Cultural assessment in bioethical advocacy--toward cultural competency in bioethical practice

The continued diversification of the U.S. population poses increasing challenges for bioethical advocates (e.g., ethicists, physicians, nurses, social workers, psychologists, surrogates, researchers, and lawyers), especially those serving rapidly expanding and culturally varied populations. The issue from the bioethics perspective is that the members of ethnically diverse groups often bring different normative expectations and their own preferred decision-making formats to the bioethics table. For example, some advocates will encounter a "collectivity," or the family-as-a-whole rather than the individual, as a decision maker. In other instances, they may encounter cultural groups whose members (or some of whose members) will value the principle of beneficence more than personal autonomy. Moreover, such value-based challenges are likely to continue since forecasters predict that diversification will actually quicken in the United States throughout the next five decades. In the face of these changes in the bioethical climate, advocates must be prepared to strengthen their cultural assessment skills. Taking a multidimensional approach to the problem yields a four-point cultural assessment model to help advocates handle the great diversity of outlook and orientation among their culturally diverse clientele.