Beyond cultural stereotyping: views on end-of-life decision making among religious and secular persons in the USA, Germany, and Israel

Abstract

BackgroundEnd-of-life decision making constitutes a major challenge for bioethical deliberation and political governance in modern democracies: On the one hand, it touches upon fundamental convictions about life, death, and the human condition. On the other, it is deeply rooted in religious traditions and historical experiences and thus shows great socio-cultural diversity. The bioethical discussion of such cultural issues oscillates between liberal individualism and cultural stereotyping. Our paper confronts the bioethical expert discourse with public moral attitudes.MethodsThe paper is based on a qualitative study comprising 12 focus group discussions with religious and secular persons in the USA, Germany, and Israel (n = 82). Considering the respective socio-political and legal frameworks, the thematic analysis focuses on moral attitudes towards end-of-life decision making and explores the complex interplay between individual preferences, culture, and religion.ResultsOur findings draw attention to the variety and complexity of cultural and religious aspects of end-of-life decision making. Although there is local consensus that goes beyond radical individualism, positions are not neatly matched with national cultures or religious denominations. Instead, the relevance of the specific situatedness of religious beliefs and cultural communities becomes visible: Their status and role in individual situations, for example, as consensual or conflicting on the level of personal perspectives, family relationships, or broader social contexts, e.g., as a majority or minority culture within a political system.ConclusionsAs the group discussions indicate, there are no clear-cut positions anchored in “nationality,” “culture,” or “religion.” Instead, attitudes are personally decided on as part of a negotiated context representing the political, social and existential situatedness of the individual. Therefore, more complex theoretical and practical approaches to cultural diversity have to be developed.

Religious observance and perceptions of end‐of‐life care

“…There are three main principles in Jewish medical ethics: the sanctity of life; ageing, illness, and death as a natural part of life; and improving patients' quality of life as a never‐ending commitment (Schweda, Schicktanz, Raz, & Silvers, ; Tulsky, ). Healing is one of the 613 commandments, and the obligation to save life (Heb.…”

“…Passive euthanasia is allowed in certain circumstances. If a patient is not suffering but is unconscious and incurable, the Halakha does not require continuing treatment (Schweda et al, ).…”

“…In 1997, Oregon became the first state to enact a law permitting physician‐assisted suicide in the event that the patient's prognosis does not exceed 6 months, and on condition that two verbal applications and one written application were submitted for the termination of life (Steinberg & Sprung, ). The Death with Dignity Law is guided by the notion that terminally ill patients should determine themselves how much pain and suffering they are willing to endure (Schweda et al, ). As in Oregon, laws in Washington and Vermont permit adults of sound mind to request a lethal prescription from their physician (Israel, ).…”

“…Approaches to decision‐making regarding EOL are rooted in the patients' culture, especially their religiosity and spirituality. One's personal background and past experiences are also contributory (Schweda et al, ). In an increasingly multicultural patient environment, cultural and religious differences on matters of medical ethics must be considered.…”

Searching for Bioethical Principles Related to Palliative Care

“…In a search, in databases, we write «end of life AND bioethical issues» in B-ON, with the criteria of peer reviewed, between 2013 and 2017; and we get 5,431 articles to read. And those articles include "Controversies surrounding continuous deep sedation at the end of life: the parliamentary and societal debates in France", 4 or "Beyond cultural stereotyping: views on end-of-life decision making among religious and secular persons in the USA, Germany, and Israel", 5,6 systematic reviews, cultural perspectives, clinical approaches.…”