Ethics, Cultural Competence, and the Changing Face of America

The population in the United States is increasingly multicultural. So, too, is the U.S. physician workforce. The combination of these diversity dynamics sets up the potential for various types of cultural conflict in the nation’s examining rooms, including the relationship between religion and medicine. To address the changing patient-physician landscape, we argue for a broad scale intervention: interdisciplinary bioethics training for physicians and other health professionals. This approach seeks to promote a common procedural expectation and language which can lead to an improved, patient-centered approach resulting in better patient-physician relationships that contribute to better health outcomes across the U.S. population. The authors illustrate their thesis and solution using a well-known case of cross-cultural dynamics taken from religion and medicine—Anne Fadiman’s The Spirit Catches You And You Fall Down.     

Image Theory, Social Identity, and Social Dominance: Structural Characteristics and Individual Motives Underlying International Images

The present study provides an empirical test of international relations image theory and extends the theory by emphasizing that individuals' social identity and social dominance motives contribute to such images. One hundred forty-five Lebanese participants completed a survey that assessed their perceptions of U.S.-Lebanese relations, the images they have of the United States, their social identities, and their social dominance orientations. Participants were more likely to hold the barbarian image of the United States than the enemy, imperialist, or ally images. Participants also tended to perceive the United States as having relatively superior power, inferior cultural status, and goals that are incompatible with those of Lebanon. Consistent with image theory predictions, this constellation of structural perceptions was associated with stronger endorsement of the barbarian image. Furthermore, participants were more likely to endorse the barbarian image of the United States the more they identified with Arabs and Palestinians, the less they identified with Christians and the Western world, and the lower their social dominance orientation. Results highlight the importance of considering both structural characteristics and individual motives underlying international images and demonstrate the need for scholars to move beyond the enemy image of nations when describing international relations.     

On White Ignorance,White Shame,and Other Pitfalls in Critical Philosophy of Race

This article examines Samantha Vice's essay ‘How Do I Live in This Strange Place?’ (2010), which sparked a storm of controversy in South Africa, as a starting point for interrogating understandings of whiteness and racism that are dominant in critical philosophy of race. I argue that a significant body of philosophical scholarship on whiteness in general and by white scholars in particular obfuscates the structural dimension of racism. The moralisation of racism that often permeates philosophical scholarship reproduces colourblind logics, which provide individualistic explanations for structural problems, thereby sustaining white dominance. In the process, I show that notions of white guilt, white habits, white ignorance, white invisibility, white privilege, and white shame as they are theorised in much critical philosophy of race share a crucial limitation: they minimise white people's active interest in reproducing the racist status quo. Studies, such as Vice's, that frame racism as a moral dilemma while silencing its institutionalisation and the central cause for its existence and longevity – that is, white people's investment in maintaining economic, political, and symbolic power – further naturalise white supremacy.     

Antiracist Moral Identities,or Iris Murdoch in South Africa

Abstract

I argue that Samantha Vice understates the moral resources white people have available to them to minimize their falling into distorted ways of perceiving and responding to the world caused by bare white advantage. In doing so, she paints an unjustifiably pessimistic picture of white civic involvement in South Africa, and anywhere where white people are unjustly advantaged, such as the United States. I delineate two similar but distinct antiracist moral identities—the ‘white ally’ and the ‘person committed to racial justice’—that can guide civic engagement, as well as provide a counterweight to the distortions of whiteness. I argue that Vice’s recommendation of withdrawal from public engagement in humble silence is not the most morally appropriate response to white privilege.     

Medical ethics in Latin America: a new interest and commitment.

Recent visits to five Latin American nations indicate that some medical professionals are eager to increase the role of bioethics in their countries. Conversations with key figures there point up similarities and differences among Latin nations, and between Latin countries and the United States, in their approaches to ethics. Opportunities exist for U.S. bioethicists to help get bioethics teaching and research off the ground in Latin America.     

Arab American Elders: Network Structure,Perceptions of Relationship Quality,and Discrimination

The metropolitan Detroit area is home to the largest concentration of Arab Americans in the United States and continues to receive immigrants from the Middle East. The nature of aging and social relations among this immigrant/ethnic group is a neglected area of study. In this article, I compared immigrant and U.S.-born Arab American elders in metropolitan Detroit with regard to social integration, relationship quality, and perceptions of discrimination. Using analyses of variance, I compared social network characteristics, revealing that immigrants report smaller, denser networks. I also evaluated quality of social relations; results demonstrate that immigrants are less likely to report that their relationships with their child and best friend are good but more likely to perceive the ability to confide in their spouse. U.S.-born elders are more likely to report that their spouse gets on their nerves and makes too many demands as well as to report experiencing ethnic discrimination. Findings highlight diversity among elder Arabs in America, documenting vulnerabilities as well as strengths in social relationships.     

America and the Eighth Deadly Sin

In this article, I argue that the cultivation of innocence in the United States, coupled with policies of free market expansionism, the acquisitiveness of capitalism, rising militarism, the hubris of democratic evangelism, free market fundamentalism, and the immense U.S. militaristic and economic power, is an especially fatal sin. In general, I contend that nurturing innocence involves overlooking the inadvertent and advertent destruction and suffering that has resulted from U.S. interventionist policies and actions in the 20th and 21st centuries. Finally, I argue that the cultivation of innocence, which is often supported by Christian theological language, contradicts central Christian beliefs. Dr. LaMothe has published two books, Revitalizing Faith through Pastoral Counseling and Becoming Alive: Psychoanalysis and Vitality as well as numerous articles, Correspondence to Ryan LaMothe, rlamothe@saintmeainrad.edu     

The role of authoritarianism, perceived threat, and need for closure or structure in predicting post-9/11 attitudes and beliefs

The authors examined relationships among authoritarianism, personal need for closure or structure, perceived threat, and post-9/11 attitudes and beliefs. Participants were 159 undergraduate students in the Southeastern United States. The authors collected data 1 week before the U.S.-led invasion of Iraq in March 2003. Correlation and regression analyses revealed that right-wing authoritarianism and social dominance orientation were significant predictors of support for restricting human rights during the U.S.-led War on Terror, support for U.S. President George W. Bush, and support for U.S. military involvement in Iraq. Right-wing authoritarianism and perceived threat emerged as the strongest predictors of the belief that Saddam Hussein supported terrorism.     

职业精神与弱势病人

医学职业研究所对美国医生的现实行为的调查说明:医生们是相信且赞同职业精神在对待弱势病人方面的关键信条的;增强美国医生的职业精神的努力,也应该包括努力转变医生照顾弱势病人的行为方面。但是,增强职业精神的努力不仅要通过书本上的或理论上的教育,也应该包括致力于制定使医生更容易履行这些义务的实践政策,提供体制上的支持可使医生更容易做他们已经知道其应该做的行为。     

Youth Suicide Trends in California: An Examination of Immigrant and Ethnic Group Risk

Although immigrants are in better health than the U.S.-born population according to a variety of indicators, little research has investigated current foreign-born/U.S.-born differentials in suicide. A review of 32,928 California death certificates from 1970 to 1992 indicates that although foreign-born persons are consistently underrepresented in the suicide deaths of 15- to 34-year-olds (risk ratio = 0.60), any foreign- versus U.S.-born difference by ethnicity appears to be decreasing. Specifically, although Hispanics born outside the United States consistently are at significantly lower risk of suicide than U.S.-born Hispanics, the discrepancy between the two groups has diminished over time. And, in a comparable trend, non-Hispanic white persons born outside the United States were at higher risk of suicide than their U.S.-born counterparts until 1990, when their risk became similar. Black and Asian/other foreign- and U.S.-born persons have been at statistically similar risk since 1970. A man using a firearm at home was the typical pattern for both the foreign- and U.S.-born.     

Individuality and community: The contrasting role of the state in family life in the United States and Sweden1

Underlying moral values of individuality versus community and assumptions about what is a “just society” make public policies toward children vastly different in Sweden and the United States. This article explores the origins, cost, and benefits of welfare policies that permit child poverty in the U. S. as a cost of the high value of autonomy/individuality, and policies that prevent child poverty in Sweden, at the cost of economic competitiveness and individual initiative. I conclude that both extremes of moral values have more social costs than benefits but that children should be protected in any nation as the future of the society.     

White Supremacy as an affective milieu

Some critical philosophers of race have argued that whiteness can be understood as a technology of affect and that white supremacy is comprised partly of unconscious habits that result in racialized perception. In an effort to deepen our understanding of the affective and bodily dimensions of white supremacy and the ways in which affective habits are socially produced, I look to insights from situated affectivity. Theorists in this field maintain that affective experience is not simply a matter of felt inner states, but rather socially and environmentally embedded and fundamentally relational. Jan Slaby presents the concept of an ‘affective arrangement’ as a way to approach affectivity in terms of relational dynamics unfolding within a particular setting. Applying this concept to the societal level, Paul Schuetze introduces the notion of ‘affective milieu.’ I argue that these notions of ‘affective arrangement’ and ‘affective milieu,’ together with an organicist account of habit, can help to illuminate the workings of white supremacy in the United States. My proposed account highlights the extent to which white supremacy is an affective, bodily phenomenon and how racist habits are formed over the course of learning and ongoing affective engagement, in the context of various social settings. Crucially, these affective habits are fully bound up with habits of appraisal, interpretation, and judgment, and therefore inseparable from how subjects come to see and understand their world.

     

Immigrant Acculturation and Transnationalism: Israelis in the United States and Europe Compared

This article examines relations between social integration into host societies, religio‐ethnic acculturation into group belonging, and ties to home country among Israeli émigrés in the United States and Europe. I use data from a 2009–2010 Internet survey into which I incorporated country‐contextual characteristics. The results of multivariate analyses show that a social integration combining duration of residence abroad and local citizenship enhances religio‐ethnic identification. Another measure of integration, social networks, deters group behaviors. All measures of general integration inhibit attachment to the home country, whereas religio‐ethnic acculturation is largely insignificant for transnationalism. The religiosity of the new country does not influence immigrants’ religio‐ethnic patterns or homeland attachment. Insofar as group size is a significant determinant of particularistic behaviors, it weakens them. The more policy‐based opportunities newcomers receive, the more they dissociate from group behaviors and homeland ties. Irrespective of individual and contextual factors, living in the United States encourages group affiliation more than living in Europe does. The results are discussed in reference to four working hypotheses—marginalization, integration, assimilation, and separation—and from a U.S.‐European comparative perspective.     

The plurality of Chinese and American medical moralities: toward an interpretive cross-cultural bioethics

Since the late 1970s, American appraisals of Chinese medical ethics and Chinese responses to American bioethics range from frank criticism to warm appreciation, from refutation to acceptance. Yet in the United States as well as in China, American bioethics and Chinese medical ethics have been seen, respectively, as individualistic and communitarian. In this widely-accepted general comparison, the great variation in the two medical moralities, especially the diversity of Chinese experiences, has been unfortunately minimized, if not totally ignored. Neither American bioethics nor Chinese medical ethics is a field with only one dominant way of thinking. Medical moralities in America and China -- traditional and modern -- have always been plural and diverse. For example, American and Chinese cultures and medical moralities both exhibit individualistic and communitarian traditions. For this reason, bioethics in general and cross-cultural bioethics in particular must be fundamentally interpretive. Interpretive cross-cultural bioethics appreciates the plurality of medical morality within any culture. It can serve as a vital means of social and cultural criticism through engaged interpretations.     

The Case for Secular Assimilation? The Latino Experience in Richmond,Virginia

Studies of 20th-century ethnic immigrant groups to the United States profile religion as a key factor in their assimilation into U.S. culture. Religious institutions provided immigrants and families with a safe haven where they could hold on to their ethnic identity, even as they and their children were mainstreamed into the larger culture. Changes in immigration law since 1965 have complicated somewhat the relationship between religion and assimilation. The variety of religious forms now present in the United States and the diversity of immigrants create new options as they seek to adapt to U.S. life. We look at the absence of religion as one of those options. The nonreligious paths chosen by some Latinos in Richmond, Virginia have implications for the way they become part of the community, especially in comparison to those who remain members of their religion of origin or who convert to U.S. faiths.     

Latino Employment and Non-Latino Homicide in Rural Areas: The Implications of U.S. Immigration Policy

From 1990 to 2000, rural counties experienced a major influx of low-skill Latinos. This was due in part to the increased enforcement of the U.S.–Mexican border, which encouraged Latino migrants already in the United States to stay for fear that they cannot return. We examine whether the increasing dominance of Latinos in rural low-skill labor markets raised rural homicide among non-Latino whites and blacks. Using 1990 and 2000 census and crime data for counties, we find that where low-skill labor markets shifted toward Latino labor, violence increases among non-Latino whites, but not among blacks. This is in contrast to prior research emphasizing how low-skill jobs loss is detrimental mainly to blacks. This major structural change in the ethnic structure of low-skill employment has negative consequences for rural white communities, and current theorizing on the loss of low-skill jobs must account for these effects.     

Normativity in Comparative Religious Ethics

This essay seeks to clarify the meaning and nature of normativity in metaethics and offers reasons why comparative religious ethics (CRE) must properly address questions about normativity. Though many comparative religious ethicists take CRE to be a normative discipline, what they say about normativity is often unclear and confusing. I argue that the third‐wave scholars face serious questions with respect to not only the justification of moral belief but also the rationality of moral belief and action. These scholars tend to view the justification of moral belief to be a matter of process (that is, discursive social practice) rather than evidence‐possession, thus overlooking crucial differences between the two. They also run the risk of confusing motivating and explanatory reasons with normative reasons for moral belief and action. Consequently, their account of normativity would be insufficient for determining the rationality of moral beliefs and actions as well as for justifying moral beliefs.     

The social‐psychological bases of far‐right support in Europe and the United States

The roles of authoritarianism, social dominance orientation (SDO), and prejudice in the prediction of far‐right support were examined in Europe and the United States. A meta‐analysis shows remarkably similar, positive, and strong associations of far‐right support with these three variables in previous studies conducted in Europe, the United Kingdom, and the United States. Results from two cross‐sectional studies in the United States further indicated that higher levels of authoritarianism and SDO related to higher voting intentions and support for Trump, via increased prejudice. In a three‐wave longitudinal study in the United Kingdom, authoritarianism and SDO predicted pro‐Brexit attitudes and support for the U.K. Independence Party, again via prejudice. These results shed a new light on the widely held beliefs in “American and British exceptionalism,” as Trump and Brexit adherents share the same social‐psychological underpinnings as far‐right supporters observed in several European countries.     

Suicide mortality among Kentucky farmers, 1979-1985

Farmers may be at high risk for suicide because of their social environment and because of chemical exposure resulting in neurotoxic effects in the workplace. Age-specific suicide rates are compared for Kentucky white farmers, Kentucky white males, and U.S. white males. Data for suicides occurring in Kentucky represent the 7-year period between 1979 and 1985; data for the United States suicides represent the period 1980. Overall, suicide rates were highest for Kentucky farmers, followed by Kentucky males and then by U.S. males. All males were most likely to use firearms as the mode of suicide, but the farmers used firearms significantly more often than the U.S. males, as did the other Kentucky males. These findings and other evidence support the need to assess suicide rates in this occupational group in other states, to begin suicide prevention programs for Kentucky, and to work to identify risk factors contributing to the Kentucky farm suicides.