Ethical Responsibilities and Ethics in Healthcare

Ethics and Ethical Responsibilities in HealthCare

Beyond Cultural Competence: Critical Consciousness, Social Justice, and Multicultural Education

Kumagai, Arno K. MD; Lypson, Monica L. MD

Our world has become a global village, meaning that we live and work amongst people of diverse nationalities, races, religious inclinations, etc. In that regard, therefore, clinicians ought to be trained on how to effectively address not only the disparities in healthcare but also the needs of a society that is becoming more diverse each passing day. The article whose title I give above seeks to accomplish two key goals; that is, in addition to discussing the cultural competency notion, the authors of the article also:

propose that educating physicians skilled at addressing the healthcare needs of a diverse society involves not the fulfillment of a competency as some sort of educational nirvana, but the development of an orientation -- a critical consciousness -- which places medicine in a social, cultural, and historical context and which is coupled with an active recognition of societal problems and a search for appropriate solutions (Kumagai and Lypson, 2009).

In the opinion of the authors, the expected outcome would be enhanced social justice; where there is clear concession of not only the autonomy but also the dignity of all members of the society, and where everybody benefits from high quality medical care regardless of their nationality, race, gender, or even socioeconomic status.

As far as the practice of medicine is concerned, the relevance of understanding the notion of justice in this very context cannot be overstated. Essentially, the notion of justice according to Kumagai and Lypson (2009) has got to do with recognizing the unique identity of individuals in the context of cultural depth and richness. It is on this same basis that the professionalism habit must be developed -- to comprise of not only the critical consciousness of oneself but also those of others. In the words of Kumagai and Lypson (2009), as far as multicultural education is concerned, "the development of this critical awareness is a central goal."

According to Paasche-Orlow (2004), like ethical relativism, cultural competence "opposes the imperialism of clinicians' enforcing their views on others." In basic terms, ethical relativism seeks to advance the notion that nothing can be regarded right or wrong (in the objective sense) -- instead, an individual's sense of that which is right or that which could be regarded wrong is largely dependent on not only the concerned individual's prevailing view but also their cultural disposition. It should, however, be noted that although the basis for cultural competence's opposition to clinician imperialism is largely rational, this whole set up brings to the fore several other challenges. For instance, aligning cultural competence to ethical relativism could effectively place the former on a collision course with conventional Western medical ethics (Paasche-Orlow, 2004). In seeking to highlight the need to go beyond cultural competence, Kumagai and Lypson (2009) propose the development of critical consciousness that in addition to positioning medicine in a historical, cultural, as well as social context, also actively recognizes social problems and seeks solutions to the said problems. This could avert the problems alluded to elsewhere in this text. To cap it all, Kumagai and Lypson, (2009) point out that to achieve the central goal in multicultural education, i.e. The advancement of critical awareness, there is need for efforts to be directed towards "action informed by an overreaching theoretical framework" (Kumagai and Lypson, 2009).