Ethics Grand Rounds: Cross-Cultural Care in a Culture of Poverty

Ethics Grand Rounds: Cross-Cultural Care in a

Culture of PovertyPresented by

Andrea Chatburn, DO, MAMedical Director for Ethics

10.16.2015

www.providence.org/ethics

Objectives

• Define and identify social determinants of health (SDH)

• Apply the concept of social determinants of health to healthcare in the TriCounty area of Washington

• Demonstrate new responses to individual patient encounters from a capabilities approach to SHD

Providence Model for Ethics

Clinical Integrity Beneficence

AutonomyJustice &

Non-Maleficence

Kockler, N. Seeing Ethics Consultations for the First Time: Disclosure Models, Analytic Design, and Ethical Decision-Making. ©2014 –Nicholas J. Kockler

Social Determinants of Health- Why Should We Care?

WHO:“Circumstances in which people are born,

grow up, live, work and age, and the systems put in place

to deal with illness”

Preda, A., K. Voigt. The Social Determinants of Health: Why Should We Care? The American Journal of Bioethics, pp. 25-36, 15(3):25-26, 2015.

By Madison Corney of CCA Baldi Middle School

Mc on Avon

WHO 2010

Arthur Gameboard

Migrant Mother by Lange

USDA Food Desert Map

http://www.ers.usda.gov/data-products/food-access-research-atlas/go-to-the-atlas.aspx

Creating Healthier Communities, Together

http://www2.providence.org/phs/Pages/default.aspx

Goals of Medicine & Social Justice

1. Give every child the best start in life2. Enable all people to maximize capabilities &

have control over their lives3. Create fair employment and good work for all4. Create and develop healthy, sustainable

communities5. Strengthen the role and impact of disease

prevention

Preda, A., K. Voigt. The Social Determinants of Health: Why Should We Care? The American Journal of Bioethics, pp. 25-36, 15(3):25-26, 2015.

Common Policy Targets

• Health care coverage & access for all• Behavior: – Smoking– Diet– Alcohol

• Distinguish between health inequalities that are unfair, unjust and those that are not

Preda, A., K. Voigt. The Social Determinants of Health: Why Should We Care? The American Journal of Bioethics, pp. 25-36, 15(3):25-26, 2015.

Social Justice reduce health inequalities

“It is always implicit in the Social Determinants of Health literature that the logical social

response to the identification of social determinants of ill health is to transform them”

-Marmot 2009

Ethics asks “how ought we be when we are with one another”

ChrisPerriman

Mission As people of Providence, we reveal God’s love for all, especially the poor and vulnerable, through our compassionate service.

Vision Together, we answer the call of every person we serve: Know me, care for me, ease my way.®

Reciprocity

Kalki

Reciprocity: Honesty & Fairness

• Honesty/fidelity and fairness in medicine look different for different patients

• Fairness fair to the patient in their own context