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This case illustrates a number of complex issues clinicians face when patients' culturally appropriate treatments are at odds with the clinician's methods of therapy. Our general view in such cases is that there are good reasons for respecting culturally differing practices, particularly when they fit into a larger rationale of explanations for health and illness, good and evil. Ms. Saeto's belief, as recounted here, appears to be well grounded in her culture; it is practiced widely; the reasons for it are widely understood among the Iu Mien; the procedure, from a Mien point of view, works; Ms. Saeto's application of the procedure, as recounted here, appears in accordance with Mien customs and not merely a personal and culturally unaccepted practice. This rules out concerns that her actions stemmed from ill-will, insanity, irrationality, and the like.

One reason for respecting cultural diversity rests on the observation that community membership, participation, and shared symbolism are important sources of human happiness and health, apart from any validity of the symbols with reference to science or to reality. In this case, Ms. Saeto clearly derives a sense of identity and security from her status within the Mien community. Given Ms. Saeto's history and social circumstances, it might be destructive for Dr. Leigh to undermine Ms. Saeto's affiliation with this cultural group.

A second justification for respect in such cases is that they offer opportunity to extend human knowledge by finding wisdom in dissimilar cultural practices, especially ones as ancient as the Chinese tradition, thought to be the source of the Mien practice of moxibustion. Many traditional therapies have provided theoretical clues and practical remethes for the treatment of disease. These traditional sources create a presumption of seriousness and warrant investigating possible applications to contemporary settings.

Furthermore, openness to other paradigms can stimulate clinicians like Dr. Leigh to examine critically the cultural norms of their own practices. Dental and injection pain and vaccination scars are seen as easily justified from a Western medical perspective. And she can reflect ironically on more questionable practices, such as the widespread use of painful and highly technological procedures, many of questionable benefit, against a background of dismal public health figures as compared with other industrialized nations. An unreflective challenge to moxibustion could rightly be seen as ethnocentric or even racist against the background of Dr. Leigh's professional culture.

On the other hand, as also voiced by Dr. Leigh, it may be impossible and inappropriate to suspend clinical training and judgment in favor of "cultural sensitivity," even when based on the good reasons we have mentioned. The need for membership in community has also been used to justify much cruelty in the past--were someone to argue that we should tolerate the torture and murder of children simply because it has a cultural foundation, we would disagree. Health practitioners should not abstain from involvement in conflict with their own or other cultures where they are concerned about basic offenses against humanity and human health. We note that respect for autonomy fares no better against cruelty and evil than does respect for culture.

Dr. Leigh has several choices about how to respond. The worst of these would be simply to tolerate the practice as a primitive cultural artifact and to take no further interest in it. We would particularly oppose a referral of child abuse to the police or Child Protective Services. In general, we think there is scope for interpreting the law in cases where there are cultural disagreements over the nature of harm. It is unlikely that harm is intended in the application of a traditional remedy--the obverse is more likely true. In this case, the mother's actions do not constitute intentional abuse; the child's welfare is a priority for her. Neither could her actions be read as neglect since she is obviously attentive and seeking care for her child.

Rather than trying to prohibit this practice directly, which might alienate Ms. Saeto, a clinician could discuss the risk of and protection against secondary infection and suggest safer pain remethes. Dr. Leigh should be more worried about being able to monitor the baby's symptoms of illness than the Mien therapy (the "head thrown back" symptom reported with the folk illness could become worrisome with a high fever). Part of her commitment to patients is to teach what, from a medical point of view, may damage health. Maximally, Dr. Leigh could try to learn more about the rationale for and techniques of moxibustion herself. If after her inquiry she is still concerned about the procedure, she should consider sharing her concerns with the local Mien community, not Ms. Saeto alone.
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Title Annotation:on Culture, Healing, and Professional Obligations, p. 15, in this issue
Author:Brown, Kate; Jameton, Andrew
Publication:The Hastings Center Report
Date:Jul 1, 1993
Previous Article:Commentary.
Next Article:The impending collapse of the whole-brain definition of death.

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