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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 patientprovider 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 Therapeutics that are considered effective are retained; the rest are ignored as quaintly outdated or offered as evidence of medical progress.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.
