Ethnographic study of a good death among elderly Japanese Americans

Abstract

Most humans desire a good death, but the nursing literature on culture-specific responses to older life, especially on issues of death and dying among Japanese Americans, is still limited. The pattern of beliefs about a good death held by elderly Japanese Americans living in Hawaii was explored. A qualitative study using ethnography and in-depth interviewing was employed. Eighteen healthy and active elderly participants were interviewed, and data analyzed using ethnography to extract categories and themes, and four supplementary interviews with experts were held for triangulation of the data. Four themes emerged, however, in this paper, the predominate one, not being a burden to family, was discussed. The participants believed burdening someone in their culture has an extremely negative implication. Sufficient preparation for older life and death, family support, friends support, and finance were their strategies to avoid being a burden. Nurses need to understand that the concept of good death is unique to every culture. Such knowledge will help them to plan and provide appropriate end-of-life care, and will reduce the risk of living wills being ignored.

Patient's Perspectives on the Notion of a Good Death: A Systematic Review of the Literature

“…Most authors agree that a good death includes but is not limited to the six themes by Steinhauser et al 10,14,23,25,31e33,36,38e41 Culture shapes the meaning people give to illness, suffering, and dying. 18,19,21,22,24,34 It is defined as an integrated system of learned behavior patterns, which are characteristics of a group of members of society. 42 Thus, differences regarding the notion of a ''good death'' may differ across cultures.…”

“…18e20, 32,33 The concept of a good death shows some variations among subgroups, given their ethnic, cultural, and socioeconomic characteristics. 22,24,34 Thus, the multicultural nature of many societies shapes the experience of dying in a complex way. 40 Among patients of ethnic-minority groups in the U.S., there is an agreement on the importance of maintaining an open view regarding diverse notions of a good death, which may not be shared by health staff or the majority of patients.…”

“…Some consider it crucial to a good death and hope that clinicians and others in the health care system acknowledge and adapt to their cultural traditions including, for instance, issues related to food and feeding or the treatment of the body after death. 22,24,25,30,34,41 The concept of a good death for Japanese-Americans greatly reflects the concept of Japanese living in Japan, with important attributes being emphasis on family relationships, not being a burden, trusting the physician and pain and symptom management. 18,21,24 However, it was found that this shared meaning could vary between generations.…”

“…22,24,25,30,34,41 The concept of a good death for Japanese-Americans greatly reflects the concept of Japanese living in Japan, with important attributes being emphasis on family relationships, not being a burden, trusting the physician and pain and symptom management. 18,21,24 However, it was found that this shared meaning could vary between generations. According to Hattori et al, the second generation of Japanese-Americans had more traditional Japanese views on death, compared with the third generation, which was more ''Americanized.''…”

“…According to Hattori et al, the second generation of Japanese-Americans had more traditional Japanese views on death, compared with the third generation, which was more ''Americanized.'' 24…”