Observing Cultural Beliefs in a Health-Care Setting

Resume the identity of the fictional medical professional to help explore the importance of cultural diversity in a health care setting.

A Jewish nurse

Write a diary entry in which you recall specific memories where cultural sensitivities had to be taken into account, such as having to care for an individual whose religious beliefs impacted how a procedure was performed.     

2/27/2015

Tonight I pounder in thought as I think of yesterday’s encounter, unfortunately a patient of ours has become deathly ill and her family does not agree with American medical treatment  and her end of life is among her and the family. This is a lovely Korean family which I have learned many things about but I never thought about their religious beliefs I guess it never came up. The family wants to fly her home to Korea to die and the doctor is not approving of this nor is he giving medical clearance however, he did call hospice in for her to be placed in their care, the family refused as they felt it was their responsibility to care for her. (Shin K.; Shin C.; Blanchette P.) I wonder if she still alive; did they somehow get her back to Korea or has she passed, I guess I will never know.

Step back from this "diary" entry to define the most important reasons for cultural sensitivity and professionalism in the medical field.

The most important reason for cultural sensitivity and professionalism in the medical field are; the communication with the patient and the patient’s family can improve which this leads to understanding of one’s cultural and these factors can enhance the healthcare provided.

Cite important cases such as Prince v. Commonwealth of Massachusetts as examples of how the legal system has ruled on religious and cultural beliefs within a medical setting. 

Commonwealth v. Twitchell:

 In this case there was the most prominent of a series of criminal cases in the late 1980s and early 1990s where parents who were members of the Christian Science church were prosecuted for the deaths of children because they chose to treat their children’s medical conditions had been treated only by Christian Science prayer. (Case Brief Summary 2012)

In 1988, Massachusetts prosecutors charged David and Ginger Twitchell with manslaughter in death of their two-year-old son Robyn. (Case Brief Summary 2012)  It was declared their son had died due to a bowel obstruction which would have been easy to correct. (Case Brief Summary 2012) The defense the couple was going with are they were within their First Amendment rights to treat their son's illness with prayer and that Massachusetts had recognized this right in an exemption to the statute outlawing child neglect. (Case Brief Summary 2012)  The parents were convicted of involuntary manslaughter and were sentenced to ten years’ probation, the court also order that their remaining children visit the pediatrician regularly. (Case Brief Summary 2012)   The conviction was overturned by the Massachusetts Supreme Judicial Court on a legal technicality that the law is now clear: parents cannot sacrifice the lives of their children in the name of religious freedom. (Case Brief Summary 2012)    

Case Brief Summary. (2012) Commonwealth v. Twitchell. Retrieved From: http://www.casebriefsummary.com/commonwealth-v-twitchell/

Shin K.; Shin C.; Blanchette P. Health and Health Care of Korean –American Elders. Retrieved From: http://web.stanford.edu/group/ethnoger/korean.html

Diaries of the Medical Professional

Assume the voice of a medical professional, employed by your physician, writing in his or her diary. Reveal the character's personal beliefs on cultural, social, and ethnic diversity in health care, as well as the individual's ethical stance on a particular issue that is on his or her mind. 

My character is a Jewish nurse her personal beliefs on cultural, social and ethnic diversity in health care are: that human life is of infinite value and that preservation of life supersedes almost all other consideration. (Reform Judaism.org 2015) She also beliefs that God endowed humanity with the understanding and ability to become one with God in making a better world for all, she feels obligated to provide health care regardless of one’s social statues.(Reform Judaism.org 2015)

The physician she works for is not Jewish and has a belief if one cannot pay for his services he will not see them after a point, as his thought is no payment equals no paycheck. The nurse has an ethical issue with this, she completely understands that paying patients equals a paycheck and the paycheck is needed, her religious beliefs are; “if a doctor withholds services it is considered as shedding blood” she beliefs everyone is equal and entitled to treatment per her religion. (Reform Judaism.org 2015)

Allow this entry to serve as a case study. Recount a workday for this individual and the ethical dilemma the person was faced with. 

2/23/2015

Monday morning is always crazy in the office, and this Monday was no different other than the heart break I am stuck with. How will I sleep tonight as I feel I have disobeyed my faith? Today a young boy was turned away from seeing the doctor as he had an outstanding balance his mom had not paid and it is extremely past due. Why didn't I just pay the balance for them, I could have? I have failed you God and my community, why can’t I get the provider to see all are B’tselem Elohim in the image of God? My confusion runs rapid tonight, and I feel as I need to not just say a prayer as a remainder for my failure but for understanding for the provider I work for; Prayer for Peace.

How did the individual deal with the situation? What was his or her rationale for doing so?   

She stood by doing nothing during the process even though she felt brokenhearted. Her rationale for doing nothing appears to be the need for a paycheck and her faith lead her to pray for understanding of the provider.

Step out of this "diary" entry and return to your own writing voice. Did this individual assess his or her situation accurately? Why or why not? 

Yes, I feel she assessed her situation accurately as she felt her personal beliefs to be everyone deserves healthcare regardless and it is clear that the doctor refuses care if bills are in collections.

How did this individual's personal ethics influence his or her job performance? 

I don’t think the nurse’s personal ethics influences her job performance, however I think it influenced her emotional which may have led her to feel anger with herself or the provider as she feels she broke her beliefs.

Relate the person's case to the broader issues facing medical professionals every day, and some of the effective and ineffective approaches there are to dealing with ethically challenging scenarios related to cultural, social, and ethnic sensitivities.  

Cultural diversity can strengthen and broaden the health care delivery systems, examples of alternatives services and treatment modalities can be provided by other cultures. Most cultural both the patient and the provider use health care that is identified with in their cultural group and is a part of the cultural beliefs system. Nurses need to realize how each cultural understands and processes life, what each cultural considerers to be illness, health and maintenance of wellness, understand what causes certain cultural to think  illness are caused for a reason and understand that how to heal or find a cure can be different across the board. Nurses also bring their own beliefs and cultural and by putting ones cultural aside can sometimes make a difference to response of service. Policies and procedures need to be put in place to accommodate all backgrounds and beliefs as cultures differ and I believe a nurse is in a position to respond to cultural diversity and influence policies in her work place.

Reform Judaism.org. (2015) Jewish Life in Your Life: Jewish Views on Healthcare. Retrieved From: http://www.reformjudaism.org/jewish-views-health-care

Fremgen B. (2012) Medical Law and Ethics. Fourth Edition. Retrieved From: Pearson Education, Inc.

Get Your Moral Hands Off My Ethics Laws!

Highlight a specific case, such as the Baby M Case, and identify the legal, ethical, and moral issues presented in the case.
Surrogate Denied Custody of Child

 

Santa ANA, Calif. in 1990 there was a case where a woman agreed to be a surrogate for a couple and after delivering a baby boy she then wanted to keep him as her own or at least wanted parental rights. (Mydans S. 1990) This case made it to a superior court judge and her parental rights where denied, judge stated “two parents are better than three”.  (Mydans S. 1990)

The surrogate felt she had a legal right as she carried the baby boy for a full pregnancy; another aspect is there is a contract that both parties entered into and are required to uphold. (Mydans S. 1990) The ethical and moral points were no matter where a baby grows the genetics of this said baby is who he/she is. (Mydans S. 1990) This case along with similar ones brings to light the Baby M case from New Jersey in this case the surrogate was both a home and a genetic parent to the baby. (Mydans S. 1990)

Explain what criteria you used to determine whether the issues were legal, ethical, or moral or a combination of the three.

Back to the Calvert case the egg was from Mrs. Calvert and it was fertilized with Mr. Calvert sperm through Vitro and the only reason they could not conceive and carry a baby without a surrogate was Mrs. Calvert had a hysterectomy however her ovaries stilled functioned normally. (Mydans S. 1990)  The biggest thing is the young lady who became the surrogate did so under a contract which paid her for a service she agreed to provide. (Mydans S. 1990)

This case to me is a combination of legal, ethical and morals all wrapped into one. Who has the rights to the baby and under what circumstance warrants that right? The fact that a contract was written and signed not to mention the surrogate was paid, by her trying to gain any rights shouldn’t that be consider a breach of contract; she knew what she signed and she agreed to the terms by accepting payment.  (Mydans S. 1990)

The ethical and morals combination comes into play with the debate regarding nature versus nurture, because of today’s advances in medicine; what role does genetics play? Was the judge in the right by stating “the role of genetics plays a decisive role”? (Mydans S. 1990) 

 This case to me brings to light all the ways a baby or child becomes part of a family, be it by natural birth, surrogacy or adoption; is it genetics or environment? Is there a difference between being a surrogate or foster parent? For me the answer is they are the same; as a mom myself. I do not doubt that you can bond with a baby you carry for 9 months even if it is not yours biologically: no different than a foster parent I am sure does, however both have enter into a contract and understand it is in the purpose to help a family have a baby or take care of said baby or child after they are here.

Examine the common misconceptions of ethical values versus moral principles.  Clearly define the characteristics of each and provide real life examples to help students better relate.     

Ethical values: is a set of established principles governing behavior. (The Free Dictionary 2015)

An example of ethical values is not treating people differently because of their religions, ethnic backgrounds, genders, ages or disabilities.

Moral principles: are the principles of right and wrong that are accepted by an individual or social group. (The Free Dictionary 2015)

 An example of moral principles is; you should not take what does not belong to you.

Mydans S. (1990) The New York Times: Surrogate Denied Custody of Child. Retrieved From: http://www.nytimes.com/1990/10/23/us/surrogate-denied-custody-of-child.html

The Free Dictionary (2015) Retrieved From: http://www.thefreedictionary.com/

Highlight a particular medical news story from the last 10 years that posed both ethical and legal dilemmas, such as the Terri Schaivo case.  

 I have chosen a case of intersex babies, which is when a baby is born with XY male chromosomes but ambiguous genitals.

Reflect on the outcome of the case. With which side of the case did you agree with? What was the ethical and legal basis for your position?  

  

I agree with the activists on intersex infants. I also believe the outcomes are unclear and would encourage the parents and medical staff to educate everyone involved regarding the risks and possible negative outcomes of performing gender assignment surgery on an infant.

The ethical basis of my position on intersexuality is, when trying to define feminine or masculine anatomy, even if you use the word “ambiguous genitalia” instead of intersexuality you still have to decide how small a baby’s penis should be to be considered “ambiguous”.

The legal basis for my position is it is the parent’s decision to make and they should have all the proper information including both short term and long term risks and negative outcomes.

Present both sides of the case and objectively debate the ethical and legal issues being presented. 

Doctor’s side: by six weeks gestation both female and male embryos develop undifferentiated gonadal tissue and can produce either female or male genitalia. Intersex occurs because somewhere along the way an abnormality happens that affects the complete masculinization or with a female some virilizing influence that acts on the developing embryo. Intersex is a condition which affects about one out of every two thousand babies. Most are easy to identify through physical exam and the parents of a baby usually wants to know if it is a boy or girl when baby is born.

Activist side: There are many reasons why when doing gender assignment surgery the wrong gender could be picked. Some conditions to consider are; hypospadias, clitoromrgaly, Complete Androgen Insensitivity Syndrome, Congenital Adrenal Hyperplasia, micropenis, True Hermaphroditism. Studies show that recipients of early gender assignment are dissatisfied with the outcomes there are also many examples in both psychological and medical literature describing the problems linked to this type of procedure.