Overview of Presentation
 2 intersecting concepts: CULTURE & ETHICS
 APPROACH to presentation
1. Why all the fuss?
2. Definitional Aspects – brief
3. Can ethics be regarded as universal?
4. Attempt to identify some key aspects regarding ethics and
culture under following headings (trifocal view):
Culture and ethics --- more generally
Professional culture and ethics
Personal ethics
5. 3 Approaches to ethics
6. Concluding remarks about ‘transcultural’ competence
1.
Why all the fuss?
SA is a melting-pot of diverse cultures
Reality: not many (if any) countries globally where
cultures are homogenous
On the other hand, ethics are fundamental to the
moral fibre of any society/profession – as such
fundamental to health care & quality of care
Basic human rights enshrined in Constitution:
- both recognition of culture + health care
Professionals occupy positions of trust where there
is a power differential
CENTRALITY: Need to deliver culturally sensitive
care
Definitional aspects
Ethics
The study of principles relating to right and wrong
conduct
Values
A collection of guiding principles; what one deems
to be correct and desirable in life, especially
regarding personal conduct
Ethical: Of or relating to the accepted principles of
right and wrong, especially those of some
organization or profession
Definitional Aspects (contd.)
Ethical behaviour is based on written and unwritten
codes of principles and values held in society
Ethical principles and values serve as a guide to
behaviors on a personal level, within professions,
and at the collective organizational level
Business ethics involves personal, professional,
and corporate behaviors
Definitional Aspects (contd.)
 Culture is the characteristics of a particular group of people,
defined by everything from language, religion, cuisine, social
habits, music and arts
 Culture is a collective programming of the mind that
distinguishes the members of one group or category of people
from another
 Culture consists of patterns, explicit and implicit, of and for
behavior acquired and transmitted by symbols, constituting the
distinctive achievement of human groups, including their
embodiments in artifacts; the essential core of culture consists
of traditional ideas and especially their attached values; culture
systems may, on the one hand, be considered as products of
action, on the other hand, as conditioning influences upon
further action
Can ethics be seen as universal?
Kim (2005) cautions about reducing culture simply to
beliefs and practices based on ethnic origin
Ignores intra-variation of culture
Minimises unique and varying socio-cultural
contexts, values and beliefs
Maintains dominance of “normativity” – whose
“normal”
Three approaches to ethics
Beauchamp & Childress (1994)
Confucianism (Tao, 2000)
African metaphysics
4 Principles Approach
 Beauchamp & Childress (1994) of the view that common
cores underlie morality of all societies
 Proposed four principles as universal prima facie moral
principles in application
 4 principles of bioethics (Beauchamp & Childress, 2001):
i. Autonomy
ii. Beneficence
iii. Nonmalificence
iv. Justice
Principles which have been used as a common-sense
framework for decision-making in health care (clinical care &
research)
Shortcomings of Principles approach
Caring, virtue + other communitarian values more
difficult to place into an ethical decision-making
model
 Not adequate to explain:
- culturally diverse patients
- families' values and behaviors
2nd Alternative view: Confucianism
 Proposed by Tao (2000): Confucianism ------ foregrounds 3
core/cardinal moral values namely, ren, yi, and li
- Ren
Obligation of altruism and humaness – welfare of other
individuals/Concern for others ---- Familial self & thus familial
decision-making
- Yi
Upholding of righteousness and the moral disposition to do
good (Social/common good)
- Li
System of norms and propriety that determines how a person
should act properly in everyday life
Emphasis on human relations rather than on individual rights
as basis of morality (WE rather than I)
3rd Alternative view: African metaphysics
 4 main assumptions
1. Hierarchy of human beings
2. Concept of consubstantiailty:
------ cosmic unity/living holism
1. Notion of life vitality
---- all organisms have an endowed life force
---- centrality of participating in communal & social
relationships
1. Communal nature of personhood
----Person in relation to family & community
---- Implies social obligations/responsibilities [Notion of
ubuntu]
3rd Alternative view: African metaphysics
(contd.)
 Whilst African metaphysics centralises the notion of
communalism it does not deny individuality – rather it
supports a dialectic relationship between individual and
community
 Of the view of a dialogic self – individual in relationship with
community
 Guards against the 2 extreme stances of
On the one side of the continuum - humans as fully
autonomous
On the other side of the continuum – individuals as totally
communal beings
Inter-relationship between ethics domains
Three parts to ethics: personal, professional and
corporate/organisational
All three are intricately related
Each rests on slightly different assumptions
Personal Domain (1st of trifocal view)
First and foremost, professionals are human beings
They seek meaning for their lives through
relationships and enterprise (professional sphere) –
human beings want their lives to amount to
something. Because ethics is chiefly the discipline
of meaning
A subconscious pursuit
WORK ETHIC ….. What’s that?
Ethics & Professional Culture (2nd of
trifocal view)
Behaving ethically is at the heart of what it means to
be a professional
 It distinguishes professionals from others in the
marketplace
Thus, professions have a clear and streamlined set of
professional and ethical standards to guide the
behaviour of members
Codes of ethics ensure a PROFESSIONAL
CULTURE that all those we deal with professionals
have confidence in us
Professional Culture (contd.)
 Professional codes of ethics normally include foundational
elements related to knowledge competence
 On the other hand – relational aspects which incorporate
elements to guide interaction with our clients/customers
 Include areas such as:
 Respect for diversity/uniqueness of individuals
 Respect for values and beliefs of others – respect for
cultural diversity
 Some codes go even further to recognise effect of our own
values
 Suggests that codes recognise need for culturally
appropriate/sensitive practice ---- referred to as CULTURAL
COMPETENCE
Organisational Domain (3rd of trifocal
view)
Employers & Organisations responsible for:
- Promoting policies committed to eliminating
discrimination and disparities
- Congruence between employee behaviours,
management practices and the organisation’s policy
An emergent view to ethics & culture
 More recent thinkers are advocating for a balanced view or
DIALOGIC ETHICS
 Recognises that ethics in & of itself is a cultural process
 Dominant Westernised worldview:
- Person as rational, wholly autonomous and self-contained
- Individual relatively free to make decisions
- Focus is on the psychological attributes of the individual as
agent
An emergent view to ethics & culture
(contd.)
Emergent view challenges:
- Dominant decision-making model based instrumental
or purposive rationality
- Nature of knowledge as universal and timeless
- Preferred mode of knowing which is distant and
detached
- Knowledge as non-perspectival
Cultural Competence
 Banerjee (2012) refers to cultural competence as a
MANDATORY skill set in multicultural healthcare settings
 Conceptualises cultural competence as:
“a set of congruent behaviours, attitudes, and policies that
come together in a system, agency, or among professionals
and enables that system, agency or those professionals to
work effectively in cross-cultural situations”
Developing Cultural Competence/Dialogic
Ethics
 Maier-Lorentz (2008) advocates for individualised and
holistic care which she feels is achievable through 6 steps:
I.
II.
III.
IV.
V.
VI.
Awareness
Developing necessary skills
Knowledge of other cultures
Being open to encounters
Interest or Desire
Self-assessment or self-evaluation
Reference List
 Banerjee L. 2012. Cultural diversity and cultural
competence. SRNA NewsBulletin.
 Kim SH. 2005. Confucian bioethics and cross-cultural
considerations in health care decision making. Journal of
Nursing Law, Vol. 10 (1): 161-166.
 Maier-Lorentz MM. 2008. Transcultural Nursing: its
importance in nursing practice. Journal of Cultural Diversity,
Vol 15 (1): 37-43.
 Strahlendorf P. 2005. Professional Ethics.
http://www.bcsp.org/pdf/presentationsarticles/714_1.pdf
[Accessed 14 November 2013]
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