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Cultural Competence And Informed Consent In Health Care: “Confronting A Fetal Abnormality”

2116 words - 9 pages

“Kindness is the language which the deaf can hear and the blind can see”—Mark Twain. Health care is a profession that should epitomize kindness. Cultural competence, being open-minded to other cultures, is essential for effective and kind healthcare in our current multicultural population. This case analysis will examine the ethical dilemmas, moral theories, principles, alternative actions, and give a recommendation about the morally best action for the case “Confronting a fetal abnormality” by Karen Peterson-Iyer.

At first glance, this case might appear to be ethically sound and the conduct of Dr. Fox was that of a normal Western doctor. However, upon further analysis a large number of issues arise. The debate over whether to inform Leyla about her diagnosis in the above case arises from the conflicting cultural norms between Leyla’s family and the attending physician. One of the main ethical questions is: was it necessary for Dr. Fox to disregard the family’s wishes, religion and cultural norms. By refusing to wait for Mr. Ansari to pray, insisting on telling Leyla himself and interrupting Mrs. Ansari’s prayer, Dr. Fox was insensitive to the patient and family’s religious and cultural needs. Furthermore, insisting on telling Leyla himself, even though he noticed that she was stressed and her family informed him that she was too vulnerable at the time to handle her diagnosis, brings up issues of competence. There is also the issue of informed consent and confidentiality when Dr. Fox employs the friend as a translator without her or Leyla’s authorization. In addition, instead of providing options in the prognosis, Dr. Fox gives a recommendation and does not discuss any other possible prognoses.
Moral Theories and Principles:
Cultural competence is very much a utilitarian paradigm. Dr. Fox’s actions would be a violation of utilitarian custom, specifically the greatest happiness principle that actions are right in proportion they promote happiness, wrong if they bring forth the reverse of happiness. Dr. Fox’s actions did not weigh the interest of the majority; his actions did not result in the greatest amount of happiness to the greatest number of people. Furthermore, if we apply rule utilitarianism to the situation, wherein we accept a rule that states that doctors should disregard religious, cultural views and family wishes, this rule would never be accepted because it does not produce the most good for the most people. (Collier & Haliburton, 5-10)
We would come to similar conclusions that Dr. Fox’s actions were ethically unsound if we apply Kant’s categorical imperative; this test asks that we not make exceptions when doing what is morally required. Dr. Fox violated this by authorizing the friend as a translator and violating Mrs. Ansari’s autonomy. Under normal circumstances, in which there is no communication barrier, Dr. Fox would have informed the patient himself. In this situation, the patient’s, autonomy and confidentiality were...

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