(PDF) Vulnerability and Marginalized Populations

Running head: DISCUSSION QUESTIONS 1
Discussion Questions
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ROLE AND NAMING CONVENTIONS 2
Discussion Questions
Assignment 4 – Vulnerability and Marginalized Populations
Case 1: Reducing Sudden Infant Death Syndrome in a Culturally Diverse Society
1. Evidence suggests that several factors affect the magnitude of risk and that bedsharing
in the absence of these factors does not significantly increase the risk of SIDS. But the
interplay of risks can be complex and difficult to communicate effectively in a national
campaign. Can a definitive “no bed-sharing” message be defended, on ethical grounds, if it
causes less confusion but overstates the risk to some groups? What are the most important
ethical considerations here?
Sudden Infant Death Syndrome (SIDS) is a complex health and ethical problem that
offers several challenges in determining the best prevention approach to reduce the number of
incidences (Wrigley & Dawson, 2016). Some factors have been identified to increase the risk of
SIDs and have been classified as modifiable and non-modifiable. The modifiable factors include
bed sharing, maternal smoking, breast feeding, prone sleeping position, and attendance level to
prenatal classes. The factors that have been classified as non-modifiable include social economic
status, baby’s sex, and the mother’s age. There have been concerns regarding the best campaigns
that would help promote awareness of the risks factors that parents can modify to reduce the
degree of vulnerability. For instance, bed sharing was identified as one of the major risk factors
that can be modified. However, it is not considered as a significant risk factor if other underlying
factors such as maternal smoking, duration of bed-sharing, and the baby’s age. Therefore, it is
difficult to scientifically define the risk factor in a clear manner that parents can understand.
Also, the campaign against bed-sharing was faced with varying degrees of criticism and
reactions among the Māori and Polynesian families because the childrearing practice is deeply

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rooted to their traditions (Wrigley & Dawson, 2016). This is a risky strategy because it may
result in alienating this group of people.
A definitive “no-bed-sharing” message cannot be defended if the cultural sensitivity of
different groups of parents is not taken into account (Hawkes, 2013; Wrigley & Dawson, 2016).
If a recommendation that just exclusively states “no bed-sharing,” it might be misleading
because parents may not be able to make informed decision, especially, if the child has a
relatively low risk of SIDS. Also, such a recommendation would not consider any discussions
regarding the reasons why parents practice bed-sharing (Wrigley & Dawson, 2016). As a result,
health practitioners might not raise the topic and may result to parents lying about their behavior.
The most important ethical consideration is that the baby should receive the best care
with minimum harm caused, autonomy, and beneficence. It can be argued that “no-bed sharing”
message aims to prevent harm to the babies but considerable harm may occur if it results in
alienating the target group because of the cultural beliefs thus fail to reduce the rates of SIDS
(Wrigley & Dawson, 2016). In regards to autonomy, parents have the right to make informed
decisions. Therefore, they should be sufficiently informed that bed sharing as a risk for SIDS is
relatively dependent on the presence of other factors. If the other factors, such as lack of
exposure to maternal smoking, healthy terms births, or exclusive breastfeeding, are considered,
the child’s risk for bed-sharing related SIDS will be significantly lower.
2. What weight should be attributed to the cultural significance of bed-sharing when
generating guideline s, and why? Should risks that relate to culturally significant parental
practices, such as bed-sharing, be treated differently from risks relating to practices that
are not held to be culturally significant?

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The cultural significance is highly sensitive and should be regarded as a critical factor
when generating guidelines because the level of acceptability of the recommendations given will
be dependent on how controversial the message is in relation to the cultural behavior (Wrigley &
Dawson, 2016). In certain cultures, such as the Māori and Polynesian populations, bed-sharing is
a common practice that has been linked with a relatively low risk level of SIDS. However, other
modifiable and non-modifiable factors such as lack of attendance to prenatal classes, maternal
smoking, low social economic status, age of first time mothers, and fewer years of education are
more prevalent among the Maori parents in comparison to non-Maori parents. Consequently,
among the Maori children, bed-sharing, in conjunction with other the mentioned factors, poses a
greater risk for SIDS than to non-Maori children (Wrigley & Dawson, 2016). It is therefore very
important to consider the cultural significance of bed-sharing among different communities in
relation to other social economic and behavioral factors that influence the risk for SIDS when
generating guidelines.
The culturally significant parental practices related risks such as bed-sharing should be
treated differently from other factors because of the complexities associated with the different
reactions among people with different traditions (Wrigley & Dawson, 2016). For instance, the
message of no bed-sharing had serious implication because it was not culturally sensitive,
therefore, some people from Māori and Polynesian ended up rejecting to comply or turning away
from SIDS prevention campaigns. Conversely, the factors that involve
8. Parents can control some risk factors for SIDS, but others involve broader societal
issues, such as socioeconomic status. Does social justice require that prevention campaigns
targeting parental practices be coupled with efforts to tackle social and economic
disparities and inequities? Who should be responsible for ensuring that this is the case?