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This work presents the case of the Yanomami indigenous people from Brazil that were the object of US ethnography initiated in the 1960s. The research brought harmful repercussions to the life of the Indigenous people of Brazil for several decades, and it took more than 40 years until the beginning of a process of reparation involving the Brazilian government and American universities. Objective: to discuss the meaning of the return of Yanomami blood samples, as well as contributions from the epistemologies of traditional Indigenous knowledge to the debate about research ethics and the structuring of means for the social control of researchers and the protection of participants in scientific studies, having as an example the Yanomami indigenous people from Brazil, subjected to noxious ethnography in the 1960s and the 1970s. This work used data reports recorded in secondary sources. In this article we argue that Bioethics needs to further diversify its epistemological foundations and to consider epistemologies and cosmologies beyond the frontiers of Western science, as the case of the abusive research involving the Yanomami indigenous people in Brazil reveals. We argue that traditional knowledge, such as those of indigenous and quilombolas, with their epistemologies and cosmologies, are fundamental for the election of less colonized and more efficient principles of research ethics, regarding the protection of the participants' rights in scientific studies. Traditional indigenous populations can teach us a great deal about doing research., (© 2020 John Wiley & Sons Ltd.)

Modern medicine's investment in the disembodied, objective 'science' of biomedicine, where patients are transformed from suffering subjects to objects of investigation, calls for heightened ethical awareness. Around the world, ethical codes of conduct emphasise beneficence and non-maleficence. Lately, we have also seen a quest for autonomy and equitable healthcare for diverse populations. However, these tenets alone do not effectively address the problems which regularly occur in transcultural consultations. By developing a 'space for reflection' based on selected writings of the moral philosophers Axel Honneth, Emmanuel Levinas and Hans Jonas, my aim is to cast light on this issue. Given the differing aspects of the doctor-patient relationship, clearly there are no clear-cut rules to obey. However, a thematic analysis of a quote from a Somali, female refugee, supported by some other studies on medical practice, suggests that, metaphorically speaking, within the developed space for reflection, medical practice has worked itself into a corner. By neglecting the patient as a social being, lacking openness to alterity, and not conveying needed information, they make it very difficult for patients to take responsibility for their situation. In spite of doctors' benevolence, the result is alienation, increased suffering and thus, potential harm. Similar tendencies are reflected in a number of recent studies on medical consultations. Therefore, rather than blaming the single doctor for moral deceit, we should see these tendencies as a 'forgetfulness of recognition' that affects the medical profession, a disturbance which source probably is hidden in doctors training., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Resettlement can be particularly challenging for women as having a lower socioeconomic status and language barriers, may impede women's access to education, employment opportunities, health-care services, as well as the cultural, social, material and resilience factors that facilitate adjustment and adaption. Thus, the aim of this study is to further explore the perception of refugee women in Sweden concerning their situation during active participation in the resettlement process in the country., Methods: Qualitative interview study with 11 recently arrived refugee women who had received their residence permits and were enrolled in the resettlement process. The interviews were conducted in Swedish with the support of an authorized Arabic translator present by telephone., Results: Refugee women suffered from being separated from their loved ones and felt compelled to achieve something of value in the host country. All experienced both physical and mental anguish., Conclusions: Stakeholders in societies that receive refugee women should stress the importance of finding opportunities for and fast entrance into employment in the host countries. This would be beneficial for the integration and well-being of refugee women after migration.

Background: Forgiveness has the potential to resolve painful feelings arising from nurse-patient conflicts. It would be useful to evaluate direct and indirect important factors which are related to forgiveness in order to design interventions that try to facilitate forgiveness., Aim/objective: The purpose of this study was to evaluate the intermediating role of empathy in the cultural competence-forgiveness association among nurses using structural equation modeling., Research Design: The research applied a cross-sectional correlational design., Participants and Research Context: The study included 380 nurses eight hospitals in southern Iran., Ethical Considerations: The Ethics and Research Committee of Birjand University of Medical Sciences approved the study protocol. The voluntary nature of participation was explained consent was obtained from participants, and anonymity was guaranteed., Findings: Most of the participants were married and female and fell in the 20- to 30-year-old category. Most of them (89.5%) had a working experience of 1-10 years. The proposed model showed that nurses' empathy intermediated the association between nurses' cultural competence and forgiveness which has fitted the data acceptably (root mean square error approximation = 0.070; comparative fit index = 0.993; goodness-of-fit index = 0.983; and χ 2 /df = 2.85)., Conclusion: Empathy skills and cultural competence training were essential for interventions aimed at increasing the tendency to forgive patients. In such interventions, planners should aim at increasing nurses' cultural competence in order to enhance their empathy toward patients, which can, in turn, lead to a greater wish to forgive patients.

Religious mental health practitioners who hold traditional views of gender and sexuality may face moral and ethical dilemmas when working with sexual and gender minority (SGM) clients. Typical responses to this dilemma include selective positioning, values-based referrals, and attempted objectivity. Grounded in social work ethics and values, this article examines the evidence base, viability, and repercussions of these approaches. This article demonstrates the importance of cultural competence and affirmative therapeutic practices for religious mental health practitioners, whether or not they expect to work with gender and sexual minority clients or their families. In addition, the author tackles the difficult issue of providing ethical, evidence-based therapeutic services for religiously conservative parents of SGM children and adolescents. SGM people exist in every community, in every faith, and in every kind of family. The ethical treatment of SGM clients is relevant to all mental health practitioners, regardless of personal values or the type of practice they maintain., (© 2019 National Association of Social Workers.)

Background: This study sought to examine the awareness/perception of intercultural competence and institutional intercultural inclusiveness among first year students at an Australian medical school over four consecutive years (2014-2017); to identify existing gaps in the curriculum and proffer recommendations., Methods: The study employed an adapted 20-item questionnaire for data collection. The reliability and interrelations of the survey items were examined. Descriptive statistics was used to examine students' perceptions, while Mann-U Whitney and Kruskal-Wallis tests were used to assess items scores in relation to participant characteristics., Results: Over the 4 years of study, there were 520 respondents with between 53 to 69% response rates per year. Cronbach's alpha for the instrument was 0.88 and factor analysis showed all items loading strongly on two components. Participants' mean score on self-reported intercultural competence levels ranged from 3.8-4.6 out of 5; indicating relatively high awareness, valuing and understanding of cultural differences among this group of students. However, their mean scores (3.4-4.2) for institutional intercultural inclusiveness were slightly lower., Conclusion: The instrument used in this study is effective in assessing level of intercultural competence among medical students. However, the results highlight the need for increased institutional support and professional development for faculty members to foster institutional intercultural inclusiveness.

Individuals responsible for carrying out research within their diverse communities experience a critical need for research ethics training materials that align with community values. To improve the capacity to meet local human subject protections, we created the research Ethics Training for Health in Indigenous Communities (rETHICS), a training curriculum aligned within American Indian and Alaska Native (AI/AN) context, culture, and community-level ethical values and principles. Beginning with the Belmont Report and the Common Rule that defines research with human subjects (46 CFR 45), the authors convened three different expert panels (N = 37) to identify Indigenous research values and principles common across tribal communities. The resulting culturally grounded curriculum was then tested with 48 AI/AN individuals, 39 who also had recorded debriefing interviews. Using a thematic analysis, we coded the qualitative feedback from the expert panel discussions and the participant debriefings to assess content validity. Participants identified five foundational constructs needed to ensure cultural-grounding of the AI/AN-specific research training curriculum. These included ensuring that the module was: (a) framed within an AI/AN historical context; (b) reflected Indigenous moral values; (c) specifically linked AI/AN cultural considerations to ethical procedures; (d) contributed to a growing Indigenous ethics; and (e) provided Indigenous-based ethics tools for decision making. Using community-based consultation and feedback from participants led to a culturally grounded training curriculum that teaches research ethical principles and procedures for conducting research with AI/ANs. The curriculum is available for free and the community-based process used can be adapted for other cultural groups., (© 2019 Society for Community Research and Action.)

Service learning trips can be a powerful means of fostering cultural competency as well as an opportunity for students to expand their clinical skill set. However, if not planned and executed thoughtfully, they might not provide lasting benefit to the communities they seek to serve. Through analysis of a case in which participants question the value of their short-term international service learning trip, we argue that such trips should be designed with the community's needs in mind, preferably as identified by the community. Ideally, both the service group and the community should seek opportunities for teaching and exchange in order to expand the community's ability to provide care to the local population long after the service learning group has left., (© 2019 American Medical Association. All Rights Reserved.)

Objectives: To determine the validity, sensitivity, specificity and acceptability of the culturally adapted nine-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander people., Design: Prospective observational validation study, 25 March 2015 - 2 November 2016., Setting, Participants: 500 adults (18 years or older) who identified as Aboriginal or Torres Strait Islander people and attended one of ten primary health care services or service events in urban, rural and remote Australia that predominantly serve Indigenous Australians, and were able to communicate sufficiently to respond to questionnaire and interview questions., Main Outcome Measures: Criterion validity of the aPHQ-9, with the depression module of the Mini-International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standard., Results: 108 of 500 participants (22%; 95% CI, 18-25%) had a current episode of major depression according to the MINI criterion. The sensitivity of the aPHQ-9 algorithm for diagnosing a current major depressive episode was 54% (95% CI, 40-68%), its specificity was 91% (95% CI, 88-94%), with a positive predictive value of 64%. For screening for a current major depressive episode, the area under the receiver operator characteristic curve was 0.88 (95% CI, 0.85-0.92); with a cut-point of 10 points its sensitivity was 84% (95% CI, 74-91%) and its specificity 77% (95% CI, 71-83%). The aPHQ-9 was deemed acceptable by more than 80% of participants., Conclusions: Indigenous Australians found the aPHQ-9 acceptable as a screening tool for depression. Applying a cut-point of 10 points, the performance characteristics of the aPHQ were good., (© 2019 AMPCo Pty Ltd.)

Background: Israel's population is diverse, with people of different religions, many of whom seek spiritual guidance during ethical dilemmas. It is paramount for healthcare providers to be familiar with different religious approaches., Objectives: To describe the attitudes of the three major monotheistic religions when encountering four complex neonatal situations., Methods: A questionnaire related to four simulated cases was presented to each participant: a non-viable extremely premature infant (case 1), a severely asphyxiated term infant with extensive brain damage (case 2), a small preterm infant with severe brain hemorrhage and likely extensive brain damage (case 3), and a term infant with trisomy 21 syndrome and a severe cardiac malformation (case 4)., Results: Major differences among the three religious opinions were found in the definition of viability and in the approach towards quality of life., Conclusions: Neonatologists must be sensitive to culture and religion when dealing with major ethical issues in the neonatal intensive care unit.

Patient-physician language discordance within the growing Spanish-speaking patient population in the United States presents a significant challenge for health systems. The Civil Rights Act, an Executive Order, and federal standards establish legal requirements regarding patients' legal right to access medical care in their language of origin and to culturally and linguistically appropriate services, and national competency standards for undergraduate and graduate medical education and licensing examinations support the importance of patient-physician communication. However, no requirements or guidelines currently exist for medical Spanish educational resources, and there is no standardized process to assess the competency of medical students and physicians who use Spanish in patient care. Relatedly, existing data regarding current medical Spanish educational resources are limited, and Spanish proficiency evaluations are often based on self-assessments. Future efforts should use a multifaceted approach to address this complex challenge. A standardized process for Spanish-language-concordant medical care education and quality assurance should incorporate the validation of medical Spanish educational resources, competency requirements for medical usage of Spanish, an incentivized certification process for physicians who achieve medical Spanish competency, and health system updates that include routine collection of language concordance data and designation of Hispanic-serving health centers.

Background: Students on international medical electives face complex ethical issues when undertaking clinical work. The variety of elective destinations and the culturally specific nature of clinical ethical issues suggest that pre-elective preparation could be supplemented by in-elective support., Methods: An online, asynchronous, case-based discussion was piloted to support ethical learning on medical student electives. We developed six scenarios from elective diaries to stimulate peer-facilitated discussions during electives. We evaluated the transcripts to assess whether transformative, experiential learning took place, assessing specifically for indications that 1) critical reflection, 2) reflective action and 3) reflective learning were taking place. We also completed a qualitative thematic content analysis of the discussions., Results: Of forty-one extended comments, nine responses showed evidence of transformative learning (Mezirow stage three). The thematic analysis identified five themes: adopting a position on ethical issues without overt analysis; presenting issues in terms of their effects on students' ability to complete tasks; describing local contexts and colleagues as "other"; difficulty navigating between individual and structural issues, and overestimation of the impact of individual action on structures and processes., Conclusion: Results suggest a need to: frame ethical learning on elective so that it builds on earlier ethical programmes in the curriculum, and encourages students to adopt structured approaches to complex ethical issues including cross-cultural negotiation and to enhance global health training within the curriculum.

Cultural competence literature and training aim to equip healthcare workers to better understand patients of different cultures and value systems, in an effort to ensure effective and equitable healthcare services for diverse patient populations. However, without nuanced awareness and contextual knowledge, the values embedded within cultural competence practice may cripple rather than empower the very people they mean to respect. A narrow cultural view can lessen cultural understanding rather than grow it. In its first part, this paper argues that a hasty, unrestrained, and uneducated willingness to accept something as a cultural good, despite being well intentioned, can still cause significant harms-particularly when based on false, misinformed, and stereotypical conceptions-including the minimization of issues, the reinforcement of stereotypes, and the impediment of cultural change. The second part of this paper examines medical autonomy within the context of Saudi Arabian women. It pushes back on the common perception that Saudi women, by virtue of culture and religion, view dependency on and deference to male relatives as a cultural good. Through a historical examination and a presentation of the current women's movement in Saudi Arabia, it is argued that the continued assumption that personal agency is a value external to Saudi women is false, misguided, and ethically problematic. Lastly, this paper considers some approaches to help providers navigate the narrow grounds between paternalism and patronization when caring for patients.

High-quality doctor-patient communication in end-of-life care results in better quality of life for patients. In linguistically and culturally diverse societies, language discordant consultations become daily practice, leading to difficulties in eliciting patient preferences toward end-of-life care. Although family members invariably act as informal interpreters, this may cause some ethical dilemmas. We present a case of a palliative patient whose son acted as an interpreter. This case generated a triple- layered ethical dilemma: (i) how to safeguard patient autonomy against paternalistic interventions by family members, (ii) how to respect the relational context in which patient autonomy can be realized, and (iii) how to respect the ethno-cultural values of the patient and his family. These issues are being discussed and reflected upon within the framework shared decision making involving informal- and professional interpreters. The complementary use of professional interpreters next to family members acting as informal interpreters is recommended.

[Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].

The debate around the ethics of homeopathy in recent issues of the journal has been approached as a binary question; is homeopathy ethical or not? This paper suggests that this is an unhelpful question and instead discusses a framework to establish the extent to which the dominant (medical) culture should tolerate non-dominant health practices such as homeopathy. This requires a sophisticated understanding of the placebo effect, a critical evaluation of what evidence is available, a consideration of the harm that the non-dominant practice might cause, and a consideration of how this might be affected by the culture of the patient. This is presented as a matter of cultural competence. At a clinical level clinicians need to respect the values and beliefs of their patients and communicate with all the practitioners involved in a patient's care. At a societal level there are a number of factors to be considered when a community decides which practices to tolerate and to what extent.

Purpose: He Tangata Kei Tua, a relationship model for biobanks, was developed to facilitate best practice in addressing Māori ethical concerns by guiding culturally informed policy and practice for biobanks in relation to governance, operational, and community engagement activities., Methods: The model is based on key issues of relevance to Māori that were identified as part of the Health Research Council of New Zealand-funded research project, Te Mata Ira (2012-2015)., Results: This project identified Māori perspectives on biobanking and genetic research, and along with tikanga Māori it developed cultural guidelines for ethical biobanking and genetic research involving biospecimens. The model draws on a foundation of mātauranga (Indigenous knowledge) and tikanga Māori (Māori protocols and practices) and will be useful for biobanks, researchers, ethics committee members, and those who engage in consultation or advice about biobanking in local, regional, national, or international settings., Conclusion: This article describes the model and considers the policy and practice implications for biobanks seeking to address Māori ethical concerns. Although the model has focused on Māori aspirations in the New Zealand context, it provides a framework for considering cultural values in relation to other community or indigenous contexts.Genet Med 19 3, 345-351.

Introduction: The objective of this study was to analyze the content and volume of literature that has been written on cultural competency in emergency medicine (EM) since its educational imperative was first described by the Institute of Medicine in 2002., Methods: We conducted a comprehensive literature search through the PubMed portal in January 2015 to identify all articles and reviews that addressed cultural competency in EM. Articles were included in the review if cultural competency was described or if its impact on healthcare disparities or curriculum development was described. Two reviewers independently investigated all relevant articles. These articles were then summarized., Results: Of the 73 abstracts identified in the initial search, only 10 met criteria for inclusion. A common theme found among these 10 articles is that cultural competency in EM is essential to reducing healthcare disparities and improving patient care. These articles were consistent in their support for cross-cultural educational advancements in the EM curriculum., Conclusion: Despite the documented importance of cultural competency education in medicine, there appears to be only 10 articles over the past 12 years regarding its development and implementation in EM. This comprehensive literature review underscores the relative dearth of publications related to cultural competency in EM. The limited number of articles found is striking when compared to the growth of EM research over the same time period and can serve as a stimulus for further research in this significant area of EM education., Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Advances in medical care may occur when a change in practice incorporates a new treatment or methodology. In surgery, this may involve the translation of a completely novel concept into a new procedure or device or the adaptation of existing treatment approaches or technology to a new clinical application. Regardless of the specifics, innovation should have, as its primary goal, the enhancement of care leading to improved outcomes from the patient's perspective. This policy statement examines innovation as it pertains to surgical care, focusing on some of the definitions that help differentiate applied innovation or innovative therapy from research. The ethical challenges and the potential for conflict of interest for surgeons or institutions seeking to offer innovative surgical therapy are examined. The importance of engaging patients and families as "innovation partners" to ensure complete transparency of expectations from the patient's and provider's perspectives is also examined, with specific emphasis on cultural competence and mutually respectful approaches. A framework for identifying, evaluating, and safely implementing innovative surgical therapy in children is provided., (Copyright © 2017 by the American Academy of Pediatrics.)

Introduction: A freely available, culturally valid depression screening tool is required for use by primary care services across Australia to screen for depression in Aboriginal and/or Torres Strait Islander populations. This is the protocol for a study aiming to determine the validity, sensitivity and specificity of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9)., Methods and Analysis: Cross-sectional validation study. A total of 500 people who self-identify as Aboriginal and/or Torres Strait Islander, are ≥18 years of age, attending 1 of 10 primary healthcare services or service events across Australia and able to communicate sufficiently to answer study questions will be recruited. All participants will complete the aPHQ-9 and the criterion standard MINI International Neuropsychiatric Interview (MINI) 6.0.0. The primary outcome is the criterion validity of the aPHQ-9. Process outcomes related to acceptability and feasibility of the aPHQ-9 will be analysed only if the measure is found to be valid., Ethics and Dissemination: Lead ethical approval was obtained jointly from the University of Sydney Human Research Ethics Committee (project 2014/361) and the Aboriginal Health and Medical Research Council of New South Wales (project 1044/14). Results will be disseminated via the usual scientific forums, including peer-reviewed publications and presentations at international conferences following presentation to, discussion with and approval by participating primary healthcare service staff and community., Trial Registration Number: ACTRN12614000705684., Competing Interests: Conflicts of Interest: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Background: In order to protect the autonomy of human subjects, we need to take their culture into account when we are obtaining informed consent., Objective and Research Design: This study describes the cultural aspects related to informed consent in health research and is based on electronic searches that were conducted using the Scopus, PubMed, CINAHL, and Cochrane databases published between 2000 and 2013. A total of 25 articles were selected., Findings: Our findings indicate that cultural perspectives relating to the informed consent process are essential during the whole research process and particularly crucial in the planning phase of a study. Our study indicates that appropriate communication between different stakeholders plays a vital role in cultural understanding., Discussion and Conclusion: The researchers' awareness of cultural differences and their ability to work in a culturally sensitive way are key factors in improving study participation and retention in a multicultural context. Taking cultural aspects into account during the whole research process improves the quality of research., (© The Author(s) 2015.)

Global ethics calls upon the discipline of nursing to critically evaluate personal and culture-based beliefs to nurture professionalism in relationships and improve health disparities. What does it potentially mean to provide nurse services based on culture and cultural competence? This article begins a discussion of potential ethical questions that surround the concept of culture and potential implications for education and practice from a nursing theoretical perspective., (© The Author(s) 2015.)

Health promotion researchers must consider the ethics of their research, and are usually required to abide by a set of ethical requirements stipulated by governing bodies (such as the Australian National Health and Medical Research Council) and human research ethics committees (HRECs). These requirements address both deontological (rule-based) and consequence-based issues. However, at times there can be a disconnect between the requirements of deontological issues and the cultural sensitivity required when research is set in cultural contexts and settings etic to the HREC. This poses a challenge for health promotion researchers who must negotiate between meeting both the requirements of the HREC and the needs of the community with whom the research is being conducted. Drawing on two case studies, this paper discusses examples from cross-cultural health promotion research in Australian and international settings where disconnect arose and negotiation was required to appropriately meet the needs of all parties. The examples relate to issues of participant recruitment and informed consent, participants under the Australian legal age of consent, participant withdrawal when this seemingly occurs in an ad hoc rather than a formal manner and reciprocity. Although these approaches are context specific, they highlight issues for consideration to advance more culturally appropriate practice in research ethics and suggest ways a stronger anthropological lens can be applied to research ethics to overcome these challenges.

Chapter 4.7 of the National Statement on Ethical Conduct in Human Research refers specifically to Aboriginal and Torres Strait Islander Peoples. It lays out the points at which researchers working with Aboriginal and Torres Strait Islanders must consider their approach, and the engagement with individuals, communities or groups who are involved in or affected by their research. History, of Australia and of research involving Aboriginal and Torres Strait Islander Australians, has informed this approach. The response to that history has been a rational, institutionalised, systematic demand for a different perception of what should direct research and research processes to ensure engagement with and service to the community with whom the researchers wish to do the work. This paper considers whether these principles could inform the approach to other research work.

Our study of queer women patients and their primary health care providers (HCPs) in Halifax, Nova Scotia, reveals a gap between providers' theoretical knowledge of "cultural competency" and patients' experience. Drawing on Patricia Benner's Dreyfusian model of skill acquisition in nursing, we suggest that the dissonance between the anti-heteronormative principles expressed in interviews and the relative absence of skilled anti-heteronormative clinical practice can be understood as a failure to grasp the field of practice as a whole. Moving from "knowing-that" to "knowing-how" in terms of anti-heteronormative clinical skills is not only a desirable epistemological trajectory, we argue, but also a way of understanding better and worse ethical practice.

The journey to excellence in palliative care practice is to recognize the three identities of patients, refine skills in assessment to understand these interrelated dimensions of personhood, and hone the practices of caring to deliver truly comprehensive and personalized care. These practices require clinicians to first connect to persons with illness on a human-human level. Being fully present and engaged with patients is critical to practicing high-quality palliative care. Clinicians must encourage and elicit the story of the illness and the life of the person experiencing the illness., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: The objective of this article is to explore three key ethical tenets that pharmacists should consider prior to participating in global health outreach., Key Findings: There are increasing opportunities for pharmacists to be involved in global health outreach; however, little attention has been given to the ethical issues that participation may raise for pharmacists. Pharmacists' widely accepted and basic ethical obligations at home lay the foundation for effective management of these ethical challenges abroad. At home, pharmacists have an ethical obligation to provide the best possible quality of care to the patients for whom they serve. During global health outreach, this involves identifying and mitigating the potential for harm, as well as understanding and respecting cultural differences. Furthermore, pharmacists have an ethical obligation to not only meet individual patient needs, but also community and societal needs, when applicable. In global health outreach, this involves tailoring interventions to the needs of the population served., Conclusions: Because of their unique skillset, pharmacists have the potential to make significant contributions to global health. Applying ethical principles, such as providing the best possible care, respecting cultural differences and meeting societal needs, provides the foundation for successful global health outreach by pharmacists., (© 2014 Royal Pharmaceutical Society.)

Israel is a multicultural state that has absorbed, and is continually absorbing people of different cultures who immigrate to Israel, a situation that could create conflicts in the physician-patient relationship. In this article, I will present several cases in which diversity of culture can lead to conflict, and suggest a way of communication that can help prevent the conflicts arising from those situations.

Disaster Victim Identification (DVI) is a triangle, the components of which are secular law, religious law and custom and professional methods. In cases of single non-criminal deaths, identification often rests with a hospital or a medical authority. When dealing with criminal or mass death incidents, the law, in many jurisdictions, assigns identification to the coroner/medical examiner, who typically uses professional methods and only answers the religious requirements of the deceased's next-of-kin according to his personal judgment. This article discusses religious considerations regarding scientific methods and their limitations, as well as the ethical issues involved in the government coroner/medical examiner's becoming involved in clarifying and answering the next-of-kin's religious requirements.

Ethnic and cultural diversity are widespread across the world, but there is growing concern that end-of-life care is not offering Black Asian and Minority Ethnic (BAME) groups the most appropriate services. This article explores the experiences of BAME patients with advanced disease and the response of the healthcare professionals who care for them. Key questions include cultural influences on symptoms of advanced disease, communication and the role of religion and spirituality., (© 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.)

Mental illnesses constitute a major burden of disease in Aboriginal Australians and Torres Strait Islanders (hereafter Aboriginal Australians), who are also overrepresented in the prison system. A legacy of colonization compounds such prevalence, and is further exacerbated by the persistence of racial discrimination and insensitivity across many sectors, including health. This research completed in a Western Australian forensic mental health setting identifies non-Aboriginal health professionals' support needs to deliver high-quality, culturally-safe care to Aboriginal patients. Data were collected from health professionals using an online survey and 10 semistructured interviews. Survey and interview results found that ongoing education was needed for staff to provide culturally-safe care, where Aboriginal knowledge, beliefs, and values were respected. The findings also support previous research linking Aboriginal health providers to improved health outcomes for Aboriginal patients. In a colonized country, such as Australia, education programmes that critically reflect on power relations privileging white Anglo-Australian cultural dominance and subjugating Aboriginal knowledge, beliefs, and values are important to identify factors promoting or compromising the care of Aboriginal patients and developing a deeper understanding of 'cultural safety' and its clinical application. Organizational commitment is needed to translate the findings to support non-Aboriginal health professionals deliver high-quality care to Aboriginal patients that is respectful of cultural differences., (© 2013 Australian College of Mental Health Nurses Inc.)

The INTERGROWTH-21st Project presented a complex set of ethical challenges given the involvement of health institutions in geographically and culturally diverse areas of the world, with differing attitudes to pregnancy. This paper addresses how the research team dealt with some of those issues., (© 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG.)

A case is considered in which the father of an adult patient from another culture requests that only limited care be provided his daughter. Additional indicated treatment was declined. The patient appeared to defer to her father as a cultural norm. Various ethical principles and the conflicts among them are considered in light of cultural competency.

In our globalizing world, health care professionals and organizations increasingly experience cross-cultural challenges in care relationships, which give rise to ethical questions regarding "the right thing to do" in such situations. For the time being, the international literature lacks examples of elaborated ethical guidelines for cross-cultural healthcare on the organizational level. As such, the ethical responsibility of healthcare organizations in realizing cross-cultural care remains underexposed. This paper aims to fill this gap by offering a case-study that illustrates the bioethical practice on a large-scale organizational level by presenting the ethical guideline developed in the period 2007-2011 by the Ethics Committee of Zorgnet Vlaanderen, a Christian-inspired umbrella organization for over 500 social profit healthcare organizations in Flanders, Belgium. The guideline offers an ethical framework within which fundamental ethical values are being analyzed within the context of cross-cultural care. The case study concludes with implications for healthcare practice on four different levels: (1) the level of the healthcare organization, (2) staff, (3) care receivers, and (4) the level of care supply. The study combines content-based ethics with process-based benchmarks., (Copyright © 2013. Published by Elsevier Ltd.)

This article examines and unpacks the "black box" of cultural competence in health interventions with racial and ethnic minority populations. The analysis builds on several recent reviews of evidence-based efforts to reduce health disparities, with a focus on how cultural competence is defined and operationalized. It finds that the use of multiple similar and indistinct terms related to cultural competence, as well as the lack of a mutually agreeable definition for cultural competence itself, has resulted in an imprecise concept that is often invoked but rarely defined and only marginally empirically validated as an effective health intervention. This article affirms the centrality of cultural competence as an essential values-based component of optimal social work practice, while also suggesting future directions for operationalizing, measuring, and testing cultural competence to build an evidence base on whether and how it works to reduce health disparities.

In this article, we argue that attaining equity, and therefore peace in health care delivery, necessitates that nursing and other health care professions more carefully attend to the sociocultural context in which health care is delivered. That sociocultural context includes culturally diverse patients, families, and communities, as well as health care providers who are themselves culturally diverse. We draw on findings from Almutairi's doctoral research with health care providers in Saudi Arabia to argue for what he has identified as critical cultural competence for health care providers. In so doing, we explicate the complexity of cultural and linguistic issues and power relations induced by race, class, and gender that can contribute to vulnerabilities for health care providers and recipients alike.

Contemporary psychosomatics is a research-based technical discipline and its social power depends on how scientific knowledge is obtained and applied in practice, considering cultural contexts. This article presents the view that the dialogical principles on which bioethical discourse is based are more inclusive than professional ethics and philosophical reflection. The distinction is advanced between rule-guided behavior and norm-justifiable acts (substantiation and justification). The practical implications of good practices in the generation of valid, reliable, generalizable and applicable knowledge are emphasized. For practitioners and researchers, the need to reflect on the distinction between patient and research participant can avoid the therapeutic misunderstanding, a form of abuse of the doctor-patient relationship. In addition, in resource-poor settings, the dilemma presented by the know-do gap (inapplicability of research results due to financial or social constraints) is part of the ethics' realm of the profession. Future prospects include a wider use of research results in practice, but avoidance of the know-do gap (the disparity between what is known and what can be done, particularly in settings with limited resources) requires a synthetic and holistic approach to medical ethics, combining moral reflection, theoretical analysis and empirical data., (Copyright © 2013 S. Karger AG, Basel.)