A Case Study in Cross-cultural Health Care and Ethics

Abstract

Health care in the United States is increasingly delivered in cross-cultural contexts. Empathy, mutual regard, respect, and compassionate communication are necessary to achieve the highest standard of care for each individual. Moral and ethical perspectives on life and death, health, and health care are not universal but rather have their origins within culture and societal norms. In a cross-cultural context, “the right decision” may be seen differently depending on an individual’s cultural background, discipline, and type of education. This pediatric case study is intended to stimulate conversation on the need for culturally sensitive health care decision making and the shortcomings of a “one-size-fits-all” approach to bioethics in our increasingly interconnected world.

The 2023-2026 Hospice and Palliative Nurses Association Research Agenda

“…Research surrounding bioethical issues in PPHC-including issues around consent and assent, futility of care, "potentially inappropriate" interventions, and parent-child conflicts and family-provider conflicts concerning decision-making-is growing 109 ; however, current published literature typically includes ethics roundtables, expert opinions, and case reports. [109][110][111][112][113][114] Few empirical studies on bioethical issues in PPHC exist; the few empirical studies that exist focus on descriptive qualitative interviews of providers' and family members' perspectives on conflicts in the PPHC setting. 115,116 More work is needed to advance empirical research into the field of bioethics when caring for seriously ill children and their families.…”

“…A growing number of studies are examining communication and decision-making across cultures and languages. Several recent studies from Middle Eastern, African, and Latin American organizations have observed unique cultural values and beliefs that impact communication styles and decision-making preferences, 113,[144][145][146][147][148][149] but the actual decision-making experience relative to preferences may differ for non-White families compared with White families. 150 More research is also warranted on the effectiveness of translators and translation services, as well as on patient advocates in supporting families from different cultural, racial and ethnic, and linguistic backgrounds in communication and decision-making within pediatric palliative care.…”

“…Quality PPHC should also be grounded in bioethical principles, yet the bioethical challenges faced by PPHC patients, families, and providers are not well studied. Research surrounding bioethical issues in PPHC—including issues around consent and assent, futility of care, “potentially inappropriate” interventions, and parent-child conflicts and family-provider conflicts concerning decision-making—is growing 109 ; however, current published literature typically includes ethics roundtables, expert opinions, and case reports 109-114 . Few empirical studies on bioethical issues in PPHC exist; the few empirical studies that exist focus on descriptive qualitative interviews of providers' and family members' perspectives on conflicts in the PPHC setting 115,116 .…”

“…Similarly, we must also improve symptom assessment and management for minoritized, historically marginalized communities. Although evidence exists that disparities in care, systemic racism, discrimination, and limited English proficiency may significantly impact the quality of care and care outcomes, 102-126 the impact of such disparities on the symptom experience for children and families remains largely unknown. Significantly more research is needed to improve symptom assessment and management in these populations in particular.…”