Cultural Competence and Ethics: Community

Cultural Competence and Ethics: Community Research and Intervention Methods

Two of the major paradigms of ethical theory in Western thought are Kantian ethics and the philosophy of utilitarianism. Utilitarianism suggests that the objective of all decisions should be to do the greatest good for the greatest number of people, even if this precedent is not applicable in all situations. In contrast, Immanuel Kant believed that all individuals should act as if they were setting ethical precedents for all time, and not change their framework of ethics on a case-by-case basis. For Kant, morality should not be based in emotions, nor should it be based in the logical assessment of future consequences of an action. The actor's motive to follow duty was more important than the moral actor envisioning the possible, projected results of his or her action, because no one can accurately predict all of the results of every decision (Vlatch, 2004).

For example, imagine a nurse working in the emergency room of a hospital. A wounded drug dealer is taken into the hospital. The dealer allegedly killed a police officer, but was wounded in the process, and must be treated before he can be taken into custody. The hospital must expend valuable time and effort to treat the dealer, whose life has resulted in nothing but misery for others. Worse yet, the hospital is experiencing a blood shortage, so the blood needed to give the dealer a transfusion will take away resources from other critically injured individuals who will no doubt come into the hospital tomorrow in need of treatment. In the waiting room, there are patients who are not in imminent danger of losing their lives, but who are in pain. Their treatment will be delayed because the ER staff must prioritize the care of the critically ill over the merely sick. The dealer is taken in handcuffed, under police escort, and may be convicted at his future trial of murder, and spend the rest of his life behind bars.

So, should the hospital act to save his life? Of course, a Kantian would respond. The hospital staff cannot pass moral judgment on who deserves or does not deserve treatment, based upon the patient's character. Imagine if you yourself were refused treatment, because the hospital did not like your race, or the fact that you were gay, or felt you 'deserved' your illness, since you had contracted a sickness due to the fact you were a smoker, obese, or sexually active? How would you like it if health care providers could decide to take an elderly person's life, so that the organs promised on the old person's organ donor card could be used to save the life of a presumably more worthy and younger individual with small, needy children? Kant would stress that the impossibility of a medical practitioner to weigh the consequences of such moral decisions, every time someone came through the doors of an ER. Instead, the doctor or nurse must obey the same ethical principle in all cases. They must uphold their moral duty to save the lives of all of their patients, and dispense the highest quality care they can conceivably give under the circumstances.