Orr R D, Marshall P A, Osborn J
Loma Linda, University Medical Center, CA.
Arch Fam Med. 1995 Feb;4(2):159-64. doi: 10.1001/archfami.4.2.159.
Cross-cultural encounters between patients and physicians are now commonplace. Although increasing attention has been given to cultural issues in clinical medicine, there has been little discussion of cultural differences presenting as ethical dilemmas. We report four cases in which such differences led to requests for ethics consultations. In analyzing these cases, we identify four elements that are essential for successful resolution of such dilemmas: (1) an ability to communicate effectively with patients and their families; (2) a sufficient understanding of the patient's cultural background; (3) identification of culturally relevant value conflicts; and (4) a willingness to pursue discussion of the ethical dilemma until a compromise is reached or an otherwise satisfactory resolution of the problem is achieved. We conclude with several practical guidelines for clinicians facing ethical dilemmas in cross-cultural interactions with patients.
患者与医生之间的跨文化交流如今已屡见不鲜。尽管临床医学中对文化问题的关注日益增加，但对于表现为伦理困境的文化差异却鲜有讨论。我们报告了四例此类差异引发伦理咨询请求的案例。在分析这些案例时，我们确定了成功解决此类困境所需的四个要素：（1）与患者及其家属有效沟通的能力；（2）对患者文化背景的充分了解；（3）识别与文化相关的价值冲突；（4）愿意就伦理困境进行讨论，直至达成妥协或实现对问题的其他满意解决方案。我们最后为在与患者的跨文化互动中面临伦理困境的临床医生提供了一些实用指南。
