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Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy

Monday, February 19, 2018

Culture and Moral Distress: What’s the Connection and Why Does It Matter?

Nancy Berlinger and Annalise Berlinger
AMA Journal of Ethics. June 2017, Volume 19, Number 6: 608-616.


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.

Here is an excerpt:

Clinicians’ shortcuts for identifying “problem” patients or “difficult” families might also reveal implicit biases concerning groups. Health care professionals should understand the difference between cultural understanding that helps them respond to patients’ needs and concerns and implicit bias expressed in “cultural” terms that can perpetuate stereotypes or obscure understanding. A way to identify biased thinking that may reflect institutional culture is to consider these questions about advocacy:

  1. Which patients or families does our system expect to advocate for themselves?
  2. Which patients or families would we perceive or characterize as “angry” or “demanding” if they attempted to advocate for themselves?
  3. Which patients or families do we choose to advocate for, and on what grounds?
  4. What is our basis for each of these judgments?