Health Care Ethics: Cultural Relativity of Autonomy

Culture refers to the totality of learned and transmitted beliefs, values, and attitudes shaped and perpetuated by mem-bers of a social group (Leininger, 1991). Ethics has been described as the study of the rules of conduct recognized in regards to a particular class of human actions. Ethics serves as a branch of philosophy that defines a role guideline for desired actions relative to social mores (Dunn, 1998). Ahronheim, Moreno, and Zuckerman (1994) have defined clinical ethics as the systematic identification, analysis, and resolution of ethical problems associated with care of particu-lar patients, goals of protecting the rights and interests of patients, assisting clinicians in ethical decision making, and encouraging cooperative relationships between patients, families, clinicians, and health care institutions. As a soci-ety’s values culminate in the development of correlating mor-als, these morals are ultimately reflected in every aspect of life. In the context of health care, cultural heritage influences the perceptual framework of illness, wellness, and accepted treatment modalities (Berger, 1998; Orr, Marshall, & Osborn, 1995). In consideration of these concepts, it can be logically understood that health care ethics can be and generally is greatly influenced by the practicing society. In Western philosophy, the four key principles that have emerged as guides to ethical health care decision making are autonomy, beneficence, nonmaleficence, and justice. Although the concept of autonomy has been interpreted vari-ous ways, it most commonly endorses the expectation that persons have the capacity to reason and make decisions con-cerning their own futures (Woodward, 1998). This funda-mental principle can be directly related to the constitutionally described American cultural values of liberty, privacy, and