Abstract
Cultural Competence is one of the competencies required of all Health Practitioners in New Zealand since the enacting of the Health Practitioners Competence Assurance Act in 2003. This dissertation examines what relationship there is between this concept and Bioethics and Health Law.
The dissertation argues that the need for the concept of Cultural Competence comes from the failure of the Bioethics community to adequately address the fundamental ethical issue that non-dominant cultural groups frequently receive inferior care, and have significantly worse health outcomes, than people who are part of the dominant cultural group.
The definition of Cultural Competence is not agreed upon in the literature so I have examined the policies of the sixteen Health Practitioner Registration Authorities in New Zealand to develop a New Zealand definition to work from. The most important triggers for the development of Cultural Competence were the fact that there were significant health outcome disparities affecting non-dominant cultural groups, and people from non-dominant cultural groups do not receive care that is cognisant of their values, beliefs and ways of living.
Cultural Competence is particularly important in New Zealand because we have an increasingly diverse community and there are significant health outcome disparities, some of which are caused by inequitable access to healthcare services. Practising in a culturally competent way is important for non-dominant cultural groups, but also for many people within the dominant cultural group. This is because of the cultural distance between many people and their health care providers, where the explanatory model of clinician and patient are not congruent. An important indicator of this is the level of non-compliance of patients with investigation and treatments recommended by their clinicians.
Most bioethics problems are complex, and if complexity science is applied to them it becomes clear that bioethical judgements are based on an uncertain factual base, change with time and need to be made by the people involved in the problem.
The concept of frame of reference is usefully applied to bioethics problems, understanding that every person will approach a problem from a different (sometimes slightly different, sometimes significantly different) frame of reference. An understanding of the frame of reference of all parties involved in a problem is essential to good decision making.
I will argue that both Cultural Relativism and Moral Objectivism are inadequate positions to deal with a multicultural society and develop a concept of Complex Principlism as a framework for analysing bioethical problems.
Bioethics is a relational activity and it is essential to focus on maintaining a functional relationship with all involved in the problem and understanding how to establish and maintain trust and utilise fair process, rather than just focussing on analysing what you as an individual believe is the right answer to the problem.
We live in a multicultural society but do not value multiculturalism, although New Zealand does value biculturalism between Maori and the dominant cultural group. There is strong evidence in favour of putting the valuing of multiculturalism at the centre of our governance. This would contribute significantly to improving health outcome disparities and is an essential strategy to learn how to live successfully in the modern world.