Selma Jelinek School of Nursing, Jerusalem College of Technology, Tal Campus, 11 Beit Hadfus Street, Jerusalem, Israel.
Department of Emergency Medicine, Hadassah Medical Center- Ein Kerem, Faculty of Medicine, The Hebrew University of Jerusalem, K.Y. Man Street, Jerusalem, Israel.
Soc Sci Med. 2023 Dec;339:116345. doi: 10.1016/j.socscimed.2023.116345. Epub 2023 Oct 27.
Biomedicine has played a key role in the dissemination of modern social norms, such as the emphasis on individual autonomy and the distinction between science and religion. This study examines the way the mostly-Jewish members of the medical staff at an emergency department of a Jerusalem hospital perceive Jewish ultra-Orthodox and Arab patients' behaviors vis-à-vis the existing biomedical norms. We analyzed participants' perceptions in terms of the social constructs they reveal, their meanings, and their implications. Semi-structured in-depth interviews were conducted with 24 staff members and were analyzed using content analysis. The staff described challenges in treating Arab and ultra-Orthodox patients, which they related to both groups' embeddedness in traditional "cultures" and collective identities. According to the participants, in both cases, the patients' cultural affiliations constrained their sense of individual autonomy and rationality. However, in the comparative analysis, two differences emerged. First, while both groups were perceived to diverge from modern norms of individual autonomy, in the case of Arab patients, these characteristics were presented as disruptive and potentially threatening to the hospital staff. By contrast, in the case of ultra-Orthodox patients, adherence to traditional and collective values was more likely to be represented as a risk to the patient, rather than to the staff. Second, staff were more likely to provide accommodations for ultra-Orthodox patients than for Arab patients. These accommodations were often described in the frame of "cultural competency." We suggest that divergences in how staff understood and responded to perceived cultural differences of each group reflect unequal impacts of structural determinants of health, including of political conflict. We recommend moving beyond the conceptual framework of cultural competency to strengthen the staff's structural competency, cultural and structural humility, and critical consciousness.
生物医学在传播现代社会规范方面发挥了关键作用，例如强调个人自主和科学与宗教的区别。本研究考察了耶路撒冷一家医院急诊部门的主要是犹太人的医务人员如何看待犹太极端正统派和阿拉伯患者对现有生物医学规范的行为。我们根据揭示的社会结构、意义和影响来分析参与者的看法。对 24 名工作人员进行了半结构化深入访谈，并使用内容分析进行了分析。工作人员描述了治疗阿拉伯和极端正统派患者的挑战，他们将这些挑战与这两个群体在传统“文化”和集体认同中的根深蒂固联系起来。根据参与者的说法，在这两种情况下，患者的文化背景都限制了他们的个人自主和理性意识。然而，在比较分析中，出现了两个差异。首先，尽管两组人都被认为偏离了个人自主的现代规范，但在阿拉伯患者的情况下，这些特征被认为是对医院工作人员的破坏性和潜在威胁。相比之下，在极端正统派患者的情况下，坚持传统和集体价值观更有可能被视为对患者而不是对工作人员的风险。其次，工作人员更有可能为极端正统派患者提供住宿，而不是为阿拉伯患者提供住宿。这些住宿通常是在“文化能力”框架内提供的。我们认为，工作人员对每个群体感知到的文化差异的理解和反应的差异反映了健康的结构性决定因素，包括政治冲突的不平等影响。我们建议超越文化能力的概念框架，加强工作人员的结构能力、文化和结构谦逊以及批判意识。
