The Nature of the Doctor-Patient Relationship by Pierre Mallia

Author:Pierre Mallia
Language: eng
Format: epub
Publisher: Springer Netherlands, Dordrecht

3.4.2 A Cultural Appraisal

The historical and epistemological analysis of autonomy can be said to be ‘vertical’ approaches insofar that they discuss temporal changes. What is taken here to be a ‘horizontal’ approach are contemporary changes or differences in interpretation across cultures.142 When one speaks of a multicultural society one usually implies individuals from many nations and diverse religious groups.143 Yet multicultural societies also have movements and groups which may be composed of individuals from diverse religions and nations but which have in common a trait which distinguishes them from the rest and which leads to problems and issues of their own and which therefore also appeal to principles and rights. These can be called subcultures, but here the term is used to encompass all.

Critics of ‘mainstream bioethics’ in the United States complain about the narrow focus on autonomy and individual rights arguing that most of the world embraces a value system that places the family, the community, or society as a whole above that of the individual person.144 Ruth Macklin acknowlegdes that the intent of autonomy was to counteract the predominant paternalism on the part of the medical profession and there was no presumption that a family-centred approach was contrary to individual rights.145 Yet Nelson146 argues that families need to be taken more seriously. In the United Kingdom, the social services take families to court for decisions parents take on behalf of their children. In some instances the child is forced to undergo operations to which the parents have not consented. Richard Nicholson147 argues that courts have viewed such cases as maltreatment of children by the parents; a fact which is not the case. He relates the story of a couple who refused a heart transplant to their second child because of fear of family breakdown in dealing with the child afterwards. They had already had one child which underwent the procedure and had to be giving a large regimen of medication daily.

Another issue is disclosure of information. Many cultures do not accept the predominant norm in the United States to disclose diagnosis of serious illness. Macklin argues that many interpret the principle of autonomy as having to tell the truth and thus impose onto the patient news which he or she may not want to know.148 She argues that this is largely a misinterpretation of autonomy and that a doctor who decides not to tell a patient a diagnosis recognising the patient’s fear of misunderstanding the diagnosis is still respecting autonomy.149 This shows how misinterpreted the principle of autonomy is.150 However when it comes to respecting autonomous decisions of people who hold cultural beliefs the question is not so simple. Such is the case for mercury sprinkling by Puerto Ricans (living in America) to send away bad spirits. They would argue that western people are imposing their form of scientific findings upon their religious practices.151 Clearly, even in the United States respect for autonomy needs to have a broad meaning but does promote reflections on cultural differences and a favour toward tolerance.

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