Ethical Challenges in Multi-Cultural Patient Care by H. Russell Searight

Author:H. Russell Searight
Language: eng
Format: epub
ISBN: 9783030235444
Publisher: Springer International Publishing

4.3.3 Cross-Cultural Perspectives on Families at the End of Life

Including all close family members in the process of decision-making for a loved one is often incongruent with the individually-focused medical and legal system found in countries such as the United States. For example, a variation on the “out-of-towner” theme may occur in non-Western and Hispanic cultures but is not typically associated with social disruption and interpersonal conflict. While not formally established as law, in Korea and Taiwan, a standard practice is that physicians communicate medical bad news to the oldest member or head of the family. However, in these Asian countries, it is also extremely important that all family be members be present at the time of their loved one’s death (Cheung et al., 2015).

Among African-American families, while there was often agreement about maintaining the dignity of the terminally ill family member, issues such as denial of the significance of the illness and differences in religious views often were the sources of internal family conflict (Johnson, Hayden, True, et al., 2016).

While not typically described as highly collectivist in their orientation, the U.S. African-American community typically places a very strong value on family. At the same time, consensus may be more difficult to achieve when it comes to an ailing family member. In a study of palliative care providers, African-American families were described by physicians as supportive yet, complex (Rhodes, Batchelor, Lee, & Halm, 2015). In the health care professional’s opinion, the patient, themselves, was often ready to move towards accepting palliative care but family members persisted in seeking aggressive treatment. It was noted that the patient, themselves, may feel pressured by family members’ agendas to “keep fighting” and may continue with unsuccessful treatment to please an adult son or daughter (Rhodes et al., 2015).

This complexity was evident in Johnson et al.’s (2016) study of end of life care among African Americans. These investigators described how family members were often very engaged in issues surrounding end of life care (Johnson et al., 2016), but, at the same time, there was often pronounced dissension within the family: “In my family, they just cannot make decisions.” (Johnson et al., 2016, p. 145). Another respondent mentioned regrettable conflict: “… the last thing that resonated with me from my father was I know it was very important to him that his family be together, but we were not all at the same place.” (Johnson et al., 2016, p. 145).

In dealing with patients from Asian and some Hispanic cultures, the Western physician may experience a desire to free the individual patient from the perceived tyranny of familial control (Ho, 2008). While it may be perceived that the family is exerting undue influence on the patient, family members may view themselves as protective—particularly in the face of a healthcare professional who may not understand their family’s culture.

As Western views of patient autonomy become more common in Africa and Asia, there has been increased interest in advance directives in these regions. However, the introduction of advance directives may

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.