5 - Culture and ethics in health care

Summary

Case example

Dr. Jordan is a neonatologist providing intensive care for Baby Sanjay, a 2-week-old premature infant with a large unilateral cerebral hemorrhagic infarct (a blood clot in the brain causing bleeding and tissue damage). Because his lungs are not fully developed, Baby Sanjay is currently dependent on a mechanical ventilator to support his breathing. Dr. Jordan believes that Baby Sanjay has a fairly good chance of survival (60–70 percent) with continuing intensive care. It is very probable, however, that he will be both physically and mentally disabled. At this early stage of Baby Sanjay's development, the degree of his eventual disability is still highly uncertain. It could be mild to profound, and there is a small chance he would survive without disability. Dr. Jordan has provided intensive care for hundreds of infants with medical conditions like Baby Sanjay, and he is committed to preserving the lives and promoting the health and well-being of his patients.

Baby Sanjay's parents are citizens of India; his father is working temporarily in the USA, but they plan to return to India shortly. They visit their son frequently and are very concerned about his serious medical problems. After hearing that, if he survives, Baby Sanjay will probably be mentally and physically disabled, the parents have asked Dr. Jordan to discontinue ventilator support and allow the baby to die. They explain that in their home city in India, disabled people face severe discrimination; little education, rehabilitation, or health care is available to them. Therefore, they prefer to allow Baby Sanjay to die rather than to live what they believe will be a life of profound suffering and indignity.

To evaluate the parents’ request, Dr. Jordan consults several of his colleagues who received their medical training in India. They corroborate the parents’ claim that mentally disabled persons, and their families, suffer great discrimination and receive little support in India. How should Dr. Jordan respond to the parents’ request?

The ubiquity of cultural diversity

Until the twentieth century, most of the world's people lived and died within their own community, region, or nation and had little contact with foreigners or “strangers.” Developments in travel, technology, communication, politics, and economics since that time have transformed this situation in all but the world's poorest and remotest regions.