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