Cultural Preferences and EndofLife Care

Cultural Preferences and End-of-Life Care Culture has always been seen as a key factor in determining the ways in which different people perceive illnesses, the suffering they go through during that period up to the time of death. In recent years, ethnic diversity has increased in the US, and this has subsequently led to an increase in interactions between patients from different cultural backgrounds and different physicians. Across continents, there exist numerous varying cultures practicing different cultural beliefs or practices. Studies have revealed that there exists a difference in the way cultures address certain medical issues: telling of the truth of a patient’s whereabouts, making of technical decisions, etc. This paper studies Kagawa-Singer and Blackhall’s (2001) article and directs its attention to the Chinese-American ethnic group, outlining some of the critical issues that affect the medical process based on the patient, family and the physician while monitoring the cultural beliefs, practices and values of the patient so as to ensure maximum satisfaction at the end of life. The paper also looks into the various challenges faced by professionals in palliative care with respect to cultural beliefs and the implications of these challenges to the professionals.
Cultural Preferences and End-of-Life Care
On January 12, 2001, a perspective editor interviewed a 38-year old Chinese woman, Ms Z, who took care of her ailing mother and father with help from her elder sister (Kagawa-Singer and Blackhall, 2001). In December 1994, her mother was diagnosed with stage IIIB adenocarcinoma of the lung and underwent chemotherapies. She received constant treatment but succumbed to her end of life in January, 1996. To add to the ill-fated departure of her mother, Ms Z’s dad was diagnosed with Parkinson during the early 90s, and died in 1997 after numerous medications had been administered (Kagawa-Singer and Blackhall, 2001). According to Ms Z, the topic of her mother’s condition was never raised by any family member. In addition, her father never discussed his condition even after they had full information from the doctor (Kagawa-Singer and Blackhall, 2001). From the interview, a number of issues were of notable concern in the Chinese culture and they are addressed below:
a) Informed consent – across many cultures, people do not appreciate telling the truth about diagnosis of certain diseases such as cancer, although it is part of U.S. health care. According to Ms Z, her mother’s diagnosis was given in a statistical book for her to read, and they never discussed that topic again. This is an implication that Chinese culture does not permit the truth telling effect in end-of-life healthcare, a trend that is common in Italy, France, Eastern Europe, Asia, Central and Southern America, and the Middle East as a sign of humanity and ethical standards (Crawley, Marshall, and Koeing, 2001). This is echoed by a Korean American who claims that he hid from his wife the fact that she had cancer, which he feels enabled her to live longer than if she were made aware of her condition (Kagawa-Singer and Blackhall, 2001).
b) Decision making – According to Ms Z, the presence of her and her sister in every medical appointment was a symbol of a Chinese culture that requires one to take care of themselves and the patient and participate actively in the decision-making process during the treatment process, an argument that is seconded by Kleinman (1980). In addition, Kleinman (1980), with reference to the Patient Self-Determinant Act of the US, suggests that patients should be allowed to make decisions regarding how medical treatment should be administered to them at the end-of-life. Other cultures view decision-making as a responsibility of the family, who are to protect their patients from the difficulty of making tough decisions about their health care.
c) Palliative care – Ms Z feels that hospice care is not suitable for her dying mother and father as it is a sign of giving up or the caretaker’s failure, which is why Asians do not appreciate the practice. Research shows that ethnic community patients constitute less than 17% of the patients in palliative care and that only a few of them are Asian Americans (Kagawa-Singer and Blackhall, 2001). According to Muller and Desmond (1992), filial piety, a practice in many Asian countries, is thought to be a contributing factor to this, as it is expected that children are to take care of their parents as a way of appreciating them for the initial care they got while young.
d) Communication – The interview revealed that the Chinese culture does not permit them to talk about treatment and care up to end of life, something evident via the lack of discussion regarding the critical health conditions of her parents and their eventual death. According to Muller and Desmond (1992), the Chinese would rather not talk about it and wait for the end-of-life moment. In the Far East countries of Asia, non-verbal communication is practiced to pass such dire information so as to avoid embarrassments in cases where truth needs to be told.
Challenges Facing Informed Consent
With reference to the U.S. health care, a patient has a right to decision making, knowledge of their medical status, and type of medication to be offered (Kagawa-Singer and Blackhall, 2001). In different cultural setups, this is hindered by a number of issues which include:
i. Level of severity of the disease – some diseases are severe and hard to bear the information. According to Kagawa-Singer and Blackhall (2001), breaking the news to a cancer patient may reduce the life time of the patient as opposed to withholding the information. The physician should consult the family before breaking the news to the patient even if the patient insists to know the diagnosis.
ii. Cultural beliefs – as we have seen from the Chinese point of view, the diagnosis is not revealed publicly to the patient, but rather, it is done delicately so as not to hurt the emotional feelings of the patient and the family. Even though the patient has the right to know their health status, cultural beliefs may hinder the process.
iii. Emotional strength of the patient – some patients have the ability to take in certain things comfortably thus can easily be informed of their status. On the other hand, a patient who is highly emotional cannot be provided with such information as it may result in immediate death, hence the need for hiding the information from them (Barker, 1992).
Implications
Healthcare professionals face a tough task to ensure that a patient and their family are satisfied with the medical care being offered. However, with culture and ethnicity in their way, there results both legal and ethical implications during their duties. When one fails to abide by the family’s decision not to tell a patient the truth, they are viewed to be cruel, non-caring and ignorant (Crawley, Marshall and Koeing, 2001). This may result in anger and mistrust which may end up in conflicts. In addition, Kagawa-Singer and Chung (1994) propose that different cultures and languages brought in by different patients need to be respected. This is a challenge to health care professionals for they have to understand other cultures, and, in some cases, deviate from their standard procedures just to incorporate the culture of a patient and ensure maximum satisfaction. In some cases, misconceptions arise owing to a professional’s little understanding of a given culture. This may result in unwanted outcomes in the clinic and inappropriate relation between the patient and families at end-of-life. With respect to Crawley, Marshall and Koeing (2001), professionals have to ensure that they are conversant with the culture of their patients so as not to cause any conflicts. In addition, hiding information from a patient may be viewed as violation of the patients’ rights to know the truth which may result in legal action.
In conclusion, health care professionals who conduct palliative care should have vast knowledge of different cultures of their patients. In addition, when a patient comes into their care, they should gather enough information from both the patient and the family in regards to the do’s and don’ts of the process. This ensures that the family and patient are satisfied with the care. Similarly, the professionals should also give the family a clear outline of their treatment procedures so that both parties can come to a mutual understanding regarding the patient’s medical attention and reduce future conflicts between the health care unit, the family and the patient (Barker, 1992).
References
Barker, J. C. (1992). Cultural diversity: Changing the context of medical practice. West J Med.,
157(3), 248–254.
Crawley, L., Marshall&nbsp.P., &amp. Koeing&nbsp.B. (2001).&nbsp.Respecting cultural differences at the end of life.&nbsp.In T. E. Quill and L. Snyder (Eds.). Physician’s guide to end-of-life care. Philadelphia: American College of Physicians – American Society of Internal Medicine.
Kagawa-Singer, M., &amp. Chung, R. (1994). A paradigm for culturally based care for minority populations. J Comm Psychol., 22(2), 192-208.
Kagawa-Singer, M., &amp. Blackhall, L. J. (2001). Negotiating cross-cultural issues at the end of life. “You got to go where he lives.” JAMA: Journal of the American Medical Association, 286(23), 2993-3001.
Kleinman, A. (1980).&nbsp.Patients and healers in the context of culture.&nbsp.Berkeley: University of California Press.
Muller, J. H., &amp. Desmond, B. (1992). Ethical dilemmas in a cross-cultural context: A Chinese example. West J Med., 157(3), 323-327.