Personal values and cultural diversity

Cross-cultural encounters in medicine are increasing in multi-ethnic societies and cultural pluralism enriches our lives. Yet, when values and ethical norms diverge in clinical encounters, bedside misunderstanding and conflicts can arise. Examples are the diverse different attitudes and practices of truth-telling, roles of families with regard to information and decision-making, approaches to end-of-life matters and significance of caregiving in different cultures. Understanding and negotiating these differences in the clinical setting is impossible without analyzing the meaning of culture and values. Culture shapes the experience and perception of illness and influences the coping mechanism adopted by each patient, through different values and belief systems. While a framework of common values underlies any therapeutic relationship, cultural differences may have major impact on the practice of medicine. In cultures centered on individual rights and freedom, for example, patient autonomy is the highest ethical value and patient information and active participation to the decision-making process are the norm. In contrast, in family and community-centered cultures, connectedness and reciprocal protection are highly valued, leading to lack of disclosure of medical truth and of patient involvement in decision-making. While in western cultures, cure is the highest goal of medicine, in cultures where suffering has redemptive meanings or endurance is supremely valued, traditional healing methods and goals differ. In this article, we attempt to clarify the complexity of cultural diversity with regard to values and norms that influence how people deal with illness, suffering, and dying by analyzing a clinical case and introducing the notion of cultural competence.