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Yet Ana and her family also sought the intervention of traditional doctors or curanderos. The curandero provides services that a Western doctor cannot: the cleansing ceremony referred to in the case study is a perfect example of differences in attitudes toward health care. A healing ceremony performed by a curandero is not likely to harm the infant and in fact may prove beneficial at least to the parents' and family's peace of mind.
There can be no absolute ethical guidelines in health care except for the fact that health care workers are obliged always to treat patients with respect. Respect entails sensitivity to cultural difference and to the norms that define attitudes towards health care. Health care workers may find that some patients require privacy and do not express emotions; whereas other patients are emotionally expressive to the point where they shock or disturb those around them. These issues should be dealt with using a philosophical underpinning of ethical relativism. Ethical relativism allows health care workers to take a detached view that respects patient autonomy. Health care services are provided without any strings attached. The health care worker does not impose the dominant culture's values on the patient, and the patient also respects the fact that the hospital is providing services to clients who cannot pay. This fact offers a sort of moral balance in the case: Ana and Hugo are receiving health care for humanitarian reasons and this understanding precludes them from seeking further assistance.
A worldview that values the differences between cultures does not preclude healthcare workers from making judgments regarding best practices. In fact, the theory of ethical relativism also ensures that the nurse or doctor's values are as valid as those of the patient. If a doctor is absolutely opposed to a patient's wish due to different moral viewpoints, then that doctor can easily reassign the case to a colleague rather than pass judgment on the patient.
Ana and Hugo are understandably afraid that they will get deported if they decide to apply for any social services. Their undocumented status presents a risk that Ana and Hugo assumed upon entering the country. While Ana and Hugo need to be respectful of American law, the health care workers helping the family has no right to interfere. Providing the best quality of patient care possible is the duty and obligation of the health care worker.
Moreover, health care workers must set aside their belief in ethical absolutism with regards to Ana's situation. Even if there is an infant involved, it is crucial to respect patient autonomy in this case. Ana and Hugo are doing whatever they can, and whatever is within their means, to help their child. The health care workers did all they could to help Ana, save for permitting the presence of the curandero. Ana and Hugo are doing the best they can within the limitations of their immigration status. At this point, I would advise health care workers to respect the independence of the couple and to cease interfering with their lives or the life of the infant. A pluralistic point-of-view acknowledges cultural differences, respects patient autonomy, and provides the best possible quality of care.
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