Three Important Cultural Factors to Consider When working with Immigrant Families in End-of-Life Care

Phyllis R. Coolen

  1. Death as a Taboo Subject

In some cultures, talking openly about death and dying is not acceptable because it is considered disrespectful, bad luck, or causes loss of hope (Giger, et al., 2006).  Many cultures actively protect dying family members from knowing their prognosis (Carteret, 2012). 

For example, some Filipinos may request the family member not be told he or she is dying because of concern for the person’s loss of hope and the belief that only God can decide a person’s fate. 

For many Southeast Asian families, the dying family member is not to be told about a terminal diagnosis because talking about death would bring it on sooner or doing so is disrespectful to the soon-to-be ancestor. 

Some Somalis consider it uncaring for the health care provider to tell the terminally ill family member he or she is dying (Stratis Health, 2010). And for some Muslims, talking about death is taboo and a religious leader may be needed to facilitate the conversation with the male family leader and the health care provider about end-of-life care.

2. Collective Decision-making

Collective decision-making is the norm in many cultures, but it often clashes with the American value of autonomy and an individual’s right to make one’s own decisions about health and dying (Giger, et al., 2006).

Collectivism’s core values can cause a treatment dilemma for the health care provider whose focus is on getting the patient involved in the treatment plan.  In collective decision making, the family decisions will be family oriented. 

In these circumstances, it is important to understand and respect that the power of collectivism is more important than an individual (Huff & Kline, 2007b; Logan, Fukuda, & Baldwin, 2006).

A family may expect information to be given to them first, so they can make the health care decisions. For example, Koreans and Mexican Americans are more likely to consider the family as the decision-maker regarding withholding of aggressive treatment, rather than the patient alone (Maly, Umezawa, Raliff, & Leake, 2006). 

For many Asians and Pacific Islanders, filial piety, as supported by Buddhism, Confucianism, and Christianity, requires family members to take over the decision-making role for the seriously ill elderly patient (Giger & Davidhizar, 2002). 

Family and extended family ties are extremely important to the Filipino and Hawaiian communities, with the extended family participating in the discussions and decision-making for the seriously ill family member. 

Some Somalis believe that health care decisions involve the whole family, with a male family member being the spokesperson for the family and the father being the bearer of bad news to the patient (Carteret, 2012).  When death is imminent, the Asian Indian male head of the household is responsible for deciding when the patient is to be told and when to inform the rest of the family members (Stratis Health, 2010).

3. Perception of the Physician’s Status and Health Care Experience in Country of Origin

Immigrant patients may come from countries where the physician makes all health care decisions and patients are unaccustomed to being asked to choose among treatment options (Kingsley, 2010).  The patient and family may have the expectation that it is the physician’s role to decide on end-of-life care (Searight & Gafford, 2005b). 

For many Filipinos, physicians are held in high esteem and are given extensive authority, so questioning the physician’s treatment decision or being asked to make a decision about one’s own health care is not expected.  They would expect the physician to make all decisions about their health care.

Additionally, some immigrant patients may not be accustomed to or comfortable asking questions of the physician, even if aspects of the illness or treatment plan are not understood because of concern that they will be perceived as challenging the physician (Shavers, Bakos, & Sheppard, 2010).  For example, Southeast Asian cultures value politeness and respect for authority, so questions or voicing concerns about the family member’s terminal illness or treatment may not occur. 

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