Hastings Center Report, Volume 52, Issue S1, Page S83-S88, March‐April 2022.

To promote so-called cultural competence in work of direct-care providers and other health professionals among diverse peoples, cross-cultural training is now widely advised. However, in ethically assessing aims and content of CCT, and surrounding issues and concerns, what should guide us? And if we can elaborate satisfactory moral touchstones, what do they imply for healthcare professionals, overarching structures, and bioethicists? Building on prior work, this paper tries to help answer these questions.

In this paper, we explore best practices for asynchronous discussions in graduate online bioethics education. We explain that online approaches have advantages and challenges in contrast to in-person discussions. Online challenges are lack of visual or auditory cues and technical access. Advantages include extended opportunities for specific focus, thoughtful reflection, and critical review. We found no significant review of related best practices in bioethics. Our more general literature review of graduate education and online approaches, plus experience in our own bioethics (...) graduate program, suggest provisional best practices that we detail. We reason that online graduate discussion provisionally should aim for a “community of inquiry” framework that incorporates cognitive, social, and teaching “presences,” as well as a learning presence. However, we also note unresolved concerns about whether the framework sufficiently addresses learning, is complete, and captures communicative functions. Drawing further on the literature, we also suggest best practices for instructor feedback to students about their discussion performance, including that remarks should be timely and specific. Summaries from two courses in our graduate bioethics program illustrate how we implement discussion strategies. Finally, we review assessment strategies and suggest that embedded formative assessments in discussion support and demonstrate deeper learning. Limitations in generalizability include that our review targets asynchronous and text-based online discussion, our program assessments do not necessarily detail best practices, student expectations and approaches could be rather particular to our program, and specific bioethics content in principle could alter best practices. (shrink)

The paper summarizes recently published data and recommendations about healthcare disparities experienced by African Americans who have Medicare or other healthcare coverage. Against this background the paper addresses the ethics of such disparities and how disadvantages of vulnerable populations like African Americans are typically maintained indecision making about how to respond to such disparities. Considering how to respond to disparities reveals much that vulnerable populations would bring to the policy-making table, if they can also be heard when they get there. (...) The paper argues that vulnerable populations like African Americans need fair representation in bodies deciding what to do about such disparities and that fairness requires proportional representation at all levels of decisions that affect healthcare – a radical change. In this decision setting, howto provide adequate protection of minorities needs much further attention. The most attractive decision-making model is deliberative democracy. The paper shows that in deliberation, fair representation requires not only having a voice in decisions, but a fair hearing of those voices. Achieving a fair hearing requires changes in norms of communication and training of all to give importance to greetings and other measures of civility and trust building, and to be open to diverse forms of expression. Decisions about how to respond to healthcare disparities would include what programs to initiate for whom, howto evaluate the programs, and what to do in response to such evaluations. Conclusions are that achieving such goals will take a sea change in how healthcare institutions and providers do their business, and that social activism at every level will be needed to effect these changes. The discussion highlights many ethical issues that need much greater attention. (shrink)

If you are black, you are more likely to get inferior health care than if you are white. And if you are Hispanic or Native American, odds are you're also in trouble. So finds the Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.

Among the greatest challenges to improving health is determining how cultural diversity should influence healthcare practices and organizations, public health measures, biomedical research, and community partnering. Important but seldom addressed are challenges for bioethicists.

Dominant social theories have rarely placed migration at the center of our understanding of society and social change. Classical theories in the Western tradition have been more preoccupied with the impact of economic and political revolutions on social change, stratification and class conflict, and have paid far less attention to other important aspects of society. Contemporary theories have expanded the theoretical gaze to include a much wider set of issues, from racial and gender divisions to warfare and the environment. In (...) an era of globalization, we argue that such a marginalization of the migrant, and the failure to better integrate both internal and external migration into a more nuanced interpretation of social change, is a significant shortcoming. By examining some of the key elements linked to such human movement in Europe, North America and China -- in the light of five recent studies in this field -- we argue that migration is a vital factor in changing the world as we know it and consequently a central concern for social theory. This is a review essay on. (shrink)

The heart-rending story of Mrs. J raises many complex ethical issues. Key elements include suffering, disagreement, culture, religion, perspective, and facts. Overarching concerns include whose voices and stories should count, the connection of pain with suffering, and how healthcare ethics committees should respond.

Among the greatest challenges to improving health is determining how cultural diversity should influence healthcare practices and organizations, public health measures, biomedical research, and community partnering. Important but seldom addressed are challenges for bioethicists.

Three years' experience in teaching a course in Literature and Medicine is reviewed. Examples of the Laboratory or in vitro functions of art are given, as they relate to and benefit both medical students and practitioners. The usefulness of literature (especially) in the medical setting is underscored, together with the need for medical personnel to be more aware of their heritage in this area. Examples of well-known physicians who have excelled in the arts (literature, music, painting/sculpture) are given and their (...) major contributions discussed. There are some surprises. (shrink)

Close attention to the meanings of certain sentences--Counterfactual-Identity sentences--Reveals that no theory in which proper names are simple designators can be a complete and correct semantics of english. An account of connotation is outlined according to which connotation varies with the linguistic environment and with the context of utterance: this accounts for the fact that no proper name is synonymous with a cluster of descriptions.

The predominant influences on health are social or upstream factors. Poverty, inadequate education, insecure and toxic environments, and inferior opportunities for jobs and positions are inequitable disadvantages that adversely affect health across the globe. Many causal pathways are yet to be understood. However, elimination of these social inequalities is a moral imperative of the first order. Some physicians by word and deed argue that medical doctors should oppose the “structural violence” of social inequalities that greatly shorten lives and wreak so (...) much suffering. (shrink)