Peace and Conflict Studies - Spring 2014

Peace and Conflict Studies Volume 21, Number 1 55 or at least not wrong” (Galtung, 1990, p. 291). Cultural violence is a mental process that operates by changing the moral value of an act from wrong to right or acceptable (Galtung, 1990). For example, black and other minority patients are usually administered less pain medication when compared to white patients (Krakauer et al., 2002; Pletcher, Kertesz, Kohn, & Gonzales, 2008). The question has been posed as to whether there is an unconscious belief that blacks have less sensitivity to pain, which was one of the many alleged features that justified the medical community to perform unconscionable experiments on them (Krakauer et al., 2002). This would make it “right” or “acceptable” to withhold pain medication. Another way in which cultural violence operates is by blurring reality so that a violent and/or unjust act becomes invisible or not so violent (Galtung, 1990). For example, providing futile healthcare or unwanted extraordinary measures to a patient that is dying has become an invisible violent act; alternatively, it is not seen as overly violent. Biotechnology has turned into an ideology and physicians feel compelled to exercise power over the patient and sustain life, in spite of the patient’s wish (Brodwin, 2000). Technology becomes a social imperative and is seen as necessary and not as a contingency; “what is contingent […] is regarded as natural” (Brodwin, 2000, p. 214). Cultural violence also takes place through language. Medical students learn how to communicate in very formalized, unambiguous, and precise terms with the purpose of selecting from the patient’s narrative “only the ‘important negatives’ that might cast doubt on a diagnosis, and not to mention a positive symptom or finding without following its implications further” (Sinclair, 1997, p. 213). In end-of-life conversations, the focus continues to be on specific interventions rather than long term implications (e.g., “Do you want an insulin drip?”) (Lamas & Rosenbaum, 2012, p. 1656). Although some medical schools are beginning to address this issue, medical students continue to focus on the problem at hand and thinking in terms of “what ifs?” is not encouraged (Dokken & Ahmann, 2006, p.175). The focus is on the present. For example, oncologists “deliberately ‘blur the horizon of the future’ and create for patients an experience of immediacy or living for the moment” (Johnson, Cook, Giacomini, & Willms, 2000, p. 281; Lamas & Rosenbaum, 2012). The mother of a premature baby who died in a pediatric intensive care unit describes the impact of the doctor’s discourse on her in the following way: For the most part in the critical care setting, thinking tends to be short-term. We were never, and I say truly never, given enough information or enough of an opening to discuss a long term view of