Peace and Conflict Studies - Spring 2014

Peace and Conflict Studies Volume 21, Number 1 57 “and the analysis of it to be therefore not an experimental science in search of law but an interpretive one in search of meaning” (p.5). In the context of end-of-life care, culture shapes the manner in which patients, doctors, family members and those who participate in the decision-making process make sense of and experience death, life, and illness. Herein, I am adopting Kleinman’s (1988) definition of illness as opposed to disease: illness is how the sick person and those who comprise their social network experience and make sense of their symptoms; disease is the situation as seen through the lens of the physician and the biomedical model (e.g., hypertension, panic attack). In healthcare, cultural competence is defined as “the ability of health care professionals to communicate with and effectively provide high-quality care to patients from diverse sociocultural backgrounds; aspects of diversity include, but go beyond, race, ethnicity, gender, sexual orientation, and country of origin” (Betancourt & Green, 2010, p. 583). After examining the definition of culture, it is perplexing that CCT has focused on categories, such as race and ethnicity, to increase cultural competence and reduce health care inequalities. It raises the question, if culture is about making sense and finding meaning, why is the focus of CCT on boilerplate categories? How do these trainings reduce healthcare inequalities for the dying patient? Since the late 1970s many universities began to offer as part of their medical education CCT to teach students about the health beliefs and practices of ethnic populations; examples include the University of California at Davis and the Harvard Medical School (Good, James, Good, & Becker, 2002). However, these trainings rarely focus on the socialization of physicians or how it may contribute to the institutionalization of racism in the practice of medicine (Good et al., 2002). Cross-cultural competency trainings in medicine usually focus on attitudes, knowledge, and skills (IOMNA, 2002). The main focus in attitude training is to increase provider awareness on how patient’s social and cultural background impacts health care decisions (IOMNA, 2002). This approach encourages self-reflection, which includes understanding one’s culture and biases (IOMNA, 2002). However, these trainings usually are not effective in addressing the implicit biases that physicians hold. For example, a recent study found that physicians show implicit (i.e., non-conscious beliefs not apparent to the individual) reference for white Americans when compared to black Americans (Sabin et al., 2009). The second approach, usually referred to as an etic approach, is to focus on teaching providers the attitudes and beliefs of certain cultural groups (e.g.,