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SAFELY EMBRACING CULTURE: THE ADEQUACY OF THE CULTURAL SAFETY PARADIGM...
LINGUISTIC DIFFICULTIES
Linguistically, “cultural safety” implicitly permits a host of oppressive
behaviours. A physician who receives a bulletin about their hospital adopting
culturally safe care programs is probably not going to be well versed in the
definition or history of the paradigm. Indeed, they are likely only going to
engage with the paradigm insofar as they adhere to the expectations laid out
by their workplace. It is possible that these expectations may be incredibly
close to the intentions of the paradigm’s ideal form, but (at least in Canada
and the U.S.) this is unlikely. Even so, there are many things that “cultural
safety” insinuates that may lead to unethical behaviour in an uninitiated
individual.
The term “cultural” is not inherently problematic, but can become
concerning when interpreted in the wrong way. When used appropriately (as
intended by the ideal form of the paradigm), “cultural” means belonging to a
group of people within a system of shared values. In this, the idea of culture
applies equally to both Indigenous cultures and medical culture, invoking
an understanding and reflection on both. When used inappropriately,
the term “culture” insinuates an othering wherein "culture" is defined in
anthropological terms most consistently by its proximal relationship to
difference”. That is, using the term “culture” to refer to anything that is not
part of the sphere in which it is being invoked (i.e., Indigeneity and medical
dogma). This creates a sense in which Indigenous culture contributes to the
body of knowledge that is medicine, but medicine does not reciprocate nor
should it be expected to. This oppresses Indigenous cultural understanding to
an epistemic status unworthy of the same consideration of dogmatic medical
understanding.
The term “safety” is much more concerning. “Safety” implies that a certain
group is vulnerable and another authority/purveyor group is responsible
for making the vulnerable group safe. Although identifying and caring
for vulnerable persons is important, it inherently divides and inequitably
establishes power relationships. In the case of medicine, these power
relationships already exist, and are a large reason why the rapport between
medicine and Indigenous individuals is so poor. Indigenous people do not
need to be protected or saved, they need to be respected and understood.
Assuming otherwise only serves to perpetuate colonial ideals like “saving the
savages”.
54 Audra Simpson, On Ethnographic Refusal: Indigeneity, “Voice” and Colonial Citizenship,
Junctures: The Journal for Thematic Dialogue, Vol. 0, No. 9 (2007), 70.