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SAFELY EMBRACING CULTURE: THE ADEQUACY OF THE CULTURAL SAFETY PARADIGM...
create. During the development of the cultural safety paradigm, Ezekiel
and Linda Emanuel were publishing their seminal article, Four Models of
the Physician-patient Relationship.”* Although this article was not a direct
influence on the development of the cultural safety paradigm, it provides a
very clear depiction of the type of relationship the paradigm is hoping to
frame. Emanuel and Emanuel argue that the traditional model of the patient¬
provider relationship is unbalanced, granting too much praxiological and
epistemic power to the provider. That is, healthcare providers and the culture
of healthcare (e.g., non-pluralistic biomedicine) are given authority over
patients, when the authority over health should be shared. Put wonderfully
by Maureen Lux:”
Past medical therapeutics [i.e., healthcare] are most often judged by modern
assessments and their effectiveness: Did they work according to our understanding
of science and medicine? Therapeutics that are considered effective are retained;
the rest are ignored as quaintly outdated or offered as evidence of medical
progress. But therapeutics are much more than chemical formulae and responses.
Therapeutics imply a relationship between healer and patient — a relationship
that must be viewed within a particular cultural context... That therapies may be
judged ineffective in another time or place does not limit their significance. For
instance, today’s cancer patients share their physician’s faith in science to such a
degree that they willingly undergo near fatal doses of chemotherapy that are for a
time much worse than the disease. Therapeutics are culturally relative and must
be studied within the framework of explanations, relationships, and worldview.
To rectify the more authoritarian form of healthcare traditionally seen in
“therapeutics” illustrated in this quote, Emanuel and Emanuel emphasize a
form of patient-provider relationship that is embedded in cultural relativity
and a shared responsibility for health. Specifically, they suggest what they
refer to as the “deliberative model”, wherein the relationship between a patient
and provider aims to achieve a mean between the extremes of autonomy
and paternalism. In doing so, trust and a common frame of reference can
be established between the patient and the provider. This requires mutual
engagement of and humble reflection upon patient and provider values.
Recognizing that neither patients nor provider are value neutral (nor should
they be), this allows for an effective integration of health ideals that ultimately
improve the quality of care. It is these sorts of patient-provider relationships
that cultural safety hopes to encourage.
28 Ezekiel Emmanuel — Linda Emanuel, Four Models of the Physician-patient Relationship,
Journal of the American Medical Association, Vol. 267 (1992), 2251-2256.
29 Maureen K. Lux, Medicine That Walks, 72.