Clinical ethics, cultural competence and importance of dialogue: a case study.

Authors: Gray, Ben.

Reference: J Clin Res Bioeth 2016, 7:1

Summarised on: 31 May 2018

The author argues there is a need to pay greater attention to cultural differences, and to employ bioethical mediation as a way to overcome differences between a doctor and patient. The author begins the paper by discussing cultural relativism, arguing that there may not be one universal ethic, and there is a need for medical professionals to take this into consideration when they have disagreements with patients.

The author uses the case study of an immunisation to illustrate his point. In the case study, a couple bring their two year old son into the clinic because he has infected sores on his leg. He is triaged by the practice nurse who notes that he has had no immunisations and refers him to the doctor for management. From a traditional perspective the doctor would treat the sores and then discuss the benefits of immunisation. However, the problem with this approach is that it is not patient centric, and it is overly paternalistic.

The author suggests doctors take an alternative approach, where they ask open-ended questions about why the couple have decided not to have their son immunised. It is important these questions are not based on judgement. Furthermore, there is a need for the GP to explain their own perspective on the issue. In the case study, the author asked the family if they knew much about immunisations and if they would like an explanation on why they are important.

Next, the author said it is important to achieve a shared understanding. In most cases this is acknowledging that both the GP and the parents have the child’s best interests at heart. The author suggests GPs need to take care not to assume that a parent’s disagreement is due to lack of education. Even if parents continue to feel apprehensive about immunisation, it might be best to suggest making a decision at a future date to see if they have changed their mind. By arranging an agreed management plan, a parent will feel listened to and valued.

In the case study, the parents did decide to have their child immunised. However, even if they hadn’t, at the very least the discussion would have improved the doctor/patient relationship. As the author points out GPs can’t force parents to immunise their children. The best way to increase the likelihood of immunisation is to improve the quality of relationships they have with their patients.

The author concludes the article by stating that as New Zealand is a diverse community there likely will be disagreements between doctors and patients. As such, doctors need to be willing to have open conversations with patients and to listen to their concerns. As the author writes ‘an approach that accepts and respects diversity and focusses on developing a trusting relationship is the most effective way to reach the best available resolution for clinical ethical dilemmas.’


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