Health Care Analysis

, Volume 11, Issue 2, pp 99–117 | Cite as

Bioethics in a Multicultural World: Medicine and Morality in Pluralistic Settings

  • Leigh Turner


Current approaches in bioethics largely overlook the multicultural social environment within which most contemporary ethical issues unfold. For example, principlists argue that the “common morality” of “society” supports four basic ethical principles. These principles, and the common morality more generally, are supposed to be a matter of shared “common sense.” Defenders of case-based approaches to moral reasoning similarly assume that moral reasoning proceeds on the basis of common moral intuitions. Both of these approaches fail to recognize the existence of multiple cultural and religious traditions in contemporary multicultural societies. In multicultural settings, patients and their families bring many different cultural models of morality, health, illness, healing, and kinship to clinical encounters. Religious convictions and cultural norms play significant roles in the framing of moral issues. At present, mainstream bioethics fails to attend to the particular moral worlds of patients and their family members. A more anthropologically informed understanding of the ethical issues that emerge within health care facilities will need to better recognize the role of culture and religion in shaping modes of moral deliberation.

multicultural societies medical anthropology and bioethics cultural models of moral reasoning 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Appadurai, A. (1996) Modernity at Large: Cultural Dimensions of Globalization. Minneapolis: University of Minnesota Press.Google Scholar
  2. Beauchamp, T. and Childress, J. (1979) Principles of Biomedical Ethics, 1st Edition. Oxford: Oxford University Press.Google Scholar
  3. Beauchamp, T. and Childress, J. (1994) Principles of Biomedical Ethics, 4th Edition. Oxford: Oxford University Press.Google Scholar
  4. Beauchamp, T. and Childress, J. (2001) Principles of Biomedical Ethics, 5th Edition. Oxford: Oxford University Press.Google Scholar
  5. Berger, J. (1998) Cultural Discrimination in Mechanisms for Health Decisions: A View from New York. Journal of Clinical Ethics 9 (2), 127-131.Google Scholar
  6. Berger, P. (1967) The Sacred Canopy: Elements of a Sociological Theory of Religion. New York: Anchor Books.Google Scholar
  7. Beyene, Y. (1992) Medical Disclosure and Refugees: Telling Bad News to Ethiopian Patients. Western Journal of Medicine 157 (3), 328-332.Google Scholar
  8. Blackhall, L. J., Frank, G., Murphy, S., and Michel, V. (2001) Bioethics in a Different Tongue: The Case of Truth-Telling. Journal of Urban Health 78 (1), 59-71.Google Scholar
  9. Carrese, J. and Rhodes, L. (2000) Bridging Cultural Differences in Medical Practice: The Case of Discussing Negative Information With Navajo Patients. Journal of General Internal Medicine 15, 92-96.Google Scholar
  10. Carrese, J. and Rhodes, L. (1995) Western Bioethics on the Navajo Reservation: Benefit or Harm? Journal of the American Medical Association 274 (10), 826-829.Google Scholar
  11. Coleman, D. (1998) The Seattle Compromise: Multicultural Sensitivity and Americanization. Duke Law Journal 47, 717-783.Google Scholar
  12. Edgerton, R. (1992) Sick Societies: Challenging the Myth of Primitive Harmony. New York: Free Press.Google Scholar
  13. Engelhardt, Jr., H. (1991) Bioethics and Secular Humanism: The Search for a Common Morality. Philadelphia: Trinity Press International.Google Scholar
  14. Engelhardt, Jr., H. (1999) Bioethics in the Third Millenium: Some Critical Anticipations. Kennedy Institute of Ethics Journal 9(3), 225-243.Google Scholar
  15. Fox, R. (1989) The Sociology of Bioethics, In The Sociology of Medicine: A Participant Observer's View. Englewood Cliffs, N.J.: Prentice Hall.Google Scholar
  16. Fox, R. and Swazey, J. (1984) Medical Morality is Not Bioethics: Medical Ethics in China and the United States. Perspectives in Biology and Medicine 27 (3), 336-360.Google Scholar
  17. Frank, G., Blackhall, L., Michel, V., Murphy, S., Azen, S. and Park, K. (1998) A Discourse of Relationships in Bioethics: Patient Autonomy and End-of-Life Decision Making Among Elderly Korean Americans. Medical Anthropology Quarterly 12 (4), 403-423.Google Scholar
  18. Friedman, T. (1999) The Lexus and the Olive Tree: Understanding Globalization. New York: Farar, Straus, Giroux.Google Scholar
  19. Geertz, C. (1973) The Interpretation of Cultures. USA: BasicBooks.Google Scholar
  20. Gilligan, C. (1982) In A Different Voice: Psychological Theory and Women's Development. Cambridge, Massachusetts: Harvard University Press.Google Scholar
  21. Goodman, N. (1978) Ways of Worldmaking. Indianapolis: Hackett Publishing.Google Scholar
  22. Gordon, D. (1990) Embodying Illness, Embodying Cancer. Culture, Medicine and Psychiatry 14 (2), 275-297.Google Scholar
  23. Gordon, D. and Paci, E. (1997) Disclosure Practices and Cultural Narratives: Understanding Concealment and Silence Around Cancer in Tuscany, Italy. Social Science and Medicine 44 (10), 1433-1452.Google Scholar
  24. Hatch, E. (1983) Culture and Morality: The Relativity of Values in Anthropology. New York: Columbia University Press.Google Scholar
  25. Hern, Jr., H., Koenig, B., Moore, L. and Marshall, P. (1998) The Difference that Culture Can Make in End-of-Life Decisionmaking. Cambridge Quarterly of Healthcare Ethics 7, 27-40.Google Scholar
  26. Hoffmaster, B. (1992) Can Ethnography Save the Life of Medical Ethics? Social Science and Medicine 35 (12), 1421-1432.Google Scholar
  27. Holm, S. (1995) Not Just Autonomy—The Principles of American Biomedical Ethics. Journal of Medical Ethics 21, 332-338.Google Scholar
  28. Ignatieff, M. (1998) The Warrior's Honour: Ethnic War and the Modern Conscience. Toronto: Penguin Books Canada.Google Scholar
  29. Jonsen, A. and Toulmin, S. (1988) The Abuse of Casuistry: A History of Moral Reasoning. Berkeley: University of California Press.Google Scholar
  30. Kleinman, A. (1995) Writing at the Margin: Discourse Between Anthropology and Medicine. Berkeley: University of California Press.Google Scholar
  31. Koenig, B. and Gates-Williams, J. (1995) Understanding Cultural Differences in Caring for Dying Patients. Western Journal of Medicine 163 (3), 244-249.Google Scholar
  32. Lane, S. and Rubinstein, R. (1996) Judging the Other: Responding to Traditional Female Genital Surgeries. Hastings Center Report 26 (3), 31-40.Google Scholar
  33. Levenson, J. (2000) The New Enemies of Circumcision. Commentary 109 (3), 29-36.Google Scholar
  34. Long, S. (1999) Family Surrogacy and Cancer Disclosure: Physician-Family Negotiation of an Ethical Dilemma in Japan. Journal of Palliative Care 15 (3), 31-42.Google Scholar
  35. MacIntyre, A. (1981) After Virtue: A Study in Moral Theory. Notre Dame, Indiana: University of Notre Dame Press.Google Scholar
  36. Macklin, R. (1999) Against Relativism: Cultural Diversity and the Search for Ethical Universals in Medicine. Oxford: Oxford University Press.Google Scholar
  37. Marshall, P. (1992) Anthropology and Bioethics. Medical Anthropology Quarterly 6 (1), 49-73.Google Scholar
  38. Michel, V. (1994) Factoring Ethnic and Racial Differences into Bioethics Decision Making. Generations: 23-26.Google Scholar
  39. Muller, J. (1994) Anthropology, Bioethics, and Medicine: A Provocative Trilogy. Medical Anthropology Quarterly 8 (4), 448-467.Google Scholar
  40. Orona, C., Koenig, B. and Davis, A. (1994) Cultural Aspects of Nondisclosure. Cambridge Quarterly of Healthcare Ethics 3, 338-346.Google Scholar
  41. Pang, M. (1999) Protective Truthfulness: The Chinese Way of Safeguarding Patients in Informed Treatment Decisions. Journal of Medical Ethics 25, 247-253.Google Scholar
  42. Rawls, J. (1999) The Law of Peoples; with, The Idea of Public Reason Revisited. Cambridge, Massachusetts: Harvard University Press.Google Scholar
  43. Roberts, L., Battaglia, J., Smithpeter, M. and Epstein, R. (1999) An Office on Main Street: Health Care Dilemmas in Small Communities. Hastings Center Report 29 (4), 28-37.Google Scholar
  44. Scheper-Hughes, N. (1995) The Primacy of the Ethical: Propositions for a Militant Anthropology. Current Anthropology 36 (3), 409-420.Google Scholar
  45. Scheper-Hughes, N. (1996) Theft of Life: The Globalization of Organ Stealing Rumours. Anthropology Today 12 (3), 3-11.Google Scholar
  46. Zussman, R. (2000) The Contribution of Sociology to Medical Ethics. Hastings Center Report 30 (1), 7-11.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • Leigh Turner
    • 1
  1. 1.Biomedical Ethics Unit, Department of Social Studies of Medicine, Faculty of MedicineMcGill UniversityMontrealCanada

Personalised recommendations