CROSS CULTURAL MEDICAL ETHICS

1. CROSS CULTURAL MEDICAL ETHICS Manfred Maier Dept. of General Practice, Medical University of Vienna

2. OVERVIEW • key terminology • recent data • patient autonomy • epidemiology of disease Dept. of General Practice, Medical University of Vienna

3. OBJECTIVES • participants should be able to • recall key aspects of medical ethics • deduce the influence of cultural context on the autonomy of the patient • to estimate the consequences of the cultural background for the prevalence of illness / disease Dept. of General Practice, Medical University of Vienna

4. MEDICAL ETHICS • access • beneficience - non maleficience • equality – justice/disparity (resource allocation ) • autonomy – informed consent • truthfulness (interpreter) Dept. of General Practice, Medical University of Vienna

5. Fragment of the Hippocratic Oath on Papyrus from the Third Century. Courtesy of Wellcome Library, London. Dept. of General Practice, Medical University of Vienna

6. EQUALITY Dept. of General Practice, Medical University of Vienna

7. JUSTICE - EQUALITY • The principle of justice requires that all people be treated equally. Dept. of General Practice, Medical University of Vienna

8. ACCESS Dept. of General Practice, Medical University of Vienna

9. ACCESS Dept. of General Practice, Medical University of Vienna

10. AUTONOMY • Autonomy of the patient means respect for his/her self – determination. Dept. of General Practice, Medical University of Vienna

11. AUTONOMY • the cultural background of a patient may influence • his/her way of living • his/her understanding of health / illness • his/her authority over his/her own life (informed consent) Dept. of General Practice, Medical University of Vienna

12. CULTURE AND DIET • classification of food / non food (frogs – cats – dogs) • sacred food – profane food (forbidden) • Hinduism (cows, animals) • Islam (pork/pig, fish with fins, ritually slaughtered-halal) • Judaism (pork/pig, fish with fins, kosher) • Sikhism (beef – pig, jhatka) • parallel food classifications • hot – cold (symbolic value) • medicines as food • social food (ritual aspects, social status, group identity) • infant feeding practices (breast feeding) Dept. of General Practice, Medical University of Vienna

13. DIETARY CULTURE AND HEALTH / DISEASE • malnutrition • rickets • anaemia (Asians) • overnutrition • cancer Dept. of General Practice, Medical University of Vienna

14. CULTURE AND GENDER • components of gender (genetic, somatic, psychological, social) • gender cultures / sexual behavior • medicalization (stress, menstruation, old age) • health (male- female) • reproduction and birth culture • fertility / infertility Dept. of General Practice, Medical University of Vienna

15. CULTURE AND PAIN • response to pain (private- public pain) • pain perception and pain tolerance • communication/presentation of pain • response to pain behavior Dept. of General Practice, Medical University of Vienna

16. CULTURE AND PAIN • pain behavior • beliefs about meaning and significance • context in which it occurs • emotions associated with it • social aspects • reaction to pain behavior • pain – “bad behavior” – guilt • attitudes shaped by society Dept. of General Practice, Medical University of Vienna

17. CULTURE AND MEDICATION • response to medication may vary • total drug effect (attributes, recipient, prescriber, setting) • placebo effect (culture bound) • abuse and dependence (alcohol, smoking, psychotropic drugs) • sacramental drugs (rituals, social interactions) Dept. of General Practice, Medical University of Vienna

18. RITUALS • “aspects of prescribed and repetitive formal behavior, which have no direct technological consequence and which are symbolic” • types of ritual • calendrical rituals • rituals of social transitions • rituals of misfortune Dept. of General Practice, Medical University of Vienna

19. CULTURE AND PSYCHIATRY • normality – abnormality • mental disorders (biological, social labeling or combined approach) • somatization (vague, particular organ) • culture bound psychological disorders (amok, hsieping, susto,..) • family role in the cause and cure of mental disease • prevalence in migrants Dept. of General Practice, Medical University of Vienna

20. PERCEPTIONS OF SOCIAL BEHAVIOR • controlled symbolic inversions religious states culture – bound -syndromes „normality“ abnormal normal „mad“ „bad“ uncontrolled Dept. of General Practice, Medical University of Vienna

21. economic situation family structure gender role marriage pattern sexual behavior pregnancy/birth practices child rearing practices body image alterations diet dress personal hygiene housing arrangements sanitation arrangements occupation religion funerary customs culturogenic stress leisure pursuits domestic animals self/lay treatment CULTURAL FACTORS IN EPIDEMIOLOGY Dept. of General Practice, Medical University of Vienna

22. STANDARDS FOR ACCREDITATION OF MEDICAL EDUCATION PROGRAMS LCME, September 2003 • ED-21. The faculty and students must demonstrate an understanding of the manner in which people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments. Dept. of General Practice, Medical University of Vienna

23. STANDARDS FOR ACCREDITATION OF MEDICAL EDUCATION PROGRAMS LCME, September 2003 • ED-22. Medical students must learn to recognize and appropriately address gender and cultural biases in themselves and others, and in the process of health care delivery. Dept. of General Practice, Medical University of Vienna

24. STANDARDS FOR ACCREDITATION OF MEDICAL EDUCATION PROGRAMS LCME, September 2003 • ED-23. A medical school must teach medical ethics and human values, and require its students to exhibit scrupulous ethical principles in caring for patients, and in relating to patients' families and to others involved in patient care. Dept. of General Practice, Medical University of Vienna

25. Dept. of General Practice, Medical University of Vienna