Culture, Medicine, and Psychiatry

, Volume 42, Issue 1, pp 32–48 | Cite as

Diversity, Conflict, and Recognition in Hospital Medical Practice

  • Sylvie FortinEmail author
  • Serge Maynard
Original Paper


The hospital is a place of encounter between health care providers, patients and family members, the healthy and the suffering, migrants and non-migrants, as well as social and cultural minorities, and majorities of various backgrounds. It is also a space where multiple conceptions of care, life, quality of life, and death are enacted, sometimes inhibiting mutual understanding between caregivers and the cared for, a scenario that in turn may provoke conflict. Through the lens of conflict, we explore in this article the theme of Otherness within the clinic, basing analysis on an ethnographic study conducted in recent years in three cosmopolitan Canadian cities. Daily practices and—on a larger scale—the social space of the clinic become material here for reflecting on recognition (and non-recognition) of the Other as actors in the clinical encounter. The examination of structural and situational conditions that contribute to the emergence of conflict offers an understanding of the diversity of values that pervade the clinic. By way of conclusion, we argue that recognition of diversity, at least on the part of practitioners, is a key condition for the emergence of a pluralist normativity in the social space of the clinic.


Therapeutic relationships Diversity Otherness Recognition Conflict Ethnography 



This study was funded by the Canadian Institutes of Health Research (MOP - 74673).

Compliance with Ethical Standards

Conflict of interest

Sylvie Fortin declares she has no conflict of interest. Serge Maynard declares he has no conflict of interest.

Ethical approval

This study received approval from relevant Ethics Review Boards at all participating institutions. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in this study.


  1. Appiah, Anthony Kwame 2006. Cosmopolitanism: Ethics in a World of Strangers. New Haven, London: W.W. Norton & Co.Google Scholar
  2. Benaroyo, Lazare 2010 Éthique et herméneutique du soin. In La philosophie du soin. Éthique, médecine et société. Lazare Benaroyo, Céline Levève, Jean-Christophe Mino, and Frédéric Worms, eds., pp. 23-36. Paris: PUF.Google Scholar
  3. Bibeau, Gilles, 2002. Dieux étrangers, société post-religieuse et clinique. Prisme 38:60-82.Google Scholar
  4. Bluebond-Langner, Myram 1978. The Private World of Dying Children. Princeton: Princeton University Press.Google Scholar
  5. Boltanski, Luc and Laurent Thevenot, 1991. De la justification: les économies de la grandeur. Paris: Gallimard.Google Scholar
  6. Bonnet, Marie 2011. Anthropologie d’un service en cancérologie pédiatrique, De la parole au choix. Paris: L’Harmattan.Google Scholar
  7. Carle, Marie-Éve 2013. Logiques divergentes et confrontations des savoirs Quelle place pour la rationalité des patients? Anthropologie et Sociétés 37(3):139-156.CrossRefGoogle Scholar
  8. Cassel, Joan 2005. Life and Death in Intensive Care. Philadelphia: Temple University Press.Google Scholar
  9. Clifton-Soderstrom, Michelle, 2003. Levinas and the Patient as Other: The Ethical Foundation of Medicine. Journal of Medicine and Philosophy 28 (4):447-460.CrossRefGoogle Scholar
  10. Cognet, Marguerite 2013a L’hôpital, un ordre négocié à l’aune des origines. “Français” et “Africains” en traitement pour un VIH-sida. Migrations Santé 144-145:79-110.Google Scholar
  11. Cognet, Marguerite 2013b Le conflit: un element dynamique des situations cliniques interethniques. Anthropologie et Sociétés 37(3):201-214.Google Scholar
  12. Coser, Rose Laub 1962. Life in the Ward. East Lansing: Michigan State University Press.Google Scholar
  13. Engel, George L, 1978. The biopsychosocial model and the education of health professionals. Annals of the New York Academy of Sciences, 310:169-181.CrossRefGoogle Scholar
  14. Fabian, Johannes 2001. Anthropology with an Attitude: Critical Essays. Stanford: Stanford University Press.Google Scholar
  15. Fainzang, Sylvie, 2013. Champ-Contrechamp. La relation médecin-malade entre anciennes et nouvelles normes, Anthropologie et sociétés, 37 (3) :83-97.Google Scholar
  16. Fortin, Sylvie 2008. The Pediatric Clinic as Negotiated Social Space. Anthropology and Medicine 15:175-87.CrossRefGoogle Scholar
  17. Fortin, Sylvie 2013. Éthique et prise de décision médicale en contexte de diversité. Migrations Santé 146-147:17-51.Google Scholar
  18. Fortin, Sylvie forthcoming Between Reason, Science and Culture: Biomedical Decision-Making, International Journal of Bioethics.Google Scholar
  19. Fortin, Sylvie and Josiane Le Gall 2012. Parentalité et processus migratoire. In La naissance de la famille. Accompagner les parents et les enfants en période périnatale. Francine de Montigny, Annie Devault and Christine Gervais, eds., pp. 178-196. Montréal: Chenelière ÉducationGoogle Scholar
  20. Freidson, Eliot 1970. Professional Dominance: The Social Structure of Medical Care. New York: Atherton Press.Google Scholar
  21. Goffman Erving 1961. Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. London: Anchor Books.Google Scholar
  22. Good, Byron 1993. Medicine, Rationality and Experience: An Anthropological Perspective. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  23. Good, Mary-Jo DelVecchio, Sarah S. Willen, Seth Donal Hannah, Ken Vickery, and Lawrence Taesing Park, eds., 2011. Shattering Culture: American Medicine Responds to Hyperdiversity. New York: Russell Sage Foundation.Google Scholar
  24. Hannah, Seth Donal 2011. Clinical care in environments of hyperdiversity. In Shattering Culture: American Medicine Responds to Hyperdiversity. Mary-Jo DelVecchioGood, Sarah S. Willen, SethDonal Hannah, Ken Vickery and LawrenceTaeseng Park, eds., pp. 35-69. New York: Russell Sage Foundation.Google Scholar
  25. Honneth Axel 2004. La théorie de la reconnaissance : une esquisse. Revue de MAUSS 1:133-136.CrossRefGoogle Scholar
  26. Kirmayer, Laurence 2012. Rethingking cultural competence. Transcultural Psychiatry 49:149-164.CrossRefGoogle Scholar
  27. Kirmayer, Laurence 2011. Multicultural medicine and the politics of recognition. Journal of Medicine and Philosophy, 36:410-423.CrossRefGoogle Scholar
  28. Kleinman, Arthur 2013. From Illness as Culture to Caregiving as Moral Experience. The New England Journal of Medicine 365 (15):1376-77.CrossRefGoogle Scholar
  29. Kleinman, Arthur 2012. The Art of Medicine. Caregiving as a Moral Experience. Lancet 380:1550-51.Google Scholar
  30. Kleinman Arthur 1988. The Illness Narratives : Suffering, Healing, and the Human Condition. New York: Classic Books.Google Scholar
  31. Laplantine, François, and Alexis Nouss 2008 [1978] Le métissage. Paris: Téraèdre.Google Scholar
  32. Lévinas, Emmanuel 1996 In Emmanuel Levinas: Basic Philosophical Writings. A.T. Peperzak, S. Critchley and R. Bernasconi, eds. Indiapolis: Indiana University Press.Google Scholar
  33. Lévinas, Emanuel 1969. Totality and Infinity : An Essay on Exteriority. Pittsburgh: Duquesne University PressGoogle Scholar
  34. Marie-Anne, Archambault-Grenier, Marie-Hélène, Roy-Gagnon, Hugues, Masse, Jean-Francois, Lefebvre, France, Gauvin, Hubert, Doucet, Nago, Humbert, Sanja, Stojanovic, Antoine, Payot, Sylvie, Fortin, Annie, Janvier, and Michel, Duval forthcoming Pediatric End-of-Life Conflicts: Frequency, Participants, Contributing Factors, Coping Strategies, and Interventions. Journal of Pediatrics.Google Scholar
  35. Masquelet, Alain-Charles 2009. Mutation de la clinique ou la révolution des sens. In La mort de la clinique ?. Daniel Couturier, Georges David, Dominique Lecourt, Jean-Daniel Sraer and Claude Sureau, eds. pp. 29-46. Paris: Presses universitaires de France.Google Scholar
  36. Deirdre Meintel 2008 Identités ethniques plurielles et reconnaissance connective en amérique du Nord. In La reconnaissance à l’épreuve: explorations socio-anthropologiques. Jean-Paul Payet and Alain Battegay, eds. pp. 311–319. Villeneuve d’Ascq: Presses universitaires du Septentrion.Google Scholar
  37. Payot, Antoine, Sylvie Gendron, Francine Lefebvre and Hubert Doucet 2007. Deciding to resuscitate extremely premature babies: How do parents and neonatologists engage in the decision? Social Science and Medicine, 67(7):1487-1500.CrossRefGoogle Scholar
  38. Pellegrino, Edmond D., and David C. Thomasma 1997. Helping and Healing. Religious Commitment in Health Care. Washington: Georgetown University Press.Google Scholar
  39. Ricoeur, Paul 2004. Parcours de la reconnaissance: trois études. Paris: Éditions Gallimard.Google Scholar
  40. Ricoeur, Paul 2001. Le Juste 2. Paris: Éditions Esprit.Google Scholar
  41. Guy Rocher 1996 Les phénomènes d’internormativité: faits et obstacles. In Le Droit Soluble. Contributions québécoises à l’étude de l’internormativité. Jean-Guy Belley, ed., pp. 25–42. Paris: I.G.D.J.Google Scholar
  42. Saillant, Francine and Éric Gagnon 1999. Vers une anthropologie des soins ? Anthropologie et Sociétés 23(2):5-14.CrossRefGoogle Scholar
  43. Sainsaulieu, Ivan 2003. Les malaise de soignants : le travail sous pression à l’hôpital. Paris: L’Harmattan.Google Scholar
  44. Sauvegrain, Priscille 2012. La santé maternelle des “Africaines” en Île-de-France : racisation des patients et trajectoires de soins. Revue européenne des migrations internationales 28 (2):81-100.CrossRefGoogle Scholar
  45. Simmel, George 2010 [1908] Sociologie. Études sur les formes de socialisation. Paris: Presses universitaires de France.Google Scholar
  46. Street, Alice and Simon Coleman, 2012. « Introduction : Real and Imagined Spaces » , Space and Culture, 15, 4 : 4-17.CrossRefGoogle Scholar
  47. Taboada-Leonetti, Isabelle 1994. Intégration et exclusion dans la société duale Le chômeur et l’immigré. Revue internationale d’action communautaire 71:93-103.Google Scholar
  48. Van der Geest Sjaak and Finkler, Kaja 2004. Hospital Ethnography: Introduction. Social Science and Medicine 59(10):1995-2001CrossRefGoogle Scholar
  49. Vega, Anne 2000. Une ethnologue à l’hôpital. Paris: Éditions des Archives Contemporaines.Google Scholar
  50. Max Weber 1946 In: Hans HeinrichGerth and Charles WrightMills (eds.), From Max Weber: Essays in Sociology. New York: Oxford University Press.Google Scholar
  51. Willen, Sarah S. 2011. Clinicien-Patient Matching. In Shattering Culture: American Medicine Responds to Hyperdiversity. Mary-Jo DelVecchio Good, Sarah S. Willen, Seth Donal Hannah, Ken Vickery and Lawrence Taeseng Park, eds., pp. 112-130. New York: Russell Sage Foundation.Google Scholar
  52. Worms, Frédéric 2012. Soin et politique. Paris: Presses Universitaires de France.CrossRefGoogle Scholar
  53. Zaman, Shahaduz 2005. Broken Limbs, Broken Lives: Ethnography of a Hospital Ward in Bangladesh. Amsterdam: Het Spinhuis.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of AnthropologyUniversité de MontréalMontréalCanada
  2. 2.McGill University Health CenterMontréalCanada

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