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Spring 2002
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Cultural Diversity
Dr.
Marie Bourgeois has provided the following discussion and case studies.
Sequence of
Cultural Behavior in Illness
In some American Indian tribes if a person is merely not felling well,
the members of the family diagnose and prescribe. Resorting to folk
remedies and patent medicines is usual for colds and other minor
complaints. Sometimes, however, when it is recognized that the
individual is ailing, but when at the same time he is not recognizably
ill since he can carry on his ordinary duties, the family adopts a
"wait and see" attitude. They keep a watchful eye on him or
her and they may arrive at a tentative diagnosis, after which, depending
on the symptoms, they may insist on diet regulations and/or
administration of patent medicines or herbal remedies. Only when the
symptoms become more pronounced do the families take the more drastic
action involving outside medical service. Such action is usually
postponed until the individual is actually incapacitated. In coming to a
decision regarding such cases, the general pattern is to hold a family
council and give the greatest weight to the opinion of the oldest
member. The values of the culture are manifested in the family's beliefs
and behavior when a member is ailing.
CASE 1
A Native American woman lived on a reservation where a white American
physician managed the health clinic. The woman hit her leg on a stool in
a factory where she was working. She noticed several days later a large
sore on her leg.
Her sister and son took her to a private doctor. The doctor dressed the
sore and gave her a prescription. She applied the prescribed ointment
and bandaged the wound every day, but it did not heal. The family
decided to take her to the clinic on the reservation. The doctor there
gave her a medication to apply and told her to return in a week. The
sore did not heal. The medicine woman on the reservation suggested
applying a poultice made of plantain leaves to the sore. She was very
concerned about her leg. The family decided she should go to another
doctor in a nearby town. He tested her blood for "sugar". It
was negative. He gave her a prescription for the sore on her leg. When
she returned home, a friend made an herbal brew for her to drink. She
had to drink six quarts of it. The wound began to heal but she went back
to the doctor in the health clinic and he told her the medicine he had
prescribed was working to keep taken it. He knew about some of her
beliefs in ‘folk medicine’. She believed the herbal remedy was the
cure. The family believed their medicine was best and did not think the
white man's medicine always worked. She never told the doctor in the
clinic that she had used ‘folk medicine’ and had visited two other
doctors. The ‘folk therapy’` (whether herbal or traditional curing
rites) was credited as the reason for recovery.
Case 2
A similar case of combined therapies is that of a Native American
obviously suffering from yellow jaundice. The members of his family and
that of his wife’s family diagnosed it as such. They judged, however,
that the "poison" in his system was "running into his
eyeballs" and tuning them yellow. They decided an herbal brew
should be administered but none was on hand so they sent word to a
friend to obtain some for them. In the meantime, the wife and her sister
took the patient to the health clinic on the reservation where their
diagnosis was confirmed. The doctor gave him some medicine and told him
to return in two days time.
The patient took one of the prescribed pills, but since the herbal
medicine had been delivered, the family decided he should first take a
laxative. The next day they had the patient take the herbal brew, one
glass at a time, until he had consumed about four gallons of it to flush
the poison out of his system. The following day they took him to a
private physician who did not examine him but gave him a prescription
and told him to come back in a week. They did not bother to have the
prescription filled, but did go back to the doctor in the health clinic.
When the doctor said he was much better and that the improvement was due
to the pills he had prescribed, they did not tell him that he had only
taken one of them. They let the doctor "think that his medicine was
okay." The doctor thought his prescribed medicine had worked and he
would use it again.
QUESTIONS
In Al Jonsen and Mark
Siegler's book, Clinical Ethics, A Practical Approach to Ethical
Decisions in Clinical Ethics, 4th Edition, they describe an
approach to use when collecting, reviewuating, and recommending
strategies for ethical decision-making. Essentially, they review the
patient in four dimensions:
Medical Indications
- Patient Preferences
- Quality of Life
- Contextual features (those issues,
which originate from beyond the individual patient needs, i.e.
family preferences, religious/cultural, allocation of resources,
etc.)
Re-reviewuate each of the above cases for
their exploration, or lack thereof of these elements and then re-present
the case in light of these considerations. What ethical considerations
are more prominent than others? How will you as a practitioner expand
your dialogue and inquiry regarding use of ‘folk medicine’?
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Course
Overview