Cultural Sensitivity and Patient Treatment

Coining

One of the most difficult situations a physician may face is one in which a parent is doing actual harm to her child even though she has the best of intentions. In this instance, the mother is engaging in the practice of 'coining' or using coins to administer oils. The boy appears to be in pain as a result of the bruises sustained by this treatment. Unfortunately, it is not unheard of for many children to suffer damage as a result of well-intentioned parental actions. Another example is that of Christian Scientist parents who refuse all medical treatment for their children or Jehovah's Witnesses who may refuse blood transfusions.

A physician's ultimate responsibility is to help the child. While it is possible to argue that some medical procedures do cause some pain and discomfort when initially administered, they do so with the purpose of ultimately reversing the course of the patient's illness and there must be medically-proven effectiveness. Even when children participate in clinical trials, ethics demand that there is at least some evidence that the treatment will work.

In such an instance, the parent must be clearly informed of the necessary conventional medical treatments required to reverse the child's illnesses. Also, when a parent refuses medical treatment or administers inappropriate medical treatment "it is often helpful ... to involve a 'religious translator'" or in this case a cultural translator "with some depth of education and position of authority. One reason for utilizing such a resource person is that parents (or anyone) may sometimes focus on one religious tenet while ignoring a balancing tenet" (Orr, Novotny, & Perkin 2003). A practitioner of traditional Chinese medicine may be able to explain to the mother why her use of the coining technique was inappropriate in this instance. "Parents are not at liberty to destroy, maim, or neglect their children. Similarly, by societal convention, health care choices available to parents are not unlimited. Parents are restricted to choices that conform to societal norms" (Orr, Novotny, & Perkin 2003).

Regarding the concern that taking an unduly harsh attitude towards coining may alienate members of the community from seeking help from a conventional medical practitioner, once again it is important to remember that a physician's ultimate responsibility is to the child not to hypothetical future patients. However, reporting the practice to child protective services should not be the first recourse. "Coining is associated with serious complications, and has been confused with child abuse by physicians unfamiliar to Asian cultures. Despite the availability of more simple and effective treatment for fever, coining is still widely practiced among Asians" (Tan & Mallika 2011). Education, given that the intention of the parent is not to harm the child, is the first imperative.