Culturally Diverse Communities and End-of-Life Care

Why is culture important?

Many factors including culture and ethnicity determine thoughts about death. Culture is a group’s worldview and values (Breslin, 1993). Ethnicity is one’s self-identified group and may include subgroups that share common values. Culture shapes choices for life support (e.g., resuscitation, feeding tubes) and preferences to: 

  • Know a terminal diagnosis;

  • Die at home, in the hospital, or in a hospice; and

  • Promote quality during the last days.

In some cultures talking of death is taboo. Among the Zuni and Koreans, speaking of a person’s death is taboo because it might bring sadness or hasten the demise (Hern, Koenig, Moore, & Marshall, 1998). Clinicians need to respect culture and learn culturally competent strategies to explain a person’s illness and health care.

Lack of open and culturally sensitive discussion may mean that the patient’s choice for life support is ignored. Ethnic groups have different values about using treatment or artificial nutrition with a feeding tube, trusting physicians, and participating in decisions. Some cultures (e.g., Korean) expect the eldest son to decide about a parent’s end-of-life care (Murphy, Blackhall, Michel & Azen, 1995). African Americans typically want aggressive treatment (Mouton, 2000). Groups of African American, Latino, Asian, and Russian Philadelphians initially wanted resuscitation (CPR) and feeding tubes but poorly understood either choice. Many people in all groups distrusted the health care system and providers (Phipps, True, & Pomerantz, 2000).

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