Clinical Ethics Cultural Competence and the Importance of Dialogue a Case Study

The traditional bioethical approach to addressing clinical ethical dilemmas is to apply ethical principles to analyse the dilemma to reach an ethically acceptable course of action. This paper will address the problem of what to do when the patient or patient’s proxy disagree with this advice. I will argue that ethical principles have limitations in a culturally diverse world, and that best practice guidelines whilst helpful rarely address the specifics of an individual clinical dilemma, and are often not based on robust evidence. Bioethical mediation has been proposed as an important process for clinical ethics support services. Whilst I agree with the need for this my contention is that this is not a new bioethical skill but is in fact the very core of what a good consultation consists of. I will illustrate this discussion with a general practice case study of vaccination refusal. My conclusion is that an approach that accepts and respects diversity and focusses on developing a trusting relationship is the most effective way to reach the best available resolution for clinical ethical dilemmas.