It is important to remember that much of the language used to describe ethics is itself cultural. Different cultures will have different definitions and connotations and subsequent behaviors around terms like “fairness”, “confidentiality”, “justice”, and “boundaries”, to just name a few.
In order to remain ethical, caregivers need to understand how the culture they are serving understands the language used. The authors of the required reading article “Ethics and Culture in Mental Health Care” recognize that ” in mental health care, ethics and culture are intimately intertwined. To practice ethically requires awareness, sensitivity, and empathy for the patient as an individual, including his or her cultural values and beliefs” (Ethics and Culture in Mental Health Care). The ethical caregiver will respect cultural definitions and do their best not to assume their understanding is the “right” one.
The awareness, sensitivity, and empathy mentioned in the article include religious beliefs and practices that differ from the caregiver. Agendas for conversion or the responsibility to proselytize on the part of caregivers is never ethical or appropriate. There is a necessity to take extra care in this area when working cross-culturally.
Power differentials and dynamics are maybe the most significant pieces of ethical practice with which cross-cultural caregivers need to be familiar.
Sometimes, an outsider to the culture may be honored and given a place of esteem. In this case, caregivers need to be very conscious and intentional to be sure that there is no expectation of caregivers to know what they see as helpful suggestions may carry a weight of authority that they do not mean to express.
Other times, the foreigner may be met with hesitation and suspicion. When caregivers see this dynamic, there can be a temptation to say or do things that are dishonest in order to manipulate greater influence. This needs to be avoided. Caregivers need to be content with the place they are given in the culture without abusing it.
The Quid-Pro-Quo Spectrum
The ingrained thought process that says, “If I receive, I owe,” is a part of most cultures to one extent or another. In some contexts, it is so prominent that thoughts of receiving without giving back are offensive or not even possible without impairing the future opportunity to care. In other cultures, this idea may be more subtle, but it is important for caregivers to know the environment they are entering. It should never be communicated that there is an expectation of repayment for care. In some settings, the expectation is such a part of normal practice that caregivers will need to intentionally over-emphasize that care is freely given. Beyond mitigating the expectation, caregivers may find themselves in a position of being asked to receive gifts in thanks for the care they give. When this is the case, caregivers will have to do their best to maintain the communication that gifts are not expected or required while being gracious not to offend the giver.