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Ethical Issues in Immigrant Health Care and Clinical Research

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Abstract

In the past decade, the number of immigrants and refugees has increased dramatically in various nations throughout the world. Ethnic conflict in Africa, Eastern Europe, and elsewhere has resulted in large numbers of individuals living in diaspora. Those in search of better economic conditions or political asylum emigrate to countries where opportunities for safety and security are thought to exist. Thus, in the context of health care delivery, particularly in urban centers, cultural pluralism is the norm rather than the exception. In pluralistic societies, where the influx of immigrant and refugee populations has grown, interactions between patients and health professionals from different ethnic backgrounds are becoming routine.

Keywords

  • Ethical Issue
  • Health Provider
  • Ethical Dilemma
  • Advance Care Planning
  • Ethic Consultation

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  • Agich, G. (1988). Human experimentation and clinical consent. In J. Monagle & D. C. Thomasma (Eds.), A guide for health professionals (pp. 127–139). Rockville, MD: Aspen.

    Google Scholar 

  • Angell, M. (1988). Ethical imperialism? Ethics in international collaborative clinical research. New England Journal of Medicine, 319, 1081–1083.

    CrossRef  PubMed  CAS  Google Scholar 

  • Barry, M. (1988). Ethical considerations of human investigation in developing countries: The AIDS dilemma. New England Journal of Medicine, 319, 1083–1086.

    CrossRef  PubMed  CAS  Google Scholar 

  • Baylis, F., & Downie, J. (1997). Child abuse and neglect: Cross-cultural considerations. In H. Nelson (Ed.), Feminism and families (pp. 173–187). New York: Routledge.

    Google Scholar 

  • Beauchamp, T. L., & Childress, J. (1993). Principles of biomedical ethics (4th ed.). New York: Oxford University Press.

    Google Scholar 

  • Beecher, H. K. (1966). Ethics and clinical research. New England Journal of Medicine, 274, 1354–1360.

    CrossRef  PubMed  CAS  Google Scholar 

  • Bell, S. E., & Whiteford, M. B. (1987). Tai Dam health care practices: Asian refugee women in Jowa. Social Science and Medicine, 24, 317–325.

    CrossRef  PubMed  CAS  Google Scholar 

  • Benner, P. (1991). The role of experience, narrative, and community in skilled ethical comportment. Advances in Nursing Science, 14, 1–21.

    PubMed  CAS  Google Scholar 

  • Berk, M. L., Albers, L. A., & Schur, C. L. (1996). The growth in the US uninsured population: Trends in Hispanic subgroups, 1977 to 1992. American Journal of Public Health, 86, 572–576.

    CrossRef  PubMed  CAS  Google Scholar 

  • Beyene, Y. (1992). Medical disclosure and refugees—Telling bad news to Ethiopian patients. In Cross-cultural medicine—A decade later [Special issue]. Western Journal of Medicine, 157, 328–332.

    PubMed  CAS  Google Scholar 

  • Blackhall, L. J., Murphy, S. T., Frank, G., Michel, V, & Azen, S. (1995). Ethnicity and attitudes toward patient autonomy. Journal of the American Medical Association, 274, 820–825.

    CrossRef  PubMed  CAS  Google Scholar 

  • Brody, B. A. (1998). The ethics of biomedical research: An international perspective. New York: Oxford University Press.

    Google Scholar 

  • Caralis, P. V., Davis, B., Wright, K., & Marcial, E. (1993). The influence of ethnicity and race on attitudes toward advance directives, life-prolonging directives, life-prolonging treatments and euthanasia. Journal of Clinical Ethics, 4, 155–165.

    PubMed  CAS  Google Scholar 

  • Carrese, J. A., & Rhodes, L. A. (1995). Western bioethics on the Navajo reservation. Journal of the American Medical Association, 274, 826–829.

    CrossRef  PubMed  CAS  Google Scholar 

  • Cassell, J. (1978). Risk and benefit to subjects of field-work. American Sociologist, 13, 134–143.

    PubMed  Google Scholar 

  • Christakis, N. A. (1988). The ethical design of an AIDS vaccine trial in Africa. Hastings Center Report, 18, 31–37.

    PubMed  CAS  Google Scholar 

  • Christakis, N.A. (1992). Ethics are local: Engaging cross-cultural variation in the ethics for clinical research. Social Science and Medicine, 35, 1079–1091.

    CrossRef  PubMed  CAS  Google Scholar 

  • Christakis, N. A., & Panner, M. J. (1991). Existing international ethical guidelines for human subjects research: Some open questions. Law, Medicine and HealthCare, 79, 214–221.

    Google Scholar 

  • Connor, S. S., & Fuenzalida-Puelma H. (Eds.). (1990). Bioethics: Issues and perspectives. Washington, DC: Pan American Health Organization.

    Google Scholar 

  • D’Avanzo, C. (1992). Barriers to health care for Vietnamese refugees. Journal of Professional Nursing, 8, 245–253.

    CrossRef  PubMed  Google Scholar 

  • DeCraemer, W. A. (1983) Cross-cultural perspective on personhood. Milbank Memorial Fund Quarterly, 6, 19–34.

    Google Scholar 

  • de la Torre, A., Friis, R., Hunter, H. R., & Garcia, L. (1996). The health insurance status of US Latino women: A profile from the 1982–1984 HHANES. American Journal of Public Health, 86, 533–537.

    CrossRef  PubMed  Google Scholar 

  • Dula, A. (1994). African American suspicion of the healthcare system is justified: What do we do about it? Cambridge Quarterly of Healthcare Ethics, 3, 347–358.

    CrossRef  PubMed  CAS  Google Scholar 

  • Dula, A., & Goering, S. (1994). “It Just ain’ t fair”: The ethics of health care for African Americans. West-port, CT: Praeger.

    Google Scholar 

  • Ekunwe, E. O., & Kessel, R. (1984). Informed consent in the developing world. Hastings Center Report, 14, 22–24.

    PubMed  CAS  Google Scholar 

  • Engelhardt, T. H., Jr. (1986). The foundations of medical ethics. New York: Oxford University Press.

    Google Scholar 

  • Engelhardt, T. H., Jr. (1991). Bioethics and secular humanism: The search for a common morality. Philadelphia: Trinity.

    Google Scholar 

  • Faden, R. R., & Beauchamp, T. L. (1986). A history and theory of informed consent. New York: Oxford University Press.

    Google Scholar 

  • Fox, R. C. (1990). The evolution of American bioethics: A sociological perspective. In G. Weisz (Ed.), Social science perspectives on medical ethics (pp. 201–220). Philadelphia: University of Pennsylvania Press.

    CrossRef  Google Scholar 

  • Fox, R. C., & Swazey, J. P. (1984). Medical morality is not bioethics: Medical ethics in China and the United States. Perspectives in Biology and Medicine, 27, 336–360.

    PubMed  CAS  Google Scholar 

  • Frankel, M. S., & Teich, A. H. (Eds.). (1994). The genetic frontier: Ethics, law, and policy. Washington, DC: American Association for the Advancement of Science.

    Google Scholar 

  • Frankena, W. (1973). Ethics (2nd ed.). Englewood Cliffs, NJ: Prentice-Hall.

    Google Scholar 

  • Freedman, B. (1993). Offering truth: One ethical approach to the uninformed cancer patient. Archives of Internal Medicine, 153, 572–576.

    CrossRef  PubMed  CAS  Google Scholar 

  • Garcia, J. L. A. (1992). African-American perspectives, cultural relativism and normative issues: Some conceptual problems. In H. Flack & E. D. Pellegrino (Eds.), African-American perspectives on biomedical ethics (pp. 11–65). Washington, DC: Georgetown University Press.

    Google Scholar 

  • Gilman, S. C., Justice, J., Saepharn, K., Charles, G. (1992). Use of traditional and modern health services by Laotian refugees. Western Journal of Medicine, 757, 310–315.

    Google Scholar 

  • Good, B. J. (1994). Medicine, rationality, and experience: An anthropological perspective. Boston: Cambridge University Press.

    Google Scholar 

  • Good, M. D., Good, B. J., Schaffer, C., & Lind, S. E. (1990). American oncology and the discourse on hope. Culture Medicine and Psychiatry, 14, 59–79.

    CrossRef  Google Scholar 

  • Goodgame, R. W. (1990). AIDS in Uganda: Clinical and social features. New England Journal of Medicine, 323, 383–389.

    CrossRef  PubMed  CAS  Google Scholar 

  • Gray, B. H. (1979). The regulatory context of social research: The work of the national commission for the protection of human subjects. In C. B. Klockars & F. W. O’Connor (Eds.), Deviance and decency: The ethics of research with human subjects (pp. 197–224). Beverly Hills, CA: Sage.

    Google Scholar 

  • Hern, H. E., Jr., Koenig, B. A., Moore, L. J., & Marshall, P. A. (1998). The difference that culture can make in end-of-life decision making. Cambridge Quarterly of Healthcare Ethics, 7.

    Google Scholar 

  • Hoffmaster, B. (1990). Morality and the social sciences. In G. Weisz (Ed.), Social science perspectives on medical ethics (pp. 241–260). Philadelphia: University of Pennsylvania Press.

    CrossRef  Google Scholar 

  • Hunter, K. M. (1991). Doctors’stories: The narrative structure of medical knowledge. Princeton, NJ: Princeton University Press.

    Google Scholar 

  • Ijsselmuiden, C. B., & Faden, R. R. (1992). Research and informed consent in Africa—Another look. New England Journal of Medicine, 326, 830–833.

    CrossRef  PubMed  CAS  Google Scholar 

  • Jecker, N. S., Carrese, J. A., & Pearlman, R. (1995). Caring for patients in cross-cultural settings. Hastings center report, 25, 6–14.

    PubMed  CAS  Google Scholar 

  • Jenkins, C. N. H., Le, T., Mcphee, S. J., Stewart, S., & Ha, N. T. (1996). Health care access and preventive care among Vietnamese immigrants: Do traditional beliefs and practices pose barriers? Social Science and Medicine, 43, 1049–1056.

    CrossRef  PubMed  CAS  Google Scholar 

  • Jones, J. H. (1981). Bad blood. New York: Free Press.

    Google Scholar 

  • Jonsen, A., & Toulmin, S. (1988). The abuse of casuistry. Berkeley: University of California Press.

    Google Scholar 

  • Katz, J. (1972). Experimentation with human beings. New York: Russell Sage Foundation.

    Google Scholar 

  • Kaufert, J. M., & O’Neil, J. D. (1990). Biomedical rituals and informed consent: Native Canadians and the negotiation of clinical trust. In G. Weisz (Ed.), Social science perspectives on medical ethics (pp. 41–64). Philadelphia: University of Pennsylvania Press.

    CrossRef  Google Scholar 

  • Kleinman, A. M. (1980). Patients and healers in the context of culture. Berkeley: University of California Press.

    Google Scholar 

  • Kleinman, A. (1995). Anthropology of bioethics. In W. Reich (Ed.), Encyclopedia of Bioethics (pp. 1667–1674). New York: Macmillan.

    Google Scholar 

  • Klessig, J. (1992). The effect of values and culture on life-support decisions. In Cross-cultural medicine—A decade later [Special issue]. Western Journal of Medicine, 157, 316–322.

    PubMed  CAS  Google Scholar 

  • Koenig, B. A. (1993). Diversity in decision-making about care at the end-of-life. In Dying, decisionmaking, and appropriate care. Washington, DC: Institute of Medicine/National Academy of Sciences.

    Google Scholar 

  • Koenig, B. A., & Gates-Williams, J. (1995). Understanding cultural difference in caring for dying patients. Western Journal of Medcine, 163, 244–249.

    CAS  Google Scholar 

  • Lane, S. D. (1993). Research bioethics in Egypt. In R. Gillon (Ed.), Principles of health care ethics (pp. 885–894). New York: Wiley.

    Google Scholar 

  • La Rossa, R., Bennet, L. A., & Grelles, R. (1981). Ethical dilemmas in qualitative family research. Journal of Marriage and Family, 43, 303–313.

    CrossRef  Google Scholar 

  • Lauritzen, P. (1993). Pursing parenthood: Ethical issues in assisted reproduction. Indianapolis: Indiana University Press.

    Google Scholar 

  • Leonard, T. L. (1990). Male clients of female street prostitutes: Unseen partners in sexual disease transmission. Medical Anthropology Quarterly, 4, 41–55.

    CrossRef  Google Scholar 

  • Levine, R. J. (1986). Ethics and regulation of clinical research (2nd ed.). Baltimore: Urban and Schwarzenberg.

    Google Scholar 

  • Levine, R. J. (1991). Informed consent: Some challenges to the universal validity of the western model. Law, Medicine, and Health Care, 19, 3–4.

    Google Scholar 

  • Lock, M. (1993). Education and self reflection: Teaching about culture, health and illness. In R. Masi, L. L. Mensah, & K. McLeod (Eds.), Health and cultures: Exploring the relationships (pp. 137–156). Oakville, Ontario, Canada: Mosaic.

    Google Scholar 

  • Loewy, E. (1991). Suffering and the beneficent community: Beyond libertarianism. Albany: State University of New York Press.

    Google Scholar 

  • Loue, S., Okello, D., & Kawuma, M. (1996). Research bioethics in the Ugandan context: A program summary. Journal of Law, Medicine & Ethics, 24, 47–53.

    CrossRef  CAS  Google Scholar 

  • Maclntyre, A. (1984). After virtue. Notre Dame, IN: Notre Dame University Press.

    Google Scholar 

  • Marshall, P. A. (1989). Children in medical settings. In J. Garbarino, F. M. Stott, & the Faculty of the Erikson Institute (Eds.), What children can tell us (pp. 266–290). San Francisco: Jossey-Bass.

    Google Scholar 

  • Marshall, P. A. (1991). Research ethics in applied anthropology. In C. E. Hill (Ed.), Training manual in medical anthropology (pp. 213–235). Washington, DC: American Anthropological Association and Society for Applied Anthropology.

    Google Scholar 

  • Marshall, P. A. (1992a). Anthropology and bioethics. Medical Anthropology Quarterly, 6, 47–71.

    Google Scholar 

  • Marshall, P. A. (1992b). Research ethics in applied anthropology. IRB: A Review of Human Subjects Research, 14, 1–5.

    Google Scholar 

  • Marshall, P. A., & Koenig, B. A. (1996). Anthropology and bioethics: Perspectives on culture, medicine and morality. In C. Sargent & T. Johnson (Eds.), Medical anthropology: Contemporary theory and method (2nd ed., pp. 349–373). Westport, CT: Praeger.

    Google Scholar 

  • Marshall, P. A., Thomasma, D. C., & Bergsma, J. (1994). Intercultural reasoning: The challenge for international bioethics. Cambridge Quarterly of Healthcare Ethics, 3, 321–328.

    CrossRef  PubMed  CAS  Google Scholar 

  • Marshall, P. A., Koenig, B. A., Barnes, D. M., & Davis, A. J. (1998). Multiculturalism, bioethics and end-of-life care: Case narratives of Latino cancer patients. In D. C. Thomasma & J. Monagle (Eds.), Health care ethics: Issues for the 21st century (pp. 421–431). Rockville, MD: Aspen.

    Google Scholar 

  • Muller, J. H., & Desmond, B. (1992). Ethical dilemmas in a cross-cultural context—A Chinese example. In Cross-cultural medicine—A decade later [Special issue]. Western Journal of Medicine, 157, 323–327.

    PubMed  CAS  Google Scholar 

  • National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1978). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. Washington, DC: U.S. Government Printing Office.

    Google Scholar 

  • Newton, L. H. (1990). Ethical imperialism and informed consent. IRB: A Review of Human Subjects Research, 12, 10–11.

    Google Scholar 

  • Orona, C. J., Koenig, B. A., & Davis, A. J. (1994). Cultural aspects of nondisclosure. Cambridge Quarterly Healthcare Ethics, 3, 338–346.

    CrossRef  CAS  Google Scholar 

  • Orr, R. D., Marshall, P. A., & Osborn, J. (1995). Cross-cultural considerations in clinical ethics consultations. Archives of Family Medicine, 4, 159–164.

    CrossRef  PubMed  CAS  Google Scholar 

  • Pellegrino, E. D. (1992a). Intersections of Western biomedical ethics and world culture: Problematic and possibility. Cambridge Quarterly of Healthcare Ethics, 1, 191–196 (quotation, p. 191).

    CrossRef  PubMed  Google Scholar 

  • Pellegrino, E. D. (1992b). Is truth telling to the patient a cultural artifact? [Editorial]. Journal of the American Medical Association, 268, 1734–1735.

    CrossRef  PubMed  CAS  Google Scholar 

  • Pellegrino, E. D., & Flack, H. E. (1992). African-American perspectives on biomedical ethics. Washington, DC: Georgetown University Press.

    Google Scholar 

  • Pellegrino, E. D., & Thomasma, D. C. (1989). For the patient’s good: The restoration of beneficence in health care. New York: Oxford University Press.

    Google Scholar 

  • Pellegrino, E. D., & Thomasma, D. C. (1993). The virtues in medical practice. New York: Oxford University Press.

    Google Scholar 

  • Pellegrino, E. D., Corsi, P., & Mazzarella, P. (Eds.). (1992). Transcultural dimensions in medical ethics. Frederick, MD: University Publishing.

    Google Scholar 

  • Putsch, R. W., III. (1985). Cross-cultural communication: The special case of interpreters in health care. Journal of the American Medical Association, 254, 3344–3348.

    CrossRef  PubMed  Google Scholar 

  • Rothman, D. (1991). Strangers at the bedside: A history of how law and bioethics transformed medical decision-making. New York: Basic Books.

    Google Scholar 

  • Schneiderman, L. J., & Jecker, N. S. (1995). Wrong medicine: Doctors, patients, and futile treatment. Baltimore, MD: Johns Hopkins University Press.

    Google Scholar 

  • Schoepf, B. G. (1991). Ethical, methodological and political issues of AIDS research in central Africa. Social Science Medicine, 33, 749–763.

    CrossRef  PubMed  CAS  Google Scholar 

  • Seiler, L. H., & Muirtha, J. M. (1980). Federal regulation of social research using “human subjects”: A critical assessment. American Sociologist, 15, 146–157.

    Google Scholar 

  • Shweder, R. (1990). Ethical relativism: Is there a defensible version? Ethos, 18, 219–223.

    CrossRef  Google Scholar 

  • Siddharthan, K., & Alalasundaram, S. (1993). Undocumented aliens and uncompensated care: whose responsibility? American Journal of Public Health, 83, 410–412.

    CrossRef  PubMed  CAS  Google Scholar 

  • Stepick, A., & Stepick, C. D. (1990). People in the shadows: Survey research among Haitians in Miami. Human Organization, 49, 64–11.

    Google Scholar 

  • Surbone, A. (1992). Truth telling to the patient [Letter]. Journal of the American Medical Association, 268, 1661–1662.

    CrossRef  PubMed  CAS  Google Scholar 

  • Teno, J., Hill, T. P., & O’Connor, M. A. (1994). Advance care planning: Priorities for ethical and empirical research. Hastings Center Report, 24 (Suppl.), 1.

    Google Scholar 

  • Thamer, M., Richard, C., Casebeer, A. W., & Ray, N. F. (1997). Health insurance coverage among foreignborn US residents: The impact of race, ethnicity, and length of residence. American Journal of Public Health, 87, 96–102.

    CrossRef  PubMed  CAS  Google Scholar 

  • Tong, R. (1996). Feminist approaches to bioethics. Boulder, CO: Westview.

    Google Scholar 

  • Uba, L. (1992) Cultural barriers to health care for southeast Asian refugees. Public Health Reports, 107, 544–548.

    PubMed  CAS  Google Scholar 

  • U.S. Department of Health and Human Services (USDHHS). (1981). Final Regulations Amending Basic HHS Policy for the Protection of Human Research Subjects: Final Rule: 5 CFR 46. Federal Register: Rules and Regulations 46 (16, January 26), 8366–8392.

    Google Scholar 

  • US. National Commission for the Protection of Human Subjects of Biomedical and Behavior Research. (1978). Report and recommendations: Research involving those institutionalized as mentally infirm. Bethesda, MD: US. Department of Health, Education and Welfare.

    Google Scholar 

  • Veatch, R. M. (1981). A theory of medical ethics. New York: Basic Books.

    Google Scholar 

  • Veatch, R. M. (1987). The patient as partner: A theory of human-experimentation ethics. Bloomington: Indiana University Press.

    Google Scholar 

  • Veatch, R. M. (1989). Cross cultural perspectives in medical ethics: Readings. Boston: Jones and Bartlett.

    Google Scholar 

  • Veatch, R. M. (1991). The physician-patient relationship: The patient as partner: Part 2. Bloomington: Indiana University Press.

    Google Scholar 

  • Ware, N. C., & Kleinman, A. R. (1992). Culture and somatic experience. Psychosomatic Medicine, 54, 546–560.

    PubMed  CAS  Google Scholar 

  • Wasongarz, D., Carter, J., Barnes, D. M., & Koenig, B. A. (1995). Bioethics and the intermediary role of interpreters: Negotiating language and emotion. Unpublished manuscript, Stanford University Center for Biomedical Ethics. First presented as a paper at the 1994 annual meeting of the American Anthropological Association, Atlanta, GA.

    Google Scholar 

  • Wax, M. L., & Cassell, J. (Eds.). (1979). Fieldwork, ethics and politics: The wider context. In M. L. Wax & J. Cassell (Eds.) Federal regulations: Ethical issues and social research (pp. 85–101). Boulder, CO: Westview.

    Google Scholar 

  • Weisz, G. (Ed.). (1990). Social science perspectives on medical ethics. Philadelphia: University of Pennsylvania Press.

    Google Scholar 

  • Wolf, S. (1996). Feminism and bioethics: Beyond reproduction. New York: Oxford University Press.

    Google Scholar 

  • World Health Organization and Council for International Organizations of Medical Sciences (WHO-CIOMS). (1993). International ethical guidelines for biomedical research involving human subjects. Geneva, Switzerland: Author.

    Google Scholar 

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Marshall, P.A., Koenig, B.A., Grifhorst, P., van Ewijk, M. (1998). Ethical Issues in Immigrant Health Care and Clinical Research. In: Loue, S. (eds) Handbook of Immigrant Health. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-1936-6_11

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