Sigal Gooldin
The concept of ‘cultural competence’ emerged as a pedagogic and ethical project in healthcare systems in the mid-1990s, mainly in the USA and the UK, and has received growing attention since then as a field of scholarly work and implemental practice. This paper argues that while the discourse of ‘cultural Competency’ marks an institutionalized commitment to acknowledge existing ethnic disparities in health, and to eliminate these disparities by means of education and regulation, the implemental practices of this concept evoke some urgent ethical dilemmas and tensions. The paper offers a sympathetic critique of the pedagogic and ethical issues that arise in the effort to produce ‘culturally competent’ healthcare systems. The focus of this critique is on some potential tensions between a ‘culturally competent’ commitment to acknowledge and respond to consumers’ unique ‘cultural needs’, and an ‘ethically competent’ commitment to best serve consumers’ physical and emotional well-being. The discussion suggests an initial outline of situations in which ‘cultural’ and ‘ethical’ competence appear to clash. This theoretical discussion draws on findings from a sociological study of assisted reproductive technologies (ART) in Israel, where rates of utilization of ART are notoriously high. Israel has ‘permissive’ legislation of ART, the highest rate in the world of IVF treatments per capita, and the highest rate in the world of public funding allocated to fertility treatments. The overwhelming formal and informal support for IVF in Israel is often explained as the appropriate (i.e. morally and ethically legitimate) response to culturally based consumers’ demand for biological parenthood in a pro-natal cultural context. The result is an unparalleled rate of utilization of ART, which further reproduces and amplifies existing ‘cultural needs’, and which can potentially affect the physical and emotional well-being of some ‘infertile’ individuals, mainly women. The concluding section of the paper calls for a more careful examination and reflexive application of ‘cultural competency’ and ‘cultural responsiveness’ as an ethical project in healthcare systems.
