Communication Between Cultures

by the need to understand how cultures differ in the delivery and reception of such

information.

Healthcare practice in the United States reflects the belief in the importance,

uniqueness, dignity, and sovereignty of every person; the sanctity of individual life;

and everyone’s legal entitlement to patient autonomy and self-determination. From

this perspective, it is assumed that the patient is always the best person to make

health decisions. In many other cultures, however, the interdependence between

patient and family can override individual self-determination. In other cultures, the

family is vested with the decision-making authority and the task of informing the

patient. In Japan, for instance, it is common for physicians to consult with family

members rather than the patient about treatment regimens. In the Filipino commu-

nity, family members will decide among themselves if a patient should be informed

of a terminal condition.^67 Euro-American healthcare practitioners have to recognize

that the Western practice of disclosing diagnostic information directly to the patient

may not be applicable in all cultures.

The discussion of death is also marked by cultural differences. Although end-of-life

decisions and procedures are often only reluctantly discussed in the United States,

patients are continually urged to execute advanced healthcare directives to specify

desired treatment and procedures should they become incapacitated and unable to

communicate. Among many other benefits, an advanced directive relieves family

members and loved ones of having to make difficult decisions, thereby preserving

everyone’s autonomy. However, the hesitancy to address end-of-life issues is evident

in that only around 30 percent of the people in the United States have an advanced

healthcare directive. But imagine how difficult it would be to discuss an advanced

healthcare directive with someone from the Navajo culture, where even the mention

of death is thought to invite it. Mexicans, on the other hand, take a more stoic view

of death as just another part of life and God’s will.^68

To conclude our examination of multicultural healthcare, we remind you again

that an understanding of varied medical perspectives, communication styles, and indi-

vidual beliefs will assist healthcare providers in becoming more sensitive to the cultur-

ally based health expectations held by people from different cultures.

DEVELOPINGINTERCULTURALCOMMUNICATION

COMPETENCE INCONTEXTS

From reading this chapter, along with others, you have probably already discerned the

importance of becoming interculturally competent, which can be broadly defined as

“the knowledge, motivation, and skills to interact effectively and appropriately with

members of different cultures.”^69 This general definition provides a template that

can be used in identifying more specific requirements for attaining intercultural com-

petence in various contexts. Therefore, as a conclusion to this chapter, we offer a

brief discussion on means of acquiring those skills as they relate to business, educa-

tion, and healthcare contexts.

While they differ significantly in appearance and objectives, each of the contexts

discussed in this chapter share some common traits, the most salient being they each

require an organizational structure and involved personnel. These shared characteris-

tics allow us to make the claim that the responsibility for the acquisition and employ-

ment of intercultural communication competence rests with the service provider and

374 CHAPTER 10• Intercultural Communication in Contexts

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