Culture and medical intervention

Journal of Clinical Ethics

Volumn 15, Issue 2, 2004, Pages 188-200

  Boylan, Michael ^a  

^a MARYMOUNT UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CLINICAL PRACTICE; CULTURAL ANTHROPOLOGY; DOCTOR PATIENT RELATION; HUMAN; MEDICAL DECISION MAKING; MEDICAL ETHICS; PHYSICIAN;

PROFESSIONAL PATIENT RELATIONSHIP;

ASIAN AMERICANS; ATTITUDE TO HEALTH; BREAST NEOPLASMS; CHINA; CORONARY DISEASE; FEMALE; GUATEMALA; HISPANIC AMERICANS; HUMANS; INFORMED CONSENT; MALE; NARRATION; PATIENT ACCEPTANCE OF HEALTH CARE; PROFESSIONAL-PATIENT RELATIONS; SOCIAL VALUES; UNITED STATES;

EID: 4844230727     PISSN: 10467890     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (63)

1. This depiction of the cultural frame is intentionally geared toward the patient. It is true that it is also important to examine the cultural background of the physician and other healthcare workers. However, this essay takes an intentionally bland position concerning the physician because when one sets out a variable (the patient) and a control (the physician), the dynamics of the variable are more apparent. In this case the variable is meant to be a patient whose cultural background can have clinical implications. If I were to set a frame of analysis for the physician as well, I am afraid that by creating two variables I would rob the force of the exposition of its clarity. As Jacques Derrida has said, the creation of interpretative frames is like going into a hall of mirrors. There is really no true stopping point. One could talk about the ethnicity of the narrator, and then of the author-as-narrator, and so on. Though there is some merit to also examining the physician's ethnic assumptions, such a treatment would be more appropriate to a book-length study than to an essay such as this.
2. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
3. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
4. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
5. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
6. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
7. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
8. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
9. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
10. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
11. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
12. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
13. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
14. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
15. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
16. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
17. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
18. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
19. The exploration of multicultural literacy in clinical practice is a developing area of research. Recent work includes K.K. Kundhal, "Cultural Diversity: An Evolving Challenge to Physician-Patient Communication," Journal of the American Medical Association 289, no. 1 (January 2003): 94; J.H. Tanne, "U.S. Medical Schools Should Consider Race in Admitting Students," British Medical Journal 325, no. 7364 (September 2002): 565; V. Tolo, "The Challenges of Change: Is Orthopaedics Ready?" Journal of Bone and Joint Surgery 84-A, no. 9 (September 2002): 1707-13; the special theme issue of Academic Medicine 77, no. 3 (2002), especially K. Fuller, "Eradicating Essentialism from Cultural Competency Education," A.R. Green, J.R. Betancourt, and J.E. Carrilo, "Integrating Social Factors into Cross-cultural Medical Education," and J. Drouin and P. Jean, "Educating Future Physicians for a Minority Population: A French-language Stream at the University of Ottawa"; the November/December 2001 issue of the Park Ridge Center Bulletin, especially L.M. Hunt, "Beyond Cultural Competence," D.B. McCurdy, "A 'Competence' We Can't do Without," and L. Barnes and G. Harris, "Changing Medical Landscape"; A.E. Núñez, "Transforming Cultural Competence into Cross-Cultural Efficacy in Women's Health Education," Academic Medicine 75 (2000): 1071-80; C. Brach and I. Fraser, "Can Cultural Competency Reduce Racial and Ethnic Health Disparities?" Medical Care and Research Review 57, supp. 1 (2000): 181-217; R.M. Mayberry, F. Mili, and E. Ofili, "Racial and Ethnic Differences in Access to Medical Care," Medical Care and Research Review 57, supp. 1 (2000): 108-45; J.E. Carillo, A.R. Green, and J.R. Betancourt, "Cross-Cultural Primary Care: A Patient-Based Approach," Annals of Internal Medicine 130 (1999): 829-34; P.M. Lantz et al., "Socioeconomic Factor, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults," Journal of the American Medical Association 279 (1998): 1703-08; and K.A. Culhane-Pera et al., "A Curriculum for Multicultural Education in Family Practice," Family Medicine 28 (1997): 719-23. Readers may look to note 22 for a discussion of issues regarding Asian cultures. The question of Guatemala is discussed in notes 3, 5, and 6. For another angle, see G.R. Gillett, "Medical Ethics in a Multicultural Context," Journal of Internal Medicine 238, no. 6 (1995): 531-37; L. Hipshman, "Attitudes towards Informed Consent, Confidentiality, and Substitute Treatment Decisions in Southern African Medical Students: A Case Study in Zimbabwe," Social Science and Medicine 49, no. 3 (1999): 313-28.
20. The dynamics of Hispanic cultures in the United States are of critical importance. Documented and undocumented peoples from these regions constitute a substantial minority of people residing in the country. For a brief discussion of these cultural issues as they relate to healthcare, see C.A. Howard, SJ. Andrade, and T. Byrd, "The Ethical Dimensions of Cultural Competence in Border Health Care Settings," Family and Community Health 23, no. 4 (2001): 36-49.
21. I will use the words Latina/Latino interchangeably with Hispanic. However, there is some dispute about the use of these terms. According to a poll of 1,200 readers of Hispanic Magazine, 65 percent preferred the term Hispanic to the term Latino. C. Granados, " 'Latino' versus 'Hispanic'," Hispanic Magazine (December 2000), http://www. hispanicmagazine.com/2000/dec, accessed 6 August 2004. However, one must note that the name of the magazine as a possible caveat. Kathie Neff Ragsdale suggested the term is rather one of social consciousness: the younger, more avant-garde prefer Latino; the more mature mainstream term is Hispanic. A second ground for demarcation is geographic versus linguistic. Neff Ragsdale suggests that Latino refers to the countries of Latin America, while Hispanic refers to speaking Spanish. K. Neff Ragsdale, " 'Hispanic' vs. 'Latino'," Eagle Tribune (Andover, Mass.), 23 May 1999. Others, such as the Hispanic Geneology Forum, emphasize two different linguistic origins: one from Latin Italy and one from España (aka the latinized Hispania). See the forum's website: http:/ /home.att.net/~Alsosa/whoarewe.htm. All three of these positions (social consciousness, geography versus linguistics, and linguistic origins) as well as further implications for social policy are explored in a collection of essays edited by M.C. Gutman, Perspectives on Las Américas: A Reader in Culture, History, and Representations (Malden, Mass.: Blackwell, 2003). Since there is no standard usage at the writing of this essay, I will try to remain neutral by using the terms interchangeably.
22. I will use the words Latina/Latino interchangeably with Hispanic. However, there is some dispute about the use of these terms. According to a poll of 1,200 readers of Hispanic Magazine, 65 percent preferred the term Hispanic to the term Latino. C. Granados, " 'Latino' versus 'Hispanic'," Hispanic Magazine (December 2000), http://www. hispanicmagazine.com/2000/dec, accessed 6 August 2004. However, one must note that the name of the magazine as a possible caveat. Kathie Neff Ragsdale suggested the term is rather one of social consciousness: the younger, more avant-garde prefer Latino; the more mature mainstream term is Hispanic. A second ground for demarcation is geographic versus linguistic. Neff Ragsdale suggests that Latino refers to the countries of Latin America, while Hispanic refers to speaking Spanish. K. Neff Ragsdale, " 'Hispanic' vs. 'Latino'," Eagle Tribune (Andover, Mass.), 23 May 1999. Others, such as the Hispanic Geneology Forum, emphasize two different linguistic origins: one from Latin Italy and one from España (aka the latinized Hispania). See the forum's website: http:/ /home.att.net/~Alsosa/whoarewe.htm. All three of these positions (social consciousness, geography versus linguistics, and linguistic origins) as well as further implications for social policy are explored in a collection of essays edited by M.C. Gutman, Perspectives on Las Américas: A Reader in Culture, History, and Representations (Malden, Mass.: Blackwell, 2003). Since there is no standard usage at the writing of this essay, I will try to remain neutral by using the terms interchangeably.
23. The question on where to draw cultural boundaries is a difficult one. Guatemala may be an overly restrictive window to access by itself. One contemporary study by Edward F. Fischer suggests that the Central American region, including all of the ancient Mayan empire, really creates the most identifiable unit for examination, see E.F. Fischer, Cultural Logics and Global Economics (Austin, Tex: University of Texas Press, 2002). For a recent overview of Guatemalan culture in its particularity, see M.E. Shea, Culture and Customs of Guatemala (Westport, Conn.: Greenwood, 2000).
24. L.R. Chavez et al., "Understanding Knowledge and Attitudes about Breast Cancer: A Cultural Analysis" Archives of Family Medicine 4 (1995): 145-52; C. Morgan, E. Park, and D.E. Cortes, "Beliefs, Knowledge, and Behavior about Cancer among Urban Hispanic Women," Journal of the National Cancer Institute Monographs 18 (1995): 57-63. Part of the problem may also be related to minority women's health. Recent studies of note that discuss cultural problems in treating Hispanic women who have had medical problems are discussed in P. McCartney, "Internet Resources on Minority Women's Health," American Journal of Maternal Child Nursing 27, no. 6 (Nov/Dec 2002): 355 and B. Riegel et al., "Standardized Telephonic Case Management in a Hispanic Heart Failure Population: An Effective Intervention," Disease Management and Health Outcomes 10, no. 4 (2002): 241-9.
25. L.R. Chavez et al., "Understanding Knowledge and Attitudes about Breast Cancer: A Cultural Analysis" Archives of Family Medicine 4 (1995): 145-52; C. Morgan, E. Park, and D.E. Cortes, "Beliefs, Knowledge, and Behavior about Cancer among Urban Hispanic Women," Journal of the National Cancer Institute Monographs 18 (1995): 57-63. Part of the problem may also be related to minority women's health. Recent studies of note that discuss cultural problems in treating Hispanic women who have had medical problems are discussed in P. McCartney, "Internet Resources on Minority Women's Health," American Journal of Maternal Child Nursing 27, no. 6 (Nov/Dec 2002): 355 and B. Riegel et al., "Standardized Telephonic Case Management in a Hispanic Heart Failure Population: An Effective Intervention," Disease Management and Health Outcomes 10, no. 4 (2002): 241-9.
26. L.R. Chavez et al., "Understanding Knowledge and Attitudes about Breast Cancer: A Cultural Analysis" Archives of Family Medicine 4 (1995): 145-52; C. Morgan, E. Park, and D.E. Cortes, "Beliefs, Knowledge, and Behavior about Cancer among Urban Hispanic Women," Journal of the National Cancer Institute Monographs 18 (1995): 57-63. Part of the problem may also be related to minority women's health. Recent studies of note that discuss cultural problems in treating Hispanic women who have had medical problems are discussed in P. McCartney, "Internet Resources on Minority Women's Health," American Journal of Maternal Child Nursing 27, no. 6 (Nov/Dec 2002): 355 and B. Riegel et al., "Standardized Telephonic Case Management in a Hispanic Heart Failure Population: An Effective Intervention," Disease Management and Health Outcomes 10, no. 4 (2002): 241-9.
27. L.R. Chavez et al., "Understanding Knowledge and Attitudes about Breast Cancer: A Cultural Analysis" Archives of Family Medicine 4 (1995): 145-52; C. Morgan, E. Park, and D.E. Cortes, "Beliefs, Knowledge, and Behavior about Cancer among Urban Hispanic Women," Journal of the National Cancer Institute Monographs 18 (1995): 57-63. Part of the problem may also be related to minority women's health. Recent studies of note that discuss cultural problems in treating Hispanic women who have had medical problems are discussed in P. McCartney, "Internet Resources on Minority Women's Health," American Journal of Maternal Child Nursing 27, no. 6 (Nov/Dec 2002): 355 and B. Riegel et al., "Standardized Telephonic Case Management in a Hispanic Heart Failure Population: An Effective Intervention," Disease Management and Health Outcomes 10, no. 4 (2002): 241-9.
28. Obviously, money is often an issue in hospitals that deal with indigent patients. However, too many variables can make any case more difficult. In the case of money, it is either the dominant factor or it isn't. Since ability to pay personally or with insurance or through a government program constitutes another sort of issue, I will leave this variable for a future essay.
29. Among some urban Hispanic communities in the United States, there is the belief that surgery is not an effective treatment for breast cancer. See Morgan, Park, and Cortes, note 6 above.
30. This is a rather controversial issue. What is at stake here (and in case two) is a sense of a universally recognized set of biomedical ethical principles. This sort of position has been advocated by G. Neitzke, "Global Aspects of Medical Ethics: Conditions and Possibilities," Wiemer Medizinische Wochenschrift 151, no. 9-10 (2002): 208-12; F.A. Chervenak and L.B. McCullough, "The Moral Foundation of Medical Leadership: The Professional Virtues of the Physician as Fiduciary of the Patient," American Journal of Obstetrics and Gynecology 184, no. 5 (2001): 875-9, discussion 879-89; E.D. Pellegrino, "Intersections of Western Biomedical Ethics and World Culture: Problematic and Possibility," Cambridge Quarterly of Healthcare Ethics 1, no. 3 (1992): 191-6.
31. This is a rather controversial issue. What is at stake here (and in case two) is a sense of a universally recognized set of biomedical ethical principles. This sort of position has been advocated by G. Neitzke, "Global Aspects of Medical Ethics: Conditions and Possibilities," Wiemer Medizinische Wochenschrift 151, no. 9-10 (2002): 208-12; F.A. Chervenak and L.B. McCullough, "The Moral Foundation of Medical Leadership: The Professional Virtues of the Physician as Fiduciary of the Patient," American Journal of Obstetrics and Gynecology 184, no. 5 (2001): 875-9, discussion 879-89; E.D. Pellegrino, "Intersections of Western Biomedical Ethics and World Culture: Problematic and Possibility," Cambridge Quarterly of Healthcare Ethics 1, no. 3 (1992): 191-6.
32. This is a rather controversial issue. What is at stake here (and in case two) is a sense of a universally recognized set of biomedical ethical principles. This sort of position has been advocated by G. Neitzke, "Global Aspects of Medical Ethics: Conditions and Possibilities," Wiemer Medizinische Wochenschrift 151, no. 9-10 (2002): 208-12; F.A. Chervenak and L.B. McCullough, "The Moral Foundation of Medical Leadership: The Professional Virtues of the Physician as Fiduciary of the Patient," American Journal of Obstetrics and Gynecology 184, no. 5 (2001): 875-9, discussion 879-89; E.D. Pellegrino, "Intersections of Western Biomedical Ethics and World Culture: Problematic and Possibility," Cambridge Quarterly of Healthcare Ethics 1, no. 3 (1992): 191-6.
33. Some might demur, saying that counter example 1 really supports the absolute value of human life, except that in this case it quantifies it such that if x is valuable, then 2x is twice as valuable. In this case we are involved merely in a calculation concerning saving one life or many. Utilitarians will take this tack, but I am aiming to focus on whether there are ever any good reasons for one to question whether the spy should continue to live. If there are, then my point is made.
34. For a discussion on this, see J. Savulescu and R.W. Momeyer, "Should Informed Consent be Based on Rational Beliefs?" Journal of Medical Ethics 23 (1997): 282-8.
35. See my discussion of the fact-value distinction (co-written with J.A. Donahue) in Ethics Across the Curriculum: A Practice-Based Approach (Lanham, Md.: Lexington Books, 2003), chap. 2.
36. The role of coherentism in modern epistemology is discussed by K. Lehrer, Theory of Knowledge (Boulder, Colo.: Westview, 1990); W. Sellars, Science, Perception and Reality (London: Routledge & Kegan Paul, 1963); N. Rescher, The Coherence Theory of Truth (Oxford: Clarendon Press, 1973); A. Plantinga, Warrant: The Current Debate (Oxford: Oxford University Press, 1993). It is the position of this author that, in the particular situation described in the text, a pragmatic coherentism would constitute the most workable solution to the problem of the "rationality of the patient." Thus, if the patient presents a series of propositions that are internally coherent and are grounded in an established cultural milieu, the physician should accept them as rational.
37. The role of coherentism in modern epistemology is discussed by K. Lehrer, Theory of Knowledge (Boulder, Colo.: Westview, 1990); W. Sellars, Science, Perception and Reality (London: Routledge & Kegan Paul, 1963); N. Rescher, The Coherence Theory of Truth (Oxford: Clarendon Press, 1973); A. Plantinga, Warrant: The Current Debate (Oxford: Oxford University Press, 1993). It is the position of this author that, in the particular situation described in the text, a pragmatic coherentism would constitute the most workable solution to the problem of the "rationality of the patient." Thus, if the patient presents a series of propositions that are internally coherent and are grounded in an established cultural milieu, the physician should accept them as rational.
38. The role of coherentism in modern epistemology is discussed by K. Lehrer, Theory of Knowledge (Boulder, Colo.: Westview, 1990); W. Sellars, Science, Perception and Reality (London: Routledge & Kegan Paul, 1963); N. Rescher, The Coherence Theory of Truth (Oxford: Clarendon Press, 1973); A. Plantinga, Warrant: The Current Debate (Oxford: Oxford University Press, 1993). It is the position of this author that, in the particular situation described in the text, a pragmatic coherentism would constitute the most workable solution to the problem of the "rationality of the patient." Thus, if the patient presents a series of propositions that are internally coherent and are grounded in an established cultural milieu, the physician should accept them as rational.
39. The role of coherentism in modern epistemology is discussed by K. Lehrer, Theory of Knowledge (Boulder, Colo.: Westview, 1990); W. Sellars, Science, Perception and Reality (London: Routledge & Kegan Paul, 1963); N. Rescher, The Coherence Theory of Truth (Oxford: Clarendon Press, 1973); A. Plantinga, Warrant: The Current Debate (Oxford: Oxford University Press, 1993). It is the position of this author that, in the particular situation described in the text, a pragmatic coherentism would constitute the most workable solution to the problem of the "rationality of the patient." Thus, if the patient presents a series of propositions that are internally coherent and are grounded in an established cultural milieu, the physician should accept them as rational.
40. I make this argument in my book, Basic Ethics (Upper Saddle River, N.J.: Prentice Hall, 2000), introduction.
41. I am thinking of cases such as lying: telling that which is untrue with intent to deceive another. Some cultural traditions assume that all speech acts are veridical; others put a higher value on compassion in cases where the truth will hurt someone. All parties in the latter culture know this so that it mitigates the condition of deceiving another because the social convention exists to promote human caring. Thus in culture #1 if a terminally ill family member asks, "Will I die?" one must always say, "yes." This is because the relevant subsumption is under the moral institution of lying. In culture #2 the answer to "Will I die?" is "no," because the loved one knows the pain of the opposite answer and wishes to make the last days of life more joyful. In this second culture, the proper subsumption is under the moral convention of loving compassion. Most moral principles (save for exploitation and murder) are subject to such social interpretation in their application.
42. I should note that some schools of legal positivism hold to this doctrine. For a discussion of these issues, see Basic Ethics, see note 14 above, chap. 8.
43. Hegel writes influentially on the master/ slave paradigm in Phenomenology of Spirit, trans. A.V. Miller (Oxford: Oxford University Press, 1977), 111-8.
44. The Stockholm syndrome in a domestic situation has been recently addressed by K. O'Leary and R.D. Roland, ed., Psychological Abuse in Violent Domestic Relations (New York: Springer, 2001). For a view into the difficulties of detecting and measuring this syndrome, see S.M. Auerbach et al., "Interpersonal Impacts and Adjustments to the Stress of Simulated Captivity: An Empirical Test of Stockholm Syndrome," Journal of Social and Clinical Psychology 13, no. 2 (1994): 207-11.
45. The Stockholm syndrome in a domestic situation has been recently addressed by K. O'Leary and R.D. Roland, ed., Psychological Abuse in Violent Domestic Relations (New York: Springer, 2001). For a view into the difficulties of detecting and measuring this syndrome, see S.M. Auerbach et al., "Interpersonal Impacts and Adjustments to the Stress of Simulated Captivity: An Empirical Test of Stockholm Syndrome," Journal of Social and Clinical Psychology 13, no. 2 (1994): 207-11.
46. Part of the problem with the issue of "what is the physician to do" is that physician training in medical ethics is still not where it needs to be - especially concerning cultural literacy. Medical schools need to engage far more in cultural literacy to train and nurture budding physicians to be sensitive to these ethical issues. This training needs to extend not only for the four years of medical school, but in residency as well. For a discussion of this, see J. Coulehan and P.C. Williams, "Vanquishing Virtue: The impact of Medical Education," Academic Medicine 76, no. 6 (2001): 598-605.
47. I have made a stab at describing this process in chapter 8 of Basic Ethics, see note 14 above.
48. The Argument for the Moral Status of Basic Goods: 1. Before anything else, all people desire to act. - Fact 2. Whatever all people desire before anything else is natural to that species. - Fact 3. Desiring to act is natural to Homo sapiens. - 1,2 4. People value what is natural to them. - Assertion 5. What people value they wish to protect. - Assertion 6. All people wish to protect their ability to act beyond all else. - 1,3,4,5 7. The strongest interpersonal "oughts" are expressed via our highest value systems: religion, morality, and aesthetics. - Assertion 8. All people must agree, on pain of logical contradiction, that what is natural and desirable to them individually is natural and desirable to everyone collectively and individually. - Assertion 9. Everyone must seek personal protection for her own ability to act via religion, morality, and/or aesthetics. - 6.7 10. Everyone, on pain of logical contradiction, must admit that all other humans will seek personal protection of their ability to act via religion, morality, and/or aesthetics. - 8,9 11. All people must agree, on pain of logical contradiction, that since the attribution of the basic goods of agency are predicated generally, that it is inconsistent to assert idiosyncratic preferences. - Fact 12. Goods that are claimed through generic predication apply equally to each agent and everyone has a stake in their protection. - 10,11 13. Rights and duties are correlative. - Assertion 14. Everyone has at least a moral right to the basic goods of agency and others in the society have a duty to provide those goods to all. - 12, 13 A slightly modified version of this argument in my forthcoming book, A Just Society (Lanham, Md.: Oxford: Rowman and Littlefield, 2004), chap. 3.
49. The discussion of the communitarian-individualism dynamics in traditional Chinese cultures has been a subject of interest of late. Some of the social institutions are complex and are by no means uniform. For a taste of this discussion, see J.B. Nie, "The Plurality of Chinese and American Moralities: Toward an Interpretive Cross-Cultural Bioethics," Kennedy Institute of Ethics Journal 10, no. 3 (2000): 239-60; M.C. Pang, "Protective Truthfulness: the Chinese way of Safeguarding Patients in Informed Treatment Decisions," Journal of Medical Ethics 25, no. 3 (1999): 247-53; on the medical ethos of China and Japan, J.R. McConnell, III, "The Ambiguity about Death in Japan: An Ethical Implication for Organ Procurement," Journal of Medical Ethics 25, no. 4 (1999): 315-21; D.F. Tsai, "Ancient Chinese Medical Ethics and the Four Principles of Biomedical Ethics," Journal of Medical Ethics 25, no. 4 (1999): 315-21; Z. Guo, "Chinese Confucian Culture and the Medical Ethical Tradition," Journal of Medical Ethics 21, no. 4 (1995): 239-46; R. Ishiwata and A. Sakai, "The Physician-Patient Relationship and Medical Ethics in Japan," Cambridge Quarterly of Healthcare Ethics 3, no. 1 (1994): 60-6.
50. The discussion of the communitarian-individualism dynamics in traditional Chinese cultures has been a subject of interest of late. Some of the social institutions are complex and are by no means uniform. For a taste of this discussion, see J.B. Nie, "The Plurality of Chinese and American Moralities: Toward an Interpretive Cross-Cultural Bioethics," Kennedy Institute of Ethics Journal 10, no. 3 (2000): 239-60; M.C. Pang, "Protective Truthfulness: the Chinese way of Safeguarding Patients in Informed Treatment Decisions," Journal of Medical Ethics 25, no. 3 (1999): 247-53; on the medical ethos of China and Japan, J.R. McConnell, III, "The Ambiguity about Death in Japan: An Ethical Implication for Organ Procurement," Journal of Medical Ethics 25, no. 4 (1999): 315-21; D.F. Tsai, "Ancient Chinese Medical Ethics and the Four Principles of Biomedical Ethics," Journal of Medical Ethics 25, no. 4 (1999): 315-21; Z. Guo, "Chinese Confucian Culture and the Medical Ethical Tradition," Journal of Medical Ethics 21, no. 4 (1995): 239-46; R. Ishiwata and A. Sakai, "The Physician-Patient Relationship and Medical Ethics in Japan," Cambridge Quarterly of Healthcare Ethics 3, no. 1 (1994): 60-6.
51. The discussion of the communitarian-individualism dynamics in traditional Chinese cultures has been a subject of interest of late. Some of the social institutions are complex and are by no means uniform. For a taste of this discussion, see J.B. Nie, "The Plurality of Chinese and American Moralities: Toward an Interpretive Cross-Cultural Bioethics," Kennedy Institute of Ethics Journal 10, no. 3 (2000): 239-60; M.C. Pang, "Protective Truthfulness: the Chinese way of Safeguarding Patients in Informed Treatment Decisions," Journal of Medical Ethics 25, no. 3 (1999): 247-53; on the medical ethos of China and Japan, J.R. McConnell, III, "The Ambiguity about Death in Japan: An Ethical Implication for Organ Procurement," Journal of Medical Ethics 25, no. 4 (1999): 315-21; D.F. Tsai, "Ancient Chinese Medical Ethics and the Four Principles of Biomedical Ethics," Journal of Medical Ethics 25, no. 4 (1999): 315-21; Z. Guo, "Chinese Confucian Culture and the Medical Ethical Tradition," Journal of Medical Ethics 21, no. 4 (1995): 239-46; R. Ishiwata and A. Sakai, "The Physician-Patient Relationship and Medical Ethics in Japan," Cambridge Quarterly of Healthcare Ethics 3, no. 1 (1994): 60-6.
52. The discussion of the communitarian-individualism dynamics in traditional Chinese cultures has been a subject of interest of late. Some of the social institutions are complex and are by no means uniform. For a taste of this discussion, see J.B. Nie, "The Plurality of Chinese and American Moralities: Toward an Interpretive Cross-Cultural Bioethics," Kennedy Institute of Ethics Journal 10, no. 3 (2000): 239-60; M.C. Pang, "Protective Truthfulness: the Chinese way of Safeguarding Patients in Informed Treatment Decisions," Journal of Medical Ethics 25, no. 3 (1999): 247-53; on the medical ethos of China and Japan, J.R. McConnell, III, "The Ambiguity about Death in Japan: An Ethical Implication for Organ Procurement," Journal of Medical Ethics 25, no. 4 (1999): 315-21; D.F. Tsai, "Ancient Chinese Medical Ethics and the Four Principles of Biomedical Ethics," Journal of Medical Ethics 25, no. 4 (1999): 315-21; Z. Guo, "Chinese Confucian Culture and the Medical Ethical Tradition," Journal of Medical Ethics 21, no. 4 (1995): 239-46; R. Ishiwata and A. Sakai, "The Physician-Patient Relationship and Medical Ethics in Japan," Cambridge Quarterly of Healthcare Ethics 3, no. 1 (1994): 60-6.
53. The discussion of the communitarian-individualism dynamics in traditional Chinese cultures has been a subject of interest of late. Some of the social institutions are complex and are by no means uniform. For a taste of this discussion, see J.B. Nie, "The Plurality of Chinese and American Moralities: Toward an Interpretive Cross-Cultural Bioethics," Kennedy Institute of Ethics Journal 10, no. 3 (2000): 239-60; M.C. Pang, "Protective Truthfulness: the Chinese way of Safeguarding Patients in Informed Treatment Decisions," Journal of Medical Ethics 25, no. 3 (1999): 247-53; on the medical ethos of China and Japan, J.R. McConnell, III, "The Ambiguity about Death in Japan: An Ethical Implication for Organ Procurement," Journal of Medical Ethics 25, no. 4 (1999): 315-21; D.F. Tsai, "Ancient Chinese Medical Ethics and the Four Principles of Biomedical Ethics," Journal of Medical Ethics 25, no. 4 (1999): 315-21; Z. Guo, "Chinese Confucian Culture and the Medical Ethical Tradition," Journal of Medical Ethics 21, no. 4 (1995): 239-46; R. Ishiwata and A. Sakai, "The Physician-Patient Relationship and Medical Ethics in Japan," Cambridge Quarterly of Healthcare Ethics 3, no. 1 (1994): 60-6.
54. The discussion of the communitarian-individualism dynamics in traditional Chinese cultures has been a subject of interest of late. Some of the social institutions are complex and are by no means uniform. For a taste of this discussion, see J.B. Nie, "The Plurality of Chinese and American Moralities: Toward an Interpretive Cross-Cultural Bioethics," Kennedy Institute of Ethics Journal 10, no. 3 (2000): 239-60; M.C. Pang, "Protective Truthfulness: the Chinese way of Safeguarding Patients in Informed Treatment Decisions," Journal of Medical Ethics 25, no. 3 (1999): 247-53; on the medical ethos of China and Japan, J.R. McConnell, III, "The Ambiguity about Death in Japan: An Ethical Implication for Organ Procurement," Journal of Medical Ethics 25, no. 4 (1999): 315-21; D.F. Tsai, "Ancient Chinese Medical Ethics and the Four Principles of Biomedical Ethics," Journal of Medical Ethics 25, no. 4 (1999): 315-21; Z. Guo, "Chinese Confucian Culture and the Medical Ethical Tradition," Journal of Medical Ethics 21, no. 4 (1995): 239-46; R. Ishiwata and A. Sakai, "The Physician-Patient Relationship and Medical Ethics in Japan," Cambridge Quarterly of Healthcare Ethics 3, no. 1 (1994): 60-6.
55. Obviously these risk assessments are rather subjective and will vary with the advances in medical practice. However, for our purposes it is enough to admit that treatments have various risks and rewards that in some way must be discussed with the patient.
56. Resultant risk here means the risk of death after one of the paths (A-D) is followed.
57. For a wide-ranging discussion of some of the causal relationships among the individual-family-society in contemporary America, see D.S. Browning and G.B. Rodriguez, Reweaving the Social Tapestry: Toward a Public Philosophy and Policy for Families (New York: Norton, 2002).
58. W.D. Hamilton is one of the earliest proponents of kin selection as an alternative to Sewall Wright's group selection model, see "The Evolution of Altruistic Behavior," American Naturalist 97 (1963): 354-356 and "The Genetical Evolution of Social Behavior I," Journal of Theoretical Biology 7 (1964): 1-16; "The Genetical Evolution of Social Behavior II," Journal of Theoretical Biology 7 (1964): 17-52. Two other scholars of note in this tradition are John Maynard Smith and George Price. See J.M. Smith, "How to Model Evolution," in The Latest on the Best: Essays on Evolution and Optimality, ed. J. Dupré (Cambridge: Cambridge University Press, 1987), pp. 119-31 and G. Price, "Selection and Covariance," Nature 277 (1970): 520-1.
59. W.D. Hamilton is one of the earliest proponents of kin selection as an alternative to Sewall Wright's group selection model, see "The Evolution of Altruistic Behavior," American Naturalist 97 (1963): 354-356 and "The Genetical Evolution of Social Behavior I," Journal of Theoretical Biology 7 (1964): 1-16; "The Genetical Evolution of Social Behavior II," Journal of Theoretical Biology 7 (1964): 17-52. Two other scholars of note in this tradition are John Maynard Smith and George Price. See J.M. Smith, "How to Model Evolution," in The Latest on the Best: Essays on Evolution and Optimality, ed. J. Dupré (Cambridge: Cambridge University Press, 1987), pp. 119-31 and G. Price, "Selection and Covariance," Nature 277 (1970): 520-1.
60. W.D. Hamilton is one of the earliest proponents of kin selection as an alternative to Sewall Wright's group selection model, see "The Evolution of Altruistic Behavior," American Naturalist 97 (1963): 354-356 and "The Genetical Evolution of Social Behavior I," Journal of Theoretical Biology 7 (1964): 1-16; "The Genetical Evolution of Social Behavior II," Journal of Theoretical Biology 7 (1964): 17-52. Two other scholars of note in this tradition are John Maynard Smith and George Price. See J.M. Smith, "How to Model Evolution," in The Latest on the Best: Essays on Evolution and Optimality, ed. J. Dupré (Cambridge: Cambridge University Press, 1987), pp. 119-31 and G. Price, "Selection and Covariance," Nature 277 (1970): 520-1.
61. W.D. Hamilton is one of the earliest proponents of kin selection as an alternative to Sewall Wright's group selection model, see "The Evolution of Altruistic Behavior," American Naturalist 97 (1963): 354-356 and "The Genetical Evolution of Social Behavior I," Journal of Theoretical Biology 7 (1964): 1-16; "The Genetical Evolution of Social Behavior II," Journal of Theoretical Biology 7 (1964): 17-52. Two other scholars of note in this tradition are John Maynard Smith and George Price. See J.M. Smith, "How to Model Evolution," in The Latest on the Best: Essays on Evolution and Optimality, ed. J. Dupré (Cambridge: Cambridge University Press, 1987), pp. 119-31 and G. Price, "Selection and Covariance," Nature 277 (1970): 520-1.
62. W.D. Hamilton is one of the earliest proponents of kin selection as an alternative to Sewall Wright's group selection model, see "The Evolution of Altruistic Behavior," American Naturalist 97 (1963): 354-356 and "The Genetical Evolution of Social Behavior I," Journal of Theoretical Biology 7 (1964): 1-16; "The Genetical Evolution of Social Behavior II," Journal of Theoretical Biology 7 (1964): 17-52. Two other scholars of note in this tradition are John Maynard Smith and George Price. See J.M. Smith, "How to Model Evolution," in The Latest on the Best: Essays on Evolution and Optimality, ed. J. Dupré (Cambridge: Cambridge University Press, 1987), pp. 119-31 and G. Price, "Selection and Covariance," Nature 277 (1970): 520-1.
63. My depiction of a normative standard for worldviews is set out in the Personal Worldview Imperative: "All people must develop a single comprehensive and internally coherent worldview that is good and that we strive to act out in our daily lives." This imperative is described in chapter 8 of Basic Ethics, see note 14 above, and, in the biomedical realm, in M. Boylan and K.E. Brown, Genetic Engineering: Science and Ethics on the New Frontier (Upper Saddle River, N.J.: Prentice Hall, 2002), 6-8, 121-122, 132, 141, 146, 150-151, 154-155, 167.