Death and Dying
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Living in a diverse world is a very enjoyable thing. However, it is important to be able to enjoy the diversity of the world and the people around you. Once one has obtained this skill, and has stopped judging everything that stands out of the traditional or, rather to say, out of the picture, to which one is used, life in its diversity and people in their diversity become truly interesting to such a person. It is important to mention that it is not just fun, that is brought to us by the diversity of the world. We also have to understand, that living in international and multicultural environment stands for a number of responsibilities. It demands our being to be more tolerant and open-minded, whether we are ready for it or not. Moreover, it often happens that we are not 100% open for the diversity; our minds are not open enough to comprehend the entire spectrum of cultures within the environment we live in. However, it is important to learn this from the very childhood. As a matter of fact, it is especially important for such truly multicultural countries as the United States.
In the USA, its citizens every day run into and have to interact in one way or another with the representatives of different nationalities, and there might be some misunderstandings or differences in traditions and cultural background; however, we need to have respect everybody and act respectively, so that not to upset or insult anybody.
This all may appear to be very far from medical issues, but in real fact it is not at all. Medical workers, out of other professionals, have got to deal with people more frequently and those people belong to very different groups, considering their class, nationality, race and so on. Moreover, traditions, which have got to deal with the health care, are very strong in many cultures. There are even stronger traditions, which have to deal with death and dying. This is the reason why for any medical worker it is so important to be prepared to different situations, which may be in one way or another related and depend on the matters of cultural diversity. Again, it is, especially, important for a US medical worker, since, as we have stated above, the USA is, probably, one of the most diverse countries in the cultural sense.
For many cultures, the act of dying is of essential importance for both the patient, who is about to die and his/her relatives. Therefore, medical workers, who work with patients in the intensive care units, run into different requests from the dying patients and from their relatives. On one hand, it may appear, that the medical worker should not take part in various rituals, it is not his cup of tea, he has other things to do, and, probably, his attention and his presence is very much needed by other patients. On the other hand, understanding and being ready for various manifestations of different cultures is a part of medical ethics and cannot be neglected under any circumstances.
Though in many countries, the majority of matters, related to death, are dealt with in a similar way, there are many things, which may become unexpected and even shocking for the doctor. For example, a death of a child may seem to us at first that for any culture, there is nothing more awful that can happen, than a child’s death. However, it is not quite so considering the fact that in certain cultures, where children death rate has historically been very high, the attitude may be very different. When speaking about traditions, we should remember, that in the majority of the world’s cultures black is definitely the color of death, and when a person dies the members of his/her family will wear black clothes. However, this is different for Chinese culture. It is as different as white and black, since it is white color, that is the symbol of death in Chinese culture and it is white clothes, which the members of the family will wear after the person's death.
A medical worker needs to remember about the diversity of the world and the cultural differences of the people, whom he provides medical services. Particularly, a medical worker needs to be able to make decisions, based on cultural manifestations and on medical ethics as well as rationality.
In the article by Helman (2008), an example from medical practice is presented, which illustrates, how serious of a dilemma can be faced by any medical worker at any moment of his service. The article describes a case, when the death of a 19 year old lady was established and recognized by the medical workers using the criterion of brain death. However, her parents insisted on having her connected to the ventilators for another 48 hours and also required that some substance, that had not been verified, would be provided to the patient. This was, according to the patient’s father, a traditional substance, provided to all the dying people in their culture.
The case may seem to be rather simple at first, however, at the second glance, things may appear not as straight-forward. Indeed, medical workers in that case faced a very serious cultural and professional dilemma, or, rather to say, a number of dilemmas.
First of all, it is very obvious, that the provision of the substance will not harm the patient and it is not too hard to fulfill the will of the patient’s father. However, the substance was of unknown and not verified origin, and there were chances that it could harm other patients. This is already something absolutely unacceptable. A medical worker, out of pure human kindness, should go and meet the family’s requirements, since this step may help them to overcome their loss. On the other hand, the role of any medical worker is not spread as far as providing ritual services of any kind. Though, unless his own religious beliefs and cultural reasons do not confront with the requirements of the relatives, he may do it out of his pure will to help.
Yet, there is one more very important thing to remember: keeping the dead body ventilated in an artifitial way does not prolong the life of the patient. The brain is dead and the situation in which the medical worker finds himself becomes rather complex. He is required by the patient’s parents to keep her body artificially ventilated, while there might be a need for the same set of ventilators for saving somebody’s life.
So, the medical worker is in a very severe situation, where the decision is influenced with a number of factors. For instance, the parents will come and say “good-by” to their daughter in 48 hours, and during this entire time the patient’s body would be connected to the ventilators. As a matter of fact, each day of staying in an intensive Care Unit costs a lot. Accordingly, it is not only about the money, though the financial aspect is also very important. Does the medical worker have the right of spending this amount of social money on ventilating a dead body and keeping it in ICU? What is more important, it is the time and professional care of the medical workers involved in maintaining the ventilation. Can they afford the luxury of displaying their human kindness at such a cost?
Being ready for such challenges is an essential part of being a truly professional medical worker. It is also important that such difficulties do not make a negative impact on a medical worker. As underlined by Carteret (2011), it is absolutely no use to try to apply any sort of reference books in this situation, there is any literature dealing with this issue, once you find yourself in this kind of situation. As Carteret (2011) states, “patients and families should be viewed as a source of knowledge about their special/cultural needs and norms – but health care professionals sometimes are at a loss about what to ask under such trying circumstances”.
In conclusion, the main thing for the medical worker under critical circumstances and facing the challenges of multiculturalism is not only to do his best to meet the needs of the patient and his/her family, but despite all the sentiments to remain a professional and put professional needs and interests as priorities, and be mainly guided by professional rationalism, leaving enough space in heart and soul for human kindness.