On the subject

NB: In the following post I critique the workshop guidelines, for which I was partially directly responsible. I think at the time none of us realized how our new procedures would work in practice! ***

The attempt to keep us on all topic during the workshop was welcomed. The announcement of a topic would ordinarily be sufficient to justify the welcome, but there were contributions that seemed to be off-topic, and in response comments that suggested the apparently off-topic interventions were inappropriate. As a contributor of one or two of these off-topic contributions, I will offer two reasons why they were necessary in spite of the topic. There is a historical reason they are necessary and a formal reason. Moreover, such explanations were explicitly sanctioned by the instructions.

Historical reason

Historically the workshop has picked its topics without too much regard to past topics, except to avoid topics we have already covered. There would seem to be no principles for picking topics, other than that they be “bioethical” in the sense meant in the UNESCO Universal Declaration on Bioethics and Human Rights. 

Given the extraordinary philosophical distance between the Eastern traditions and the religions (Christianity and Islam), in theory and practice, there is an equally compelling need to address the grounds for communication between the two before comparing approaches to the posed ethical subjects. How can we speak of convergence unless we have established an agreed on means to communicate between the two? I will illustrate some of the issues in other responses [blog posts] to the workshop, but for now will refer you to work I did on this in response to the Hong Kong workshop here, here and here.

Rawls and many others after him have proposed procedural means for defining a common space in which agreement can be reached, but there are 2 problems with procedural approaches: they imply a base level of commonality, at least enough to identify the problem; and the stated goal of the workshop is to reach substantive convergence. I argue in my earlier analysis that there are virtually no substantive grounds unless the religions bracket their dependence on a strict, legalistic, unidirectional, unidimensional Augustinian theory of history. That theory of history supports scientific, positivist, materialist, physicalist universalism, as opposed to the looser and holistic universalism of Aristotle (kathalou). My approach is intended to speak to the religions because they both depend on this Augustinian world-view, and they both justify their jurisdictional approaches on it. Moreover, Augustinian history and its universalist consequences lead to a much narrower vision of reality, and that narrowness excludes so much it does not make sense to shoehorn the larger and more flexible visions of reality found in the East into the narrow confines of the religious west. We can see the extremely negative consequences of this in colonialism and all of its conceptual apparatus.

The notion that these kinds of arguments are best worked out in religious theory, sociology or anthropology conferences does not comprehend the broad scope of the workshop, nor the interdisciplinary nature of ethics in general. This is understandable, as one of the unexplored issues with the workshop is the difference between ethics and religion. Participants are to approach the ethical topic from within religious traditions. Well, the notion there are religions is seriously undertheorized for us at this point, and then the follow-on notion that religious perspectives on scientific acts are ethics and not theology is also undertheorized. Are we supposed to be doing ethics or theology? And these are only problems in the western traditions, since there are no religions in the east, and no distinction between ethics and religion. In other words, our conceptual remit is inherently very broad and interdisciplinary, and not very well articulated as a practical matter.Unsanctioned, as it were, attempts to address some of these lacunae must be tolerated and digested as part of the ongoing project.

Formal reason

Here are what the instructions for the participants said:

PAPER GUIDELINES
Recognized thought leaders from diverse religions and cultures will be invited to
analyze, write a paper and discuss about these bioethical questions and their
anthropological implications:

  1. using their religious and/or cultural authoritative texts and belief sources;
    2. organized around the workshop´s featured key questions
    3. within the global bioethics paradigm of human rights and duties, articulated by
    the Universal Declaration of Human Rights (1948) and the UNESCO
    Declaration on Bioethics and Human Rights (2005).
    4. engaging questions concerning potential bridge concepts as well as
    ‘problematic’ dissimilarities with suggestions on how they might be managed to
    keep the conversation focused with the aim of fostering convergence and
    cooperation

KEY QUESTIONS TO BE ADDRESSED BY THE PAPERS

  1. How does my cultural tradition take into account genetics and epigenetics?
    What is the understanding of neuroscientific developments?
    2. Can genetic and brain interventions, drugs, and devices beyond therapeutic
    use be applied that might alter a patient’s personality, identity, and/or
    behaviors?
    3. Are genes and the brain taken into account in order to explain human nature
    and behavior better? Why or why not?
    4. What is the relationship between DNA, brain, mind, and soul?
    5. How can genetic and neuroscientific research and their clinical applications be
    cultivated to benefit developing countries?

The instructions and questions confuse, under-specify and over-specify the topic. 

Confusion:

The questions are supposed to be “bioethical” questions. What if the tradition does not have a bioethics? What if the very concept is necessarily contested if the historical tradition is to be accounted for substantively?

Both the notions of religion and culture are western notions, and both are used in a scientific way (i.e., 19th century social sciences way). This is emphasized by the requirement that “anthropological” implications be taken into account.

The words “anthropological” and  “science” have quite different connotations for English and non-English speakers, especially Europeans, for whom the two words have meanings more associated with their etymological origins, whereas English speakers hear social science (anthropology) and positivist science concepts. If we are to move towards convergence, we must be sensitized to these kinds of linguistic issues.

Reference to “religious and/or cultural authoritative texts and belief sources” is entirely framed in western concepts. The eastern participant could just ignore the confusing prompt and look beneath the literal meaning, and that would be generally appreciated but in so doing that participant continues the western reification of the project. That reification is exactly what the project hopes to overcome in its broadest goals though, so “going along to get along” does not enable the more substantive dialogue being called for.

Under-and over-specification

The references to entities such as genes, brain, epigenetics, mind, body, drugs, devices, DNA, human nature, behavior, personality, identity, soul, clinic, and developing countries put the topic(s) into outer space, but mostly a western outer space. Anyone who has studied the sociology and anthropology of science is well aware of the socially constructed meaning of these terms, or at the very least that these terms are contested sites in and of themselves. On top of that, the distinction between technology and science has to be recognized. One of the things that happens in the global south and east is the adoption of technology with a simultaneous rejection of the science. In other words, science is recognized as the philosophy with which the understanding or meaning of the technology is framed. 

We solved some of this problem at the end of the workshop by deciding to make a few scientific articles available prior to the workshop so everyone can be on the same page about the actual technology/science.

The references to specific physicalist entities such as genes and the brain overspecify because they are too narrow, and overspecify because they are too broad. The philosophical meaning of the gene remains undefined. The reference will be read by most as a reference to a physical fact and nothing more. Yet others will read the reference as to a profound philosophical discourse between materialist/physicalist philosophies of life and more open textured, non-physicalist philosophies. Reference to the gene without a corresponding explanation of its relevance is an under-specification because the facticity of the gene overwhelms its philosophical dimension. Without context it is too specific. Reference to “mind and soul” over-specify because these terms are intended to refer to all possible non-physicalist, or potentially non-physicalist philosophical entities. These are English or western terms that have virtually little or no meaning in eastern philosophical traditions, most of which are so much more sophisticated than western Enlightenment “psychologies” or philosophies of the person, which is what the references are to, as to make them seem barbaric. The real western or religious bodies of thought that should be compared, once foundations for such comparison are established, are the theologies (or perhaps systematic philosophies such as Hegelianism). Consciousness, which is an English term not used for some reason, would have gone much further to enable a question for both east and west, as there are eastern cognates for consciousness, imo. “Mind and soul” are not robust enough, they are used as comprehensive terms but they do not reference enough conceptual territory to make them useful in an undertaking that seeks to bridge east and west.

The foregoing are reasons enough an eastern participant might feel compelled to address fundamental issues, rather than the specific questions. Moreover, there is explicit remit to address foundational questions in Paper Guidelines #4, which permits exploration of potential bridge concepts and their problematics with an eye to reaching some kind of common understanding. The first part of doing that certainly consists of identifying the differences and offering reasons and explanations for them.

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Prakash Desai 

It is with great sadness that we announce the loss of our colleague and friend Dr. Prakash Desai. He not only was an extraordinary physician and scholar, but he was a beloved father, grandfather, and friend. 

Prakash N. Desai was born and raised in India. He obtained his medical education at the Faculty of Medicine of the M.S. University of Baroda and completed his psychiatric residency at Northwestern University Medical School in Chicago, Illinois. His extensive work experience includes positions at the B. M. Institute in Ahmedabad, academic psychiatry, Community, Social and Cultural psychiatry, Director of Department of Mental Health and Developmental Disabilities of the State of Illinois, Veterans health care facility on the west side of Chicago, professorial appointment at the University of Illinois at Chicago, Director of Education for the University of Illinois Hospital, and associate member of the Committee of South Asian Studies at the University of Chicago. Among his many publications are Health and Medicine in the Hindu Tradition and Triumph and Tragedy: Psychohistorical Decisions of Mahatma Gandhi, several book chapters, and over a dozen papers in professional journals. He  received numerous awards for his work including the Oscar Pfeister Award, the George Tarjan Award and the Bruce Boyer Award. He was also actively involved in the governance of the American Psychiatric Association. 

Our most sincere condolences to his family. 

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First ‘three person baby’ born using new method

Yesterday it was published the following news:

“The five-month-old boy has the usual DNA from his mum and dad, plus a tiny bit of genetic code from a donor.

US doctors took the unprecedented step to ensure the baby boy would be free of a genetic condition that his Jordanian mother carries in her genes.

Experts say the move heralds a new era in medicine and could help other families with rare genetic conditions.

But they warn that rigorous checks of this new and controversial technology, called mitochondrial donation, are needed.

It’s not the first time scientists have created babies that have DNA from three people – that breakthrough began in the late 1990s – but it is an entirely new and significant method.” You can read the whole article here: 

http://www.bbc.com/news/health-37485263.

I am wondering what does your cultural/religious perspective thinks of these technologies? Is it ethical? What principles are at stake?  Please share!

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Neurobioethics, Human Rights and Justice.

By Alberto Garcia

With the objective to continue to foster a spirit of cooperation among our international and multicultural intellectual community , and to foster the bonds created over the years as a positive alternative to the strife and division that plagues all too many communities, this year we will have our Multiculturalism and Religion Workshop and Conference. This year’s meeting on “Bioethical Challenges in Neurogenomics from an Interreligious and Multicultural Perspective” will take place at the MD Anderson Cancer Center in Houston, Texas November 14-16, 2016.

From an integral and solidarian humanism, the person  is not just a conglomerate of cells, or a brain or a body; but a transcendent and relational being. These relations are the foundation of society. That is the reason that drives us to study the ethical limits and the relationship of neurogenomics and human rights.  Neurogenomics is a topic that brings to the table many questions, especially from a legal and humanitarian perspective. It is important that as bioethicists and leaders of our different traditions, we analyse the possible outcomes of this wonderful science so that we can enjoy its benefits and prevent the possible wrongdoings and violation to human rights.  Being cautious  in the ethical judgement in neurotechnologies will help to minimize the fear to the unknown, and to moderate the euphoria of the success of these technologies.
It is important to highlight also the law and its relationship with neurogenomics. This relationship is based on the fact that humans are in need of order to promote a positive interaction among communities.  Human relationships are based on reality – a truth- that should be rooted on an integral anthropological perspective. These rules should promote human flourishing that protect personal integrity and social structures from which communities are build in.  Truth should be paired with liberty because it is the free will (along with the responsibilities and consequences of making our own decisions)  that gives us a particular dignity. These freedom is questioned by some authors in neuroscience, arguing that it is the brain that rules the person and therefore there is not such a thing as free will. However, as stated in the beginning of these paper, humans are not just brains, but a body and soul. The brain, the psique, the soul are fundamental to each human being. These three realities can only exist with their inherited relationship with the body as a whole (corpus et anuma unum). This body-soul belongs to an ontological order that is superior than other organisms and that has a special value that we call dignity.  Liberty and autonomy should always be in harmony with justice. the perception of injustice is born as a natural feeling  when basic needs are neglected.
When studying the Universal Declaration of Human Rights, we can notice that there are some fundamental goods that  have been recognized as universal and therefore they need to be protected. Neurosciences and its neurotecnologies are outstanding tools to society when used with integrity and when life, truth, freedom and personal integrity and identity are protected.  Some of the rights to be protected in the development and usage of neurotechnologies are: Right of life; right of physical and psychological integrity; right of identity; right of privacy; right of freedom; right of social security; right of freedom of science; among others.All of these rights have their respective duty, and above all the main objective is to protect human dignity. During our next workshop I hope we engaged in a fruitful conversation in order to achieve a point of convergence that help us give light to the upcoming challenges of neurotechnologies.
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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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