MED105 Medical Ethics - Diversity and Culture (University of Nicosia Medical School Lecture Notes) PDF

MED105 - Medical Ethics Diversity and Culture Prof Costas S Constantinou 26.03.2024 Learning Objectives Explain why acknowledging patients’ diversity is important in medical practice Discuss the challenges and implications of practising medicine in a diverse and multicultural society Lecture Outline...

MED105 - Medical Ethics Diversity and Culture Prof Costas S Constantinou 26.03.2024 Learning Objectives Explain why acknowledging patients’ diversity is important in medical practice Discuss the challenges and implications of practising medicine in a diverse and multicultural society Lecture Outline Case 1. Human Rights 2. Diversity and Culture 3. Summary points Case A doctor visits a refugee housing to examine patients. One patient is a 25 year-old woman who seems unwell. She has cough, fever and yellowish sputum while coughing. The doctor diagnoses bacterial infection and tells the patient that she needs to take anti-biotics. However, the patient looks worried about this option and the doctor picks it up and explores further. The patient informs the doctor that she does not trust anti-biotics and that she wants to take something more natural. She clarifies that in her country people use melissa leaves to make tea. She believes that this will help her symptoms and she will eventually recover. She also tells the doctor that she had similar symptoms last year and she recovered a few days later. Case How is knowing about this patient’s perspective useful for the doctor? What skills should the doctor activate and why? How should the doctor approach the patient? What are the ethical implications from this scenario? Can the doctor override patient’s wish in this case? How could the doctor apply the 4 main principles of ethics in this case? 1. Human rights European Convention of Human Rights, some specific rights: Right to life Prohibition of torture Right to liberty and security Right to respect for private and family life Freedom of thought, conscience and religion Freedom of expression Prohibition of discrimination https://www.echr.coe.int/documents/d/echr/convention_ENG 1. Human rights How do these human rights relate to healthcare? How do they relate to diversity and culture? 2. Diversity and Culture What is diversity? What is culture? What are the advantages of being aware of your patient’s cultural background? How does culture relate to the four principles of medical ethics? 2. Diversity and Culture Scenarios A homeless person who drinks heavily, accepted to a hospital because he had a head injury after a fall and wants to self-discharge. A very religious person who followed an exhaustive fasting diet for a month and was rushed to the emergencies because she had collapsed. 2. Diversity and Culture What is diversity? Diversity: all the characteristics that make people unique, including cognitive and personality traits, lifestyle, cultural and religious background, sexual orientation, skills, experiences etc 2. Diversity and Culture What is culture? “A shared framework of values, beliefs, attitudes and behaviour which inform how people live their lives” It is very important as people are immersed into a culture from early age – it becomes 2nd natures 2. Diversity and Culture What is cultural competence? “The ability of a healthcare provider to function effectively in the context of cultural differences with the clients he or she serves.” 2. Diversity and Culture What is cultural competence? Three commitments: Accept the importance of culture Understand the influence of culture on health Develop interventions to provide the best possible care sensitive to cultural differences 2. Diversity and Culture Advantages of being aware of patients’ background Take history by considering cultural background Understand your patient’s perspective better and what works for them Show understanding Involve them in shared decision making Establish better rapport and trust, and ensure a good doctor-patient relationship Provide care based on the four main principles of ethics (see slide further below) 2. Diversity and Culture Scenario A patient who does not want to follow standard medical care and prefers alternative medicine. 2. Diversity and Culture The case of alternative/ complementary medicine (CAM) CAM involved products and practices that are not part of standard medical care (e.g. herbal medicine, meditation, acupuncture, massage, aromatherapy etc) Use of CAM has increased in the recent times 2. Diversity and Culture The case of alternative/ complementary medicine (CAM) Reasons for the use of CAM vary: positive health outcomes, trust, satisfaction, emphasis on the person and autonomy, more natural, deal with symptoms and improve quality of life etc. 2. Diversity and Culture Diversity, Culture and the four principles of medical ethics: Autonomy: self-rule, self-determination, thought, decisions and actions, freely and independently, which are often informed by culture Justice: Provision of care regardless of and in relation to cultural background Beneficence: do good to the patient considering individual circumstances and expectations, including cultural background and diversity Non-maleficence: do no harm to the patient and others, considering patient’s background 3. Summary Points People have rights which refer to specific entitlements for living in a society These rights reflect their need for healthcare and relate to diversity and culture Cultural competence is reflected on the four main principles of medical ethics Reading Bowman D (2011). The worried student’s guide to medical ethics and law. Chapter 10. Useful resource: https://www.echr.coe.int/documents/d/echr/convention_ENG