Handbook of Minority Aging by Whitfield Keith;Baker Tamara;

Author:Whitfield, Keith;Baker, Tamara;
Language: eng
Format: epub
Publisher: Springer Publishing Company, Incorporated

Cultural Competence Framework

In the United States, the dominant discourse about illness, dying, and death focuses on autonomy, independence, self-control, and individual choice. Our health care system reinforces this autonomous decision making through the legal structures of advance directives. The focus on the individual and on planning for death presupposes the following elements: the individual is the primary decision maker; the individual has an interest in being in charge; typically, there is a clear communication and understanding between the individual and the medical team about diagnosis, prognosis, and options; the individual has equal financial access to the different options offered; and the individual has the power and sense of entitlement to make whatever choice is desired (Field et al., 1997).

There are many people in the United States, particularly minority older adults, for whom at least some of these conditions may be neither attainable nor desirable. In the absence of a cultural competence framework, this model of EOL care may be inadequate because it does not account for the experiences and values of persons who are in one way or another culturally different or socially disadvantaged. This includes ethnic and religious minorities for whom collective decision making may be a priority. Persons who are economically disadvantaged also may not access a range of different EOL care options that do not rely on informal support networks because of the cost of care.

Minority elders vary in regard to their beliefs and opinions about EOL decision making. This includes their views on the appropriateness of talking about and planning for death; truth-telling (Candib, 2002), which may take the form of advising persons that they are dying; and the roles of the collective family members and fictive kin in the decision-making process, as well as communicating with physicians regarding EOL decisions. These groups also may vary in even more basic dimensions (such as orientation to the future, the social construction of the self, and beliefs about who is in control of one’s destiny and/or fate) that may have implications for EOL decision making (Bullock, 2011). In addition, within-group differences among racial/ethnic minority elders in their social support network and/or extended family system can be as great as, or greater than, between-group differences because individuals are often exposed to multiple and sometimes contradictory systems of values. To this point, it is worth acknowledging that not all Latinos/Hispanics will desire the same EOL care, and neither will all black or African Americans, Asians, nor any other racial/ethnic group members. Group experiences and the system of values affecting attitudes and behavior are not static. Although there are cultural values and norms that are helpful to be aware of and knowledgeable about, culturally appropriate assessments should be conducted to determine the extent to which one identifies with his/her cultural norms and their individual preferences at EOL (NASW, 2004).

Cultural competency practices have been widely accepted in social work as a means to decrease disparities in the quality of services delivered to ethnic minority groups. NASW (2007) Standards for Cultural Competence include

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