Cultural elements invariably affect the delivery of professional services in whatsoever form. Professional practices are strongly guided by appropriate code of ethics. Sound ethical decision making is based on a process that involves multiple steps some of which are taken in advance and some of which are taken at the time ethical dilemma presents itself (Carter, Bennett, Jones & Naggy, 1999). The development and the application of ethical principles and standard in professional lives are strongly influenced by cultural elements.
BREIF HISTORICAL PERSPECTIVES ON WESTERN ETHICAL CODES
The influence of culture on ethical professional practice could be traced back to the time of the development of some selected code of ethics. Professional codes in the West typically follow the Hippocratic tradition (Veatch, 19997) which is often acknowledged by both physicians and lay people as the foundation of medical ethics for physicians in the west. Among the Christian cultures, a new version of the Hippocratic oath called the oath According to Hippocrates insofar as a Christian may swear it (Jones, 1924), emerged for Christian physicians with some changes to reflect the culture of the Christian Kingdom.
These includes removal of references to the Greek gods and goddesses, the dropping of the prohibition against surgery whilst strengthening the prohibition on abortion (Veatch, 19997). Similarly, the Percival’s medical ethics which become the foundation of modern Anglo-American professional physicians’ ethics also show some variation with the Hippocratic Oath. The religious virtue of purity and holiness of the Hippocratic Oath are replaced with virtues of gentleman: Physicians should “unite tenderness with steadiness and condescension with authority” (Percival, 1927).
ETHICS AND PROFESSIONAL LIFE IN GHANA Culture could be described as the integrated pattern of human behavior that includes thoughts, speech, customs, beliefs, values, social forms and material traits of a racial, religious or social group. Culture can help to define family systems i. e how the family is defined, child rearing practices, social relationships, perceptions or beliefs on physical health and mental health, help seeking behaviors as well as communication patterns. These cultural elements undoubtedly affect professional practice in Ghana.
Therapeutic approaches to treatment of physical, mental and psychological disorders are broadly categorized by Twumasi (2005) as Traditional and Scientific treatment. The traditional medicine is that service performed through the utilization of magico-religious acts and concepts (Lystead, 1958) whilst scientific medicine or modern medicine indicate a view in which the rational explanation of natural events is in terms of cause and effect, (Twumasi, 2005). Twumasi (2005) recognized four main types of traditional healers: Traditional Birth Attendants (TBA’S), Faith Healers (Pastors), Spiritualist-Diviners and Traditional herbalists.
TRADITIONAL MEDICINE AND ETHICS OF PRACTICES Traditional medicine is conceptualized as all treatment services through the utilization of magico-religious acts and concepts. It is the oldest practicing treatment option in Ghana. Traditional healers are the first line of care for many Ghanaians, both because the healers are indigenous to the community and because their techniques are familiar and comforting, more so than the newer techniques which may seem foreign and impersonal. The training, operations of these practitioners differ significantly.
The development and application of ethical principles in professional practice is heavily endowed in the training programs. However, the training programs of most if not all of these practitioners does not make provision for ethical principles. For example, the skills of becoming TBA’S are learnt from relatives by watching a trainer in action in an informal atmosphere (Twumasi, 2005).
SCIENTIFIC MEDICINE AND ETHICS OF PRACTICE Scientific medicine practitioners have their trainings regulated by professional boards which clearly spelt out the code of ethics of the various professions.
Notably among these professions include the Medical practitioners (such as Doctors, Nurses, Pharmacists, Physiotherapists, laboratory technicians, radiographers and many others), Psychologists, lawyers, journalists among others. According to Trull & Phares (2001), professional boards and associations are important because they establish who qualify to practice through Certification, Licensing, National Register and Common Knowledge and Private Practice regulation.
These requirements for practice also ensure that practitioners know the ethics of their respective professions and the applicability of the cods and the ethical standards. The practitioners in this treatment modality always keep themselves updated on the ethical codes following some procedures outlined in Canter, Bennett, Jones & Naggy (1999) such as knowing the applicable laws of the state, knowing the rules and regulations of the institution where one works, engage in continuing education in ethics among others.
CULTURAL ELEMENTS AFFECTING THE ETHICS OF PROFESSIONAL PRACTICE IN GHANA “EXTENDED FAMILY PHENOMENON”.
The practice of extended family is deeply rooted among Ghanaians which tend to have a major influence on individual’ life. It affects some part of individuals private, social, economic and professional. The concept of concern for each other’s welfare is deeply rooted in the Ghanaian Culture and every one seems to be concerned not to do things in isolation. Back in the rural setting, this is most evident in how family members gather to solve problems confronting any family member. Professionals in the various professions always invariable have their share of the extended family phenomenon.
Traditional healers make use of the extended family in diagnosing and treatment of patient’s ailments. Most rituals performed by the traditional healer involve some segment of the family. This could be due to the belief that the problem arose from the family, hence the entire or some segment of the family and not the individual would be involved in the purification rituals. Even the situations where the problems arise from the single individual behavior, the extended family get involved because of the concern for each other’s welfare.
The involvements of the extended family invariably lead to the break of confidentiality. Respect for competent wishes of the client is diminished or totally absent especially when the family dictates what should be done to the individual with the problem. Both the traditional healer and the family would be acting primarily on the principle of beneficence and non-maleficence with much emphasize on the end or consequences (Teleologicalist/ Consenquentialist) of their actions.
Sometimes or most often, these healers ignore the intrinsic nature of their act (Non-deontologists) evident in some of the activities they do. For example the same blade would be kept for a long time under unhygienic conditions and used for different patients. The scientist practitioners with more knowledge in ethical principles also experience the extended family phenomenon. These practitioners are at the mercy of family members, friends and relatives to violate some codes of their professions.
For example, a clinical Psychologist who refuses to treat a family member but referred the person to another Clinical psychologist would be considered wicked by the family simply because, the family does not understand the impact of dual relationship on therapeutic outcome and the fact that the person being a family member might not disclose what actually the problems were in therapy. Because of the extended family network, these professionals might be requested by family members to condone and overlook the wrongful act of family member e.g child abuse.
There is pressure on physicians and other health workers to disclose the status of a sick family member for which they are not supposed to. Lawyers are requested to protect family members no matter the nature of the crime even in the face of glaring evidences. Families also expect family members in high positions such as registrar of university, human resource manager of a company to admit their wards or offer them employment respectively irrespective of applicant suitability.
HIGH ILLITERACY RATE
High illiteracy rate is a problem affecting most African Countries including Ghana. Knowledge about the existence of ethical codes is paramount to ensuring it applicability. Most Ghanaians do not know what ethical principle bind professionals and what professionals are supposed to do. This means that most Ghanaians do not know the duties of some service providers in terms of information revealed during the course of treatment. The essence of informed consent, confidentiality and respect for autonomy are almost lacking. Patients’ information is sometimes on the public domain.
For example, it is uncommon to see some men of God on Television disclosing patient’s confidential information gathered during the course of therapy.
BELIEF SYSTEMS Ghanaians are described as “religious beings” because of the stench belief in religious view to explaining occurrences. For example, most Ghanaians hold that Illness is caused by curse from ancestors, punishment among others. The belief system affects the choice of treatment with most of the patients visiting the traditional healers first before if possible any scientific help is sought.
Sometimes the reverse holds where patients seeking scientific care ultimately end in the traditional healer’s camp. At the healer’s camp, because of the belief that the problem is caused by spiritual forces, all decisions are left for the healer without tolerating the views of the patient. Informed consent and confidentiality are lacking and broken because invariably the extended family phenomenon comes in. Following the above discussion, it is evident the effects that cultural elements have on adherence to professional ethical practices in Ghana.
As a country, practitioners of the various professions need to be aware of the factors and find ways of dealing with them as already existing ethical dilemma. It is therefore recommended that training institutions recognized cultural factors and to equip trainees on how to deal with them.
REFERENCES Canter. B. Mathilda. , Bennett. E. Bruce, Jones. E. Stanley, & Nagy. F. Thomas (1999). Ethics for Psychologists: A commentary on the APA Ethics Code. USA: American Psychological Association. Jones,W. H. S. (1924).
The Doctor’s oath: An Essay in the History of Medicine. Cambridge: Cambridge university press. Lystead R. A, (1958) The Asante: A proud people. New Jersey, Rutgers Percival . T. (1927). Percival’s Medical Ethics. Baltimore: Williams & Wilkins. Timothy. J. Trull & Jerry. E. Phares (2001). Clinical psychology: Concepts. Methods and Profession (Sixth Edition). USA. Wadsworth. Twumasi P. A. (Edited, 2005). Medical systems in Ghana. Ghana. Ghana Publishing Corporation. Veatch. M. Robert (2005). Medical Ethics. (second edition). USA. Jones and Bartlett Publishers.