Cross-cultural geriatric ethics: negotiating our differences.

Do we come up with different solutions to ethical problems depending on a person's ethnic or cultural backround? Mrs. Chu is an 85-yearold citizen of the People's Republic of China who has recently come to live in the United States with her adult children, both immigrants. She has some limited ability to understand English. Mrs. Chu has experienced some health problems and is being cared for at home by her family. She has now been brought to a hospital for tests. The children understand that doctors have definitively diagnosed Mrs. Chu's medical condition as cancer, but the family are adamantly opposed to telling-Mrs. Chu right away. It would be disrespectful to talk about death to her this way, they say. Instead, they tell hospital authorities they have their own approach to dealing with these matters, an approach that includes traditional Chinese herbal remedies. Members of the healthcare team involved in Mrs. Chu's case are debating what should be done next. A doctor says that he is horrified at the idea of treating cancer with herbal remedies but that he believes he has fulfilled his responsibility by informing the family. What happens next is not his responsibility. A nurse strongly insists that Mrs. Chu has a right to informed consent and that she must be told the truth directly, whatever the family says. Finally, asocial worker the healthcare team argues that we need to balance the risks and benefits of telling the truth by taking account of traditional Chinese ideas about the family and ideas ofhealth and illness One member of the team says they should tell Mrs. Chu she has "neoplastic disease," while still another argues that Mrs. Chu is a citizen of China, not the United States, and just as laws differ across countries, so do values differ across cultures, with the conclusion that we should respect other cultures as much as possible. What should the healthcare team do now? The case of Mrs. Chu illustrates a range of ethical dilemmas in geriatric care raised by cultural and ethnic differences. Some believe that rights and values are entirely relative: for example, that the Confucian idea of filial piety and family solidarity is simply different from the Western idea of individual autonomy. In this view, respect for other cultures means accepting the Chu family's version of ethics, whatever that may be. Others believe that claims about human rights-for example, the right to informed consent-are absolute and universal. For that reason, it is said, we can condemn torture and other acts that dehumanize people, even if those acts are approved by majorities or by custom in another society. The same logic leads believers in universal rights to condemn, for example, female circumcision, a practice that remains common in African societies. Finally, there are still others who believe that finding "the right thing to do" necessarily involves questions about social context: in this case, questions about the role of an elderly person in the family system. Without dialogue and deeper appreciation of context, this argument goes, broad ideologies such as cultural relativism or a belief in the existence of universal human rights can lead to irresponsible abdications or irresponsible interventions. According to this perspective, communication among all involved in an ethical dilemma becomes the paramount responsibility and is the only basis for finding a resolution acceptable to all parties. Cultural relativity, human rights, and imperatives of cross-cultural communication are all important considerations in trying to make a decision in a case like the one involving Mrs. Chu. But ethics is above all a matter of practice and decisions. In the last analysis, what do we do in the case of Mrs. Chu? Do we come up with different answers for people depending on their ethnic or cultural backgrounds? Does age make any difference at all in a case like this one? ETHNICITY, ETHICS, AND AGING In an effort to explore some of these questions, the Brookdale Center on Aging of Hunter College two years ago embarked on the project Ethnicity, Ethics, and Aging, which was supported by the Fan Fox and Samuels Foundation. …