Case analysis

 An Ob/Gyn, has had many encounters with patients of various races, cultures, and religions, and these encounters have continued to mold his vision of healthcare within a pluralistic society throughout his long career.  One interesting encounter was with a young Chinese couple that was expecting a baby.  During the nine months of the pregnancy, all seemed to go smoothly.  The couple attended their regularly scheduled pre-natal visits, asked good questions, and generally followed his instructions.  When the expectant mother was at full term, he informed the couple that she needed to be admitted to the hospital because the baby was ready to be delivered. “No, bad luck… bad luck” they said.  “What do you mean, bad luck?” “Today’s date is bad luck; our child cannot be born today.”  He didn’t understand why they believed what they did; but nonetheless the couple left his office resolute on waiting at least until the following date to go to the hospital.  Unfortunately, the baby didn’t wait.  The expectant mother ended up delivering her child on the side of the road.  My father-in-law struggled to understand how this couple had seemed so reasonable to him, yet he failed to grasp why they had suddenly become obstinate when it came to the date of the delivery.  However, having lived through this experience, he learned to take a softer approach with patients and learned to have them communicate their expectations from an earlier point in time so as to not run into emergency situations like this in the future.

Modern societies are characterized by their plurality and multiculturalism where different religious and cultural convictions entail moral diversity. In many cases this leads to a confrontation of ideologies creating a confrontation between different believes. In health care, this clash is problematic because conceptual divergences surrounding the health of each social group lead to this confrontation, leaving the uncertainty of whether the religious/cultural conviction must prevail before the right of the person (Juarez & Chamorro 2003). How do we resolve fundamental cultural and religious differences about the foundations of medical morality? Is there a way to get to a compromise between human rights and cultural differences? (Marshall & Koeing, 2004).  How do we decide what is right and just? Is it possible to have social justice in a pluralistic world? 

This issue has been topic of our previous workshops. It has been questioned if it is possible to reconcile cultural diversity and human rights and duties, especially when cultural diversity is considered a universal value to be respected and promoted, and pluralism should be respected within a specific culture. Alberto Garcia argues that this reconciliation is possible using a realistic anthropology, based on an ontological reflection that supports a comprehensive and global vision about men and women, personhood, identity and liberty, beyond their cultural features and customs. With the aim of taking theory into practice, how would you apply Alberto’s method/theory in the presented case?

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Multiculturalism= Relativism?

Interesting essay:

TERRORISM IS NOT HATE by

Do you all think that multiculturalism necessarily leads to relativism?

 

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Scientists Slowly Reintroducing Small Group Of Normal, Well-Adjusted Humans Into Society

ITHACA, NY—In an ambitious attempt to revive a population long considered to be on the brink of extinction, scientists announced Friday they have slowly begun to reintroduce normal, well-adjusted human beings back into society.

According to officials at Cornell University …

http://www.theonion.com/article/scientists-slowly-reintroducing-small-group-normal-52632

 

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On religion and law

I thought this (and its links) might be of interest to some of us.

H-Net

Greetings John Lunstroth,
New items have been posted in H-Law.

Table of Contents

  1. Anna Su on How to Study Religion in Times of Crises [blog post]

Anna Su on How to Study Religion in Times of Crises [blog post]

by Nurfadzilah Yahaya

In the recently concluded ‘Roundtable on How to Study Religion in Times of Crises’ on June 28th 2016 organized by the Asia Research Institute at the National University of Singapore, Anna Su, Assistant Professor of Law at University of Toronto spoke of law and religion. Su is the author of Exporting Freedom:  Religious Liberty and American Power published by Harvard University Press earlier this year. The book which has been widely reviewed traces America’s exportation of religious freedom in various laws and policies enacted over the course of the twentieth century, in diverse locations and under a variety of historical circumstances including in the Philippines after the Spanish–American War, in Japan following World War II, and in Iraq after 2003. She also highlights how American officials spearheaded efforts to reform the international legal order by pursuing Wilsonian principles in the League of Nations, drafting the United Nations Charter, and signing the Helsinki Accords during the Cold War.

At the Roundtable, the question that was posed to the Su’s panel was “how do times of crises affect analytical frameworks, research methodologies, writing and presentation techniques in research on religion?” She tackles the question by first looking at how religion has been packaged in the twenty-first century. After September 11 2001, religion became the object of attention in the US – especially the subject of religion ‘abroad.’ The study of religion became separate from other kinds of philosophical engagements.  More specifically, scholarship on Islam often focuses on whether it is compatible with democracy, and anything that does not fit has to be reasoned away. Increasingly over the past decade, more phenomena became ascribed to religion. For one, recent moral panic has led to an obsession with determining whether the Islamic State (IS) is truly Islamic or not. This framework has also led to an oversized role of religion in politics. For example, the Rohingya in Myanmar have been primarily identified as Muslims above all.

Su draws our attention to the reproductive health statute that was passed in the Philippines in 2014 that requires government health centers to provide contraceptives and mandates sex education in schools. The Catholic Church in the Philippines opposed this move beforehand, and invoked Catholic doctrines instead of legal doctrines to support their position, much to the chagrin of legal scholars. Although it is tempting for some legal scholars to dismiss the Church’s arguments, Su argues that they could do more to bear in mind social and historical contexts in such situations.

In other words, it would really help for scholars to contextualize how people do things. Su points out that there is indeed a strong public demand for more access to legal knowledge currently. The website ShariaSOURCE which is launched by the Islamic Legal Studies Program at Harvard Law School provides a good example of an effective platform for the dissemination of legal knowledge. Historians, as memory activators, also contribute by providing knowledge about similar phenomena in the past that might explain or clarify the present.

 

 

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Cultural Competency in Healthcare: An Illness Narrative.

By: Claudia R. Sotomayor.

B. was born in Jalisco, Mexico. Her childhood was a typical Mexican lower-income childhood: deprived from many luxuries, but still happy and surrounded by a big and loving family. She attended school until middle school, and after that she helped with the household chores, and participated in the festivities and customs of her town. On a December 12, day of our Lady of Guadalupe, the town had the usual big party, full of music and good food. It was that day when she met N., who was visiting from the United States. N was an undocumented immigrant in the United States, who left his hometown in Mexico to search for a better future for his family. They fell in love and after eight months of knowing each other, they got married. N. wanted to come back to the United States, and so they did.

The experience of crossing the border without legal documents was a shocking experience for B.  “No se lo deseo a nadie” (I don’t wish that experience to anyone)-she said- “We went through the desert in May, so it was very hot during the day and very cold at night. We ran out of food and water, and we didn’t bring warm clothes for the night. We even saw a cadaver.  I cried I lot.”  They finally got to Arizona, where a van picked them up and took them to Chicago, which was a staging area for people to be taken to various states. N. and B. were the second to last to be “delivered” to Atlanta, Georgia.

Once they were settled in their new life in a modest trailer home, N. wanted to start a family, but B. had to break the bad news that according to her doctors in Mexico, she couldn’t have any kids due to severe polycystic ovaries.  He felt disappointed, but he never lost hope.  Two months later, she noticed that her period was late, but she never thought she was pregnant because she was generally irregular, and she lost a lot of weight during their crossing through the desert. At the time, she weighed 80 pounds and she is about 5’6‘’ tall.  N. immediately bought a pregnancy test, and then they found out they were expecting their first child.

She went to a clinic to start her prenatal care with a doctor who spoke Spanish. Due to her weight and hormonal problems, she was under a high risk pregnancy care. She got the prenatal vitamins and all the medication needed. She got an ultrasound by the 5th month of pregnancy, where everything looked normal. Her blood work and other tests were normal too.  Everything was going smoothly until the 6th month of pregnancy, when one day she started feeling very sleepy and tired. N. invited her to a restaurant, and during dinner she felt a sharp lower abdominal pain that radiated to her back and was increasing over time. She started vomiting and feeling dizzy. They called her doctor’s office, but it was closed, so they decided to go to the Emergency Room.  When they arrived, they tried to communicate their situation the best way they could in English, but there was no interpreter so another Hispanic woman that was at the ER offered her help.  Due her low weight, her belly wasn’t big so they didn’t believe she was pregnant.  After a long period of time, she was seen in the triage area, where they decided to admit her to the 4th floor (labor and delivery).  When she arrived to her room, the nurse that was in charge was an intimidating African-American woman. B. impression of the nurse was that she was dirty: “She had long dirty nails, a lot of rings, smelled funny, and she kept scratching her head”. The nurse told B. that she wasn’t pregnant but rather she was complaining over nothing, “just like a Mexican soap opera actress”, so she asked her for a urine specimen to do a pregnancy test. B. went to the bathroom, when suddenly an even greater pain came and then the baby was born. She asked for help, and the nurse, without gloves or previous sanitation of her hands, grabbed the baby girl, cut the umbilical cord and ran with her, leaving B. unattended on the bathroom floor. No one came back to help B. for a long time. She was feeling terrified because she didn’t hear the baby cry, and didn’t have the chance to see her.  Finally someone came to help B. When the nurse came back, she said to her: “You really made a mess on the floor, look at that.” B. felt scared, anxious, and terrified for her baby and for herself. It took a while for her to see her baby, and she was feeling desperate: “Like if my heart was going to stop beating.” When she finally saw her baby girl, she couldn’t believe how small she was: “Her head was soft, her legs were as long as my pinky.”  The doctors told her that her baby was in a bad shape, that she was blind, had a heart condition, and needed two blood transfusions. She agreed with any treatment needed to save the life of her baby.

B.’s health was improving, and even though she wasn’t feeling very well, she managed to pump breast milk to be able to feed the baby, but her body couldn’t produce enough milk and it only lasted for a month.  She spent as much time as she could with her baby. When I asked her how she felt, she said: “There were times when I thought I couldn’t do it any more, I wasn’t sure If I was going to be able to go to the NICU because the pain of seeing my daughter under those conditions. It broke my heart. Besides, I was all alone. I needed my mom and my family to give me support, but they couldn’t come because they didn’t have the means to do it. I didn’t know anyone but N., and he had to work.  I cried every day, almost all day long.”

The baby girl was in the NICU for two months. When she was discharged, a social worker came to B’s house to see their living situation and to see if there was a cause for the premature birth. There was not an apparent cause.

The experience was painful for her, but at the end she feels blessed and happy because her daughter is alive and doing well. She had to go to auditory therapy, and she has her cardiac condition under control. So far, the girl is living a normal life.  Although traumatic in the beginning, now she sees it as a precious moment where she learned how frail life is and how important it is to cherish it.When I asked her: “What do you think caused the problem?”  She answered: “the poor service at the ER, the incompetence of the nurse and the lack of doctors.” 

  1. Reflection

B’s story is tough to imagine. It made me feel aggravated and with an urgent need to do something to improve the cultural competence in health care services.

There are several healthcare issues in her story that should have been handled differently:

  1. No Interpreter was provided. The Hispanic lady offered her assistance as an interpreter, but even though it was a good gesture, it is not acceptable according to the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. An interpreter should be always be available either by phone, in person or video[i].
  2. Tervalon and Murray-Garcia shared a similar story where an African-American nurse “knew” that Hispanic patients overexpress their pain B’s nurse probably had the same course as the nurse in Tervalon and Murray-Garcia’s story, and as they noted: “The equating of cultural competence with simply having completed a past series of training sessions is an inadequate and potentially harmful model of professional development.”[ii] There is an urgent need for cultural humility workshops because having stereotypes could put someone’s life in risk.
  3. Patients are also biased, in this case is evident that B. was really intimidated by the nurse, and that probably exacerbated of the cultural shock. The nurse was probably biased by the “melodramatic Mexican” and Bertha by the “intimidating African-American”. It would be a good exercise for the staff and healthcare providers to see how patients are seeing them and how that impression affects their performance.
  4. Finally, it is important to address the elephant in the room: the probable bias caused by the fact that B. was an “Illegal” immigrant.  Immigrants -regardless their legal status- are specially vulnerable. According to the report on the Principle of Respect for Human Vulnerability and Personal Integrity of UNESCO’s International Bioethics Committee, the Migrants in general, whether within or between States, may find themselves marginalized, because of a lack of knowledge of local language and social and legal entitlements.  These situations of social vulnerability may lead to significantly increased exposure to risks caused by social exclusion [iii].

This story shows us the importance of having a department of multicultural affairs in hospitals, especially in those where the population is diverse, so that these cases can be addressed properly and that healthcare providers are constantly trained and reminded about the importance of being culturally competent and humble. It is always challenging to break barriers and ideas, and sometimes there are persons who are not willing to be open to new cultures.  However, healthcare institutions should promote cultural competence by making it a core value impressed upon all of its staff and providers.

References.

[i]US Department of Human and Health Services ( 2016) National CLAS Standards, available at:www.thinkculturalhealth.hhs.gov  (cited 6/21/2016)

[ii] Tervalon, M, and J Murray-García. “Cultural Humility Versus Cultural Competence: a Critical Distinction in Defining Physician Training Outcomes in Multicultural Education.”Journal of Health Care for the Poor and Underserved. 9.2 (1998): 117-25. Print.

[iii] International Bioethics Committee of UNESCO (2013) THE PRINCIPLE OF RESPECT FOR HUMAN VULNERABILITY AND PERSONAL INTEGRITY Report of the International Bioethics Committee of UNESCO (IBC) . Available at: http://unesdoc.unesco.org/images/0021/002194/219494E.pdf (Cited 6/21/2016)

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How has technology changed health care delivery over the last years?

By Marieli de los Rios

Technology used in health care has been rapidly increasing over the last years, but

now always for a noble cause. Though it is of great help in some cases, not in all.

Some uses of technology have improved health: more accurate diagnostics,

gadgets that improve the expectancy of life and even machines that can maintain

life for a prolongued period of time.

Some others, on the other hand, have brought up many questions: are they

intended to cure or are they intended to enhace? What the limit is between helping

and improving and just obbeying to subjective criteria on what humans should be

like and how long should they live?

The goal of medicine is to cure and, when not possible, to care; therefore

biotechnology is intended to aid this goals but when it is base on personal or

common desires it isa r risk of loosing this main purpose.

Another problem seems to be how expensive the uses of biotechnology can be. It

looks like, for some procedures, diagnostio or therapuetic, only those who have

enough money to pay for them have access, which can cause several damages to

the concept of justice since universal care must be addressed in all countries since

the right to preserve health is a human right, hence, universal; but expensive

materials and devices are just for some, not for all. In this view, this run towards

better technology may be dangerous and open the door to a major distance

between the ones that have the money and can pay and the ones that do not

leading to an abandonmemt of this second group.

Lastly, thinking of the improvements that technology can bring to our lifes, it turns

inevitable to think on the limitless of pur practices and creativity inventing new and

many more things each day. Even though this is something desirable, I post the

question referring to up to what extent should we keep inventing solutions for

sickness or for maintaning life more than hat is expected. Will there ever be any

limit to human intellligence? How long should we live from now on? The more we

create, the farthest we reach but how far is far?

The answer we give to this question will be conclusive: if we affirm that the sky is

the limit we also say that we do not have any ultimate essence that determines

what we are, therefore, perhaps we are not humans as we have thought for the last

decades, instead we are something else, something that can be changed over and

over depending on the circumstances and of history in itself. But if we answer that

there is a limit and it is located in the core of our esssence of human beings then

there may be some things that we can do better or create form scratch but these

might not be ethicallly justifiable because the would alter this essence that

determines what and who we are.

Ultimately, what are we? Humans? Or  let the future determine that!

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Religion and Violence

Religion and Violence

 

We have recently witnessed tragic events of violence in many parts of the world.  The massacres in Belgium, Paris, and Pakistan, the shooting in California, the tension in Jerusalem, and the terrorist attacks in Turkey, Egypt, Ivory Coast, and Tunisia are but a few examples.  While many of these assaults are attributed to fanatics of Islamic extremism, there is an unspoken thesis that their religious conviction is the seed of such violence.  People like Richard Dawkins and Christopher Hitchens would like to brand all religious beliefs under the same banner of intolerance and hate.

For instance, after 9-11, this slogan was posted on some billboards: “Science will fly you to the moon…  Religion will fly you into a building.”  Occasionally, the media would reinforce the idea that religion is outdated and the enemy of modernity.

While these accusations are mostly unfair, the challenge remains.  What is the relationship between religious beliefs and violence?  Are monotheistic religions more prone to violence than polytheistic or Asian ones?  Does belief in a One True God translate into proselytization and the intolerant suppression all other “false” gods?  How do we explain the different passages in the Bible or the Koran that advocate violence towards unbelievers?

It is important to address these assertions, as religions in general and monotheistic belief in particular is increasingly under the scrutiny of the secular world.

Monotheism and violence

The claim is that polytheistic religions, which already allow for the coexistence of different deities, are therefore more tolerant to different, ‘foreign’ conceptions of God, and hence less likely to militantly enforce their view on others.  Because of this oriental religions such as Buddhism and Hinduism are also more tolerant than monotheistic religions—Judaism, Christianity and Islam—which are historically marred with much fighting internally and externally.

At a first glance, there seems to be some veracity in this.  There are many conflicts described in the Old Testament between the Jews and other peoples, and then one can add the wars between Muslims and Christians in the Crusades, between Protestants and Catholics during the Reformation and the Thirty Years War, and the current situation in Israel and the Middle East.  Christians persecuting Jews, Muslims fighting against Jews, Shiites against Sunnis, and the al-Qaeda and ISIS jihad against the West seem to validate this claim.

However, upon closer examinations, history has shown that states with polytheistic religions are not at all benign.  The Roman Empire was very violent against minorities and intolerant towards Christianity in the first three centuries.  In the past century, we witnessed how several atheistic regimes have perpetrated the worst massacres and genocides in human history.

We need to look for the causes elsewhere. Samuel Huntington, who wrote The Clash of Civilizations in the early 1990s, claims that geopolitical conflicts will occur along the lines of cultures.  Thus, these conflicts are often equated as religious ones because most civilizations define themselves along religious lines.

Rabbi Jonathan Sacks’ recent book Not in God’s Name: Confronting Religious Violence provides further insight as to why it seems religions could be a source of division.  He believes that people commit atrocities because of an identity crisis.  Human beings are social by nature, and as a result of the herd mentality tend to define their world in terms of “us” and “them.” Religious identity is often the strongest social bond that distinguishes one group from another.  He states,

“Violence has nothing to do with religion as such. It has to do with identity and life in groups. 033Religion sustains groups more effectively than any other force. It suppresses violence within. It rises to the threat of violence from without. Most conflicts and wars have nothing to do with religion whatsoever. They are about power, territory and glory, things that are secular, even profane.  But if religion can be enlisted, it will be.”

This is confirmed by the fact that many of the suicide bombers and terrorists are not really religious. Their upbringings were not ultra-religious when they were recruited.  They are often radicalized through a process of socialization when given a new mission and meaning in life.

It is interesting to note that the current wave of terrorism is related to the secularization which began in the West and now spreading across the globe. Secularization was a process that began in the 18th century with the Enlightenment, where reason was seen as the alternative to religion as the unifying force of peoples.  By depriving society of the central role that religion plays in it, it was thought that people would unite under the standard of science and reason. The secular state becomes the norm of modern societies where individual freedoms are guaranteed.  After all, wasn’t “Liberté, Égalité, Fraternité” (‘Liberty, Equality and Fraternity’) the motto of the French Revolution and the cornerstone of modern democracy?

With secularization, however, relativism and individualism have become prevalent.  And once cultures and religions become relative, modern man is forced to live an individual existence unmoored from his cultural roots and traditions and isolated from community, church and extended families. Autonomy, individual rights and “spirituality” have replaced virtues, duties and religious practices.

Yet, the modern man is restless, constantly in search of meaning and identity before an array of possibilities. Many people find comfort in religious fundamentalisms and sects which offer a sense of meaning and spirituality in the West and in Islam.  This turn towards fundamentalism can at times result in violence.

Faith and Reason

One way to resolve this tension is to emphasize the possible harmony between reason and faith. On the one hand, the secularists need to learn that while human reasoning is the common basis and starting point of knowledge, it is not the only font.  On the other hand, religionists must also shun fideism which only blindly accepts revealed sources without being open to dialogue with different interpretations in a reasoned manner.

One area where this is applicable is in the field of theology and biblical exegesis, especially the difficult passages where violence seemed to be condoned in the Old Testament. Between the two extremes of literal interpretation and historicizing away the difficulties, a mature approach that balances faith and reason can help us to better understand the biblical message.  One such example is the International Theological Commission publication God the Trinity and the unity of humanity: Christian monotheism and its opposition to violence which concludes that, “The Christian faith, in fact, sees the incitement of violence in the name of God as the greatest corruption of religion.”

Faith and reason needs one another, to purify one another from potential pathologies.  For Christians, Christ being the Logos Incarnate means that faith itself cannot be illogical. Human reason finds its fulfillment in the new commandment of charity of Christ impels believers to enter into dialogue with others. A healthy tension of faith and reason that avoids the extremes of fideism and rationalism can therefore allow peaceful dialogue to take place among cultures, religions and the secular world.

This is a re-posting of http://ethosinstitute.sg/religion-and-violence-2/

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