1. Philosophy 242 MEDICAL ETHICS
SUM2014, M-F, 9:40-10:40, SAV 156
INSTRUCTOR: BENJAMIN HOLE
OFFICE HOURS: M-F, 10:40-11 

2. Agenda Clicker Quiz Finish Sparrow: public funding
“Ethical Relativism in a Multicultural Society,” Ruth Macklin
Please set your Turning Technology Clicker to channel 41
Press “Ch”, then “41”, then “Ch”

3. Monday
In-class movie

4. Liberal Communitarian Both Neither
The following quote describes which model from the Sparrow article? “although culture remains an instrumental good, the good that it is instrumental in achieving is a particular conception of how a human life is best lived”
Liberal
Communitarian
Both
Neither

5. Macklin’s view is that values are culturally relative and, as such, cannot be analyzed from the perspective of ethical principles.
True
False

6. Ask patients if they wish to discuss their future care or options
Macklin considers how the (Navajo) cultural belief to “think and speak in a positive way” can be in tension with informed consent and the physicians duty of disclosure. According to Macklin, the best answer is to:
Respect the culture by withholding negative information from the disclosure
Respect importance of informed consent and disclose all necessary information, even if negative
Ask patients if they wish to discuss their future care or options
Disclose information to the patient’s family, but not to the patient

7. Robert Sparrow, “Defending Deaf Culture” Public Funding and Bionic Ears
Distributive Justice and Access to Healthcare

8. Objections to CIs Bionic Ears Liberal
might seem to favor BEs because the hearing world would offer a broader context for choice;
but this might not be the case from a deaf culture perspective …
Communitarian
objection from the perspective of deaf culture (based on deaf culture values)
but hearing culture would disagree based on their values
while this model would allow parents to choose either culture, bionic ears would inevitably kill deaf culture

9. Robert Sparrow
“When the government decides to devote substantial resources to the development of a technology that will allow some parents to ensure that their children avoid growing up as members of a particular culture (and which will thereby lead to the extinction of this culture), this clearly demonstrates a hostility to the values of the culture and a lack of respect for its members.”

10. Robert Sparrow Objection Responses
Not funding public research for CIs values deaf culture over hearing culture
Narrower context for choice in eliminating deaf cultural values and experiences
“Deaf culture is clearly threatened with destruction if a bionic ear is developed. Hearing culture(s) face no threat if it is not. Any public funding for research into a bionic ear therefore expresses a lack of respect for the Deaf, in a way that a refusal to fund it does not express a lack of respect for hearing culture(s).”

11. There should be public funding for bionic ears
Strongly Agree
Agree
Somewhat Agree
Neutral
Somewhat Disagree
Disagree
Strongly Disagree

12. “Ethical Relativism in a Multicultural Society”
Ruth Macklin

13. Multiculturalism “The Challenge of Cultural Relativism”
- James Rachels

14. Bioethics & Culture
“From the outset, the conceptual framework of bioethics has accorded paramount status to the value-complex of individualism, underscoring the principles of individual rights, autonomy, self- determination…”
Renée Fox

15. Bioethics & Culture
“The Spirit Catches You and You Fall Down explores the clash between a small county hospital in California and a refugee family from Laos over the care of Lia Lee, a Hmong child diagnosed with severe epilepsy.” (1997)

16. “Ethical Relativism in a Multicultural Society,” Ruth Macklin
“The multicultural composition of the United States can pose problems for physicians and patients who come from diverse backgrounds. Although respect for cultural diversity mandates tolerance of the beliefs and practices of others, in some situations excessive tolerance can produce harm to patients. Careful analysis is needed to determine which values are culturally relative and which rest on an underlying universal ethical principle.”

17. “Ethical Relativism in a Multicultural Society,” Ruth Macklin
In practice, determine:
Which values are culturally relative
Which values are universal (e.g., principles of bioethics)
Easy cases
Harder cases
FGM/female circumcision
lu Mien culture … burns on baby’s stomach

18. Perspectives of Healthcare Workers and Patients
Case
Question
“The patient and family are recent immigrants from a culture in which physicians normally inform the family rather than the patient of a diagnosis of cancer.”
“Should I adhere to the American custom of disclosure or the Argentine custom of withholding the diagnosis?”

19. “Ethical Relativism in a Multicultural Society,” Ruth Macklin
“To ask patients how much they wish to be involved in decision making does show respect for autonomy…”

20. Culture & Public Health
Case
Macklin’s Solution
“The ritual involves scattering mercury around the household to ward off bad spirits. Mercury is a highly toxic substance that can harm adults and causes grave harm to children.”
“Efforts to eradicate mercury sprinkling should enlist members of the community who agree with the public health position but who are also respected members of the cultural or religious group.”

21. Informed Consent & Culture
Case
Macklin
Navajo belief: “think and speak in a positive way”
But informed consent is negative …
“This situation is not difficult to resolve, ethically or practically …”
ASK “Navajo patients if they wish to discuss their future care or options, without introducing negative thinking.”

22. Obligations of Physicians
“African immigrant asks her obstetrician to perform genital surgery on her baby girl.”
“Loatian immigrant from the lu Mien culture brings her four-month-old baby to the pediatrician for a routine visit and the doctor discovers burns on the baby’s stomach.”

23. You are the physician. What is your ethical obligation
You are the physician. What is your ethical obligation? (no clicker poll)
“African immigrant asks her obstetrician to perform genital surgery on her baby girl.”
“Loatian immigrant from the lu Mien culture brings her four-month-old baby to the pediatrician for a routine visit and the doctor discovers burns on the baby’s stomach.”