Chapter 5: Respect for Persons and Diversity

INTRODUCTION

Respect for persons includes more than heeding simple prohibitions of intentional unequal treatment and more than tolerance in the minimal sense of not interfering with others’ liberty. Physical therapists are expected to accommodate and respect differences, not merely tolerate them. Accordingly, we begin by framing the issues concerning diversity in terms of the cultural competency required as part of the competency of health-care providers. Then we turn to objectionable forms of discrimination condemned by the APTA: “The American Physical Therapy Association (APTA) prohibits preferential or adverse discrimination on the basis of race, creed, color, sex, gender, age, national or ethnic origin, sexual orientation, disability or health status in all areas.”¹

CULTURAL COMPETENCY

Appreciating diversity involves developing cultural competence and a willingness to interact in desirable ways with members of other cultures. The Commission on Accreditation of Physical Therapy Education states that “‘Culture’ refers to integrated patterns of human behavior that include the language, thought, communications, actions, customs, beliefs, values, and institutions of race, ethnic, religious, or social groups. ‘Competence’ implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.”²

In the past, it was assumed that patients and others should assimilate into the dominant culture, learning its language and adopting its customs. Increasingly, the concept of assimilation is being balanced with a more pluralistic approach in which minorities preserve basic elements of their ethnic identity. Pluralism is valued for the diversity it brings to a population, both in terms of the population’s social enrichment and the flexibility diversity contributes to a global market economy. In addition to these desirable consequences, pluralism is valued as part of respect for autonomy, moral rights, and human uniqueness. Equally important, there is a presumption that different cultures possess worth, as Charles Taylor notes: “It is reasonable to suppose that cultures that have provided the horizon of meaning for large numbers of human beings, of diverse characters and temperaments, over a long period of time—that have, in other words, articulated their sense of the good, the holy, the admirable—are almost certain to have something that deserves our admiration and respect, even if it is accompanied by much that we have to abhor and reject.”³

Patients’ experience of illness as well as their response to health-care professionals depends in part on their culture. Culturally competent providers greatly enhance the likelihood that patients will engage with their provider in a joint effort to achieve better health. As examples of cultural competence in health care, consider the following cases.⁴