Berlinger Nancy, Berlinger Annalise
Research scholar at the Hastings Center in Garrison, New York, and the first author of the second edition of the Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life (Oxford University Press, 2013) and the author of Are Workarounds Ethical?: Managing Moral Problems in Health Care Systems (Oxford University Press, 2016), and After Harm: Medical Error and the Ethics of Forgiveness (Johns Hopkins University Press, 2005).
Nurse working in chronic disease care in Madison, Wisconsin.
AMA J Ethics. 2017 Jun 1;19(6):608-616. doi: 10.1001/journalofethics.2017.19.6.msoc1-1706.
Culture is learned behavior shared among members of a group and from generation to generation within that group. In health care work, references to "culture" may also function as code for ethical uncertainty or moral distress concerning patients, families, or populations. This paper analyzes how culture can be a factor in patient-care situations that produce moral distress. It discusses three common, problematic situations in which assumptions about culture may mask more complex problems concerning family dynamics, structural barriers to health care access, or implicit bias. We offer sets of practical recommendations to encourage learning, critical thinking, and professional reflection among students, clinicians, and clinical educators.
文化是一个群体成员之间共享且在该群体中代代相传的习得行为。在医疗保健工作中，提及“文化”也可能作为一种代码，用于表示涉及患者、家庭或人群的伦理不确定性或道德困扰。本文分析了文化如何成为导致道德困扰的患者护理情况中的一个因素。它讨论了三种常见的、存在问题的情况，在这些情况中，关于文化的假设可能掩盖了有关家庭动态、获得医疗保健的结构障碍或隐性偏见等更复杂的问题。我们提供了一系列实用建议，以鼓励学生、临床医生和临床教育工作者进行学习、批判性思考和专业反思。
