Ethics and Advance Care Planning in a Culturally Diverse Society

Abstract

Emerging international research suggests that in multicultural countries, such as Australia and the United States, there are significant disparities in end-of-life care planning and decision making by people of minority ethnic backgrounds compared with members of mainstream English-speaking background populations. Despite a growing interest in the profound influence of culture and ethnicity on patient choices in end-of-life care, and the limited uptake of advance care plans and advance directives by ethnic minority groups in mainstream health care contexts, there has been curiously little attention given to cross-cultural considerations in advance care planning and end-of-life care. Also overlooked are the possible implications of cross-cultural considerations for nurses, policy makers, and others at the forefront of planning and providing end-of-life care to people of diverse cultural and language backgrounds. An important aim of this article is to redress this oversight.

What really matters in end-of-life discussions? Perspectives of patients in hospital with serious illness and their families

“…As a result, the applicability of our results to more diverse populations who do not speak English or French as a first language and who may have different values related to end-oflife care 22,23 remains uncertain. Although we were able to enroll most of the eligible patients and family members (62% and 74%, respectively), thus minimizing selection bias, non-consenting patients or family members may have had different perspectives on what is important during end-of-life communication and decision-making.…”

Advance care planning, culture and religion: an environmental scan of Australian-based online resources

“…The diversity of the Australian population, 25 cultural influences in ACP 11 and direction towards culturally appropriate ACP 2 provide strong rationale for the development of such resources. Resources should support health professionals and consumers in the preparation and participation of culturally appropriate ACP conversations while ensuring respect for people and avoidance of generalisations, as consistent with the identified existing combined resources.…”

“…Consideration of value assumptions between Western and minority cultural worldviews highlights differences in autonomy, decision-making processes, family inclusivity, control over dying and disclosure that affect ACP. 11 Since the initiation of ACP, resources have evolved, with many available on the Internet. 12,[15][16][17] A recent review identified the availability of Australian online ACD templates, but did not examine specific cultural and religious information.…”

“…7 Culture is based on ethnicity and influenced by race, age, sex and birth place, 8 whereas religion is the faith group an individual affiliates with; 9 both of these have the potential to influence ACP. 10,11 In Australia, there is growing governmental 2,3,12 and health professional association 13,14 support for ACP. The National Framework for Advance Care Directives advocates the need for 'cultural appropriateness' in ACP, 2 promoting recognition of cultural, spiritual and religious beliefs or backgrounds.…”

Nurses’ Knowledge and Perceptions of Advance Care Planning, an Ethical Responsibility

“…This knowledge can be used for educating nurses who are future primary care providers. It is a professional responsibility, especially since many nurses with a graduate degree may work in oncology settings [1,2].…”