Bioethics in a different tongue: the case of truth-telling

Social Science & …, 1999

The ethical and legal implications of decisions to withhold and withdraw life support have been widely debated. Making end-of-life decisions is never easy, and when the cultural background of doctor and patient dier, communication about these issues may become even more dicult. In this study, we examined the attitudes of people aged 65 and older from dierent ethnic groups toward forgoing life support. To this end, we conducted a survey of 200 respondents from each of four ethnic groups: European-American, African-American, Korean-American and Mexican-American (800 total), followed by in-depth ethnographic interviews with 80 respondents.

Geriatric Nursing, 2012

Journal of Clinical Oncology, 2003

A p p r o a c h i n g t h e E n d o f L i f e : A t t i t u d e s , P r e f e r e n c e s , a n d B e h a v i o r s o f A f r i c a n -A m e r i c a n a n d W h i t e P a t i e n t s a n d T h e i r F a m i l y C a r e g i v e r s Purpose: To investigate differences in attitudes, preferences, and behaviors regarding end of life in terminally ill patients and their designated family caregivers.

Medical …, 1998

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… of Healthcare Ethics, 1998

Cultural difference has been largely ignored within bioethics, particularly within the end-of-life discourses and practices that have developed over the past two decades in the U.S. healthcare system. Yet how should culture—specifically cultural differences as reflected among groups defined as ethnically or racially different—be taken into account?

The American Journal of Bioethics, 2006

Journal of General Internal Medicine, 2008

Ethnicity & disease, 2006

2010

Hospice. Doctor of Philosophy (Applied Gerontology), December 2010, 67 pp., 17 tables, 3 figures, references, 56 titles. The United States of America is a country composed of various ethnicities. This country is considered to be a multi-cultural society. There are various cultural traditions values, norms and superstitious practices within each ethnic group. Attitudes toward end of life care are complex and vary differently across each ethnic group. This study explored factors that explained African Americans' disproportionate use of hospice. Access to hospice care was address, experience with hospice was explored, and recommendations were provided. This study conducted non-experimental research. The design of this exploratory study was quantitative in nature. A survey approach was utilized to collect data that was statistically analyzed. The important concept was African American disproportionate use of hospice. The variable willingness to use was employed to try to explain African Americans' disproportionate use of hospice. The independent variables African Americans who mistrust formal healthcare providers and knowledge about hospice services were operationalized using multiple indicators. The independent variable experience with hospice services did not use a scale. The research findings supported all three study hypotheses. This research results recommend that an important focus of the future be to counsel persons on the availability of hospice as an option for end-of-life care. Well-structured programs of training in cultural awareness and cultural competence throughout the ranks of the health care system must be instituted. Such an effort will pay dividends in reducing cultural mistrust and push closer to eliminating health disparities between minority groups and the rest of society. v

American Journal of Critical Care, 2010

Background Tailoring care for patients and their families at the end of life is important. Purpose To examine factors associated with patients' choices for level of care at the end of life. Methods Data on demographics and level of care (full code, do not resuscitate, or withdrawal of life support) were collected on 1072 patients who died between January 1998 and June 2006 on a cardiac care unit. Logistic regression was used to identify factors associated with level of care. Results Median (interquartile range) age of blacks was 64 (50-74) years and of whites was 70 (62-78) years. At the time of death, the level of care differed significantly between blacks and whites: 41.8% (n = 112) of blacks versus 26.7% (n = 194) of whites chose full code (P <.001), 37.3% (n = 96) of blacks versus 43.9% (n = 317) of whites chose do not resuscitate (P = .03), and 20.9% (n = 54) of blacks versus 29.3% (n = 210) of whites chose withdrawal of life support (P = .005). After age, sex, diagnosis, and lengths of stay in intensive care unit and hospital were controlled for, blacks were more likely than whites to choose full code status at the time of death (odds ratio 1.91 [95% confidence interval, 2.63-1.39], P < .001). Conclusions Blacks are 1.9 times as likely as others to choose full code at time of death. Cultural differences should be acknowledged when providing end-of-life care.