Teaching: Natural or Cultural?

In this chapter I argue that teaching, as we now understand the term, is historically and cross-culturally very rare. It appears to be unnecessary to transmit culture or to socialize children. Children are, on the other hand, primed by evolution to be avid observers, imitators, players and helpers—roles that reveal the profoundly autonomous and self-directed nature of culture acquisition (Lancy in press a). And yet, teaching is ubiquitous throughout the modern world—at least among the middle to upper class segment of the population. This ubiquity has led numerous scholars to argue for the universality and uniqueness of teaching as a characteristically human behavior. The theme of this chapter is that this proposition is unsustainable. Teaching is largely a result of recent cultural changes and the emergence of modern economies, not evolution

Chinese and U.S. Internists Adhere to Different Ethical Standards

OBJECTIVE: To determine whether internists in the United States and China have different ideas and behaviors regarding informing patients of terminal diagnoses and HIV/AIDS, the role of the family in end-of-life decision making, and assisted suicide. DESIGN: Structured questionnaire of clinical vignettes followed by multiple choice questions. SETTING: University and community hospitals in San Francisco and Beijing, China. SUBJECTS: Forty practicing internists were interviewed, 20 in China and 20 in the United States. MEASUREMENTS AND MAIN RESULTS: Of the internists surveyed, 95% of the U.S. internists and none of the Chinese internists would inform a patient with cancer of her diagnosis. However, 100% of U.S. and 90% of Chinese internists would tell a terminally ill patient who had AIDS, rather than advanced cancer, about his diagnosis. When family members' wishes conflicted with a patient's preferences regarding chemotherapy of advanced cancer, Chinese internists were more likely to follow the family's preferences rather than the patient's preferences (65%) than were the U.S. internists (5%). Thirty percent of U.S. internists and 15% of Chinese internists agreed with a terminally ill patient's request for sufficient narcotics to end her life. CONCLUSIONS: We found significant differences in clinical ethical beliefs between internists in the United States and China, most evident in informing patients of a cancer diagnosis. In general, the Chinese physicians appeared to give far greater weight to family preferences in medical decision making than did the U.S. physicians

Implications for Policy-Making and Further Developments

A discussion of the overall findings specifically aimed at highlighting the implications for policy-making. We will argue that sense-making processes can play an important role in helping design policies, in mapping and in understanding how people of given social milieus interpret social reality and therefore intend to act or react upon it. In recent years, a more realistic understanding of human behaviour and decision-making has challenged the often-implicit assumptions about people on which policies were often conceived. From the individual rational choice based citizen, we moved to a bounded rationality perspective. A further step, outlined by this project, is to take into account the interpretative and cultural nature of human behaviour as a fundamental element to consider at both the policy design and implementation stages.