TY - JOUR
T1 - Cultural beliefs about a patient's right time to die
T2 - An exploratory study
AU - Perkins, Henry S.
AU - Cortez, Josie D.
AU - Hazuda, Helen P.
N1 - Funding Information:
Grant Support: The John A. Hartford Foundation; the American Federation on Aging Research; and the Mexican-American Medical Treatment Effectiveness Research Center, the Aging Research and Education Center, and the Medical Dean’s Office at The University of Texas Health Science Center at San Antonio all contributed funds for this research. The sponsors played no role in any part of the study. Received November 17, 2008 Revised June 01, 2009 Accepted August 24, 2009 Published online October 2, 2009
PY - 2009/11
Y1 - 2009/11
N2 - Background: Generalist physicians must often counsel patients or their families about the right time to die, but feel ill-prepared to do so. Patient beliefs may help guide the discussions. Objective: Because little prior research addresses such beliefs, we investigated them in this exploratory, hypothesis-generating study. Design and subjects: Anticipating culture as a key influence, we interviewed 26 Mexican Americans (MAs), 18 Euro-Americans (EAs), and 14 African Americans (AAs) and content-analyzed their responses. Main results: Nearly all subjects regardless of ethnic group or gender said God determines (at least partially) a patient's right time to die, and serious disease signals it. Yet subjects differed by ethnic group over other signals for that time. Patient suffering and dependence on "artificial" life support signaled it for the MAs; patient acceptance of death signaled it for the EAs; and patient suffering and family presence at or before the death signaled it for the AAs. Subjects also differed by gender over other beliefs. In all ethnic groups more men than women said the time of death is unpredictable; but more women than men said the time of death is preset, and family suffering signals it. Furthermore, most MA women-but few others-explicitly declared that family have an important say in determining a patient's right time to die. No confounding occurred by religion. Conclusions: Americans may share some beliefs about the right time to die but differ by ethnic group or gender over other beliefs about that time. Quality end-of-life care requires accommodating such differences whenever reasonable.
AB - Background: Generalist physicians must often counsel patients or their families about the right time to die, but feel ill-prepared to do so. Patient beliefs may help guide the discussions. Objective: Because little prior research addresses such beliefs, we investigated them in this exploratory, hypothesis-generating study. Design and subjects: Anticipating culture as a key influence, we interviewed 26 Mexican Americans (MAs), 18 Euro-Americans (EAs), and 14 African Americans (AAs) and content-analyzed their responses. Main results: Nearly all subjects regardless of ethnic group or gender said God determines (at least partially) a patient's right time to die, and serious disease signals it. Yet subjects differed by ethnic group over other signals for that time. Patient suffering and dependence on "artificial" life support signaled it for the MAs; patient acceptance of death signaled it for the EAs; and patient suffering and family presence at or before the death signaled it for the AAs. Subjects also differed by gender over other beliefs. In all ethnic groups more men than women said the time of death is unpredictable; but more women than men said the time of death is preset, and family suffering signals it. Furthermore, most MA women-but few others-explicitly declared that family have an important say in determining a patient's right time to die. No confounding occurred by religion. Conclusions: Americans may share some beliefs about the right time to die but differ by ethnic group or gender over other beliefs about that time. Quality end-of-life care requires accommodating such differences whenever reasonable.
KW - Attitude toward death
KW - Cross-cultural comparison
KW - End-of-life
KW - Hospice
KW - Terminal care
UR - http://www.scopus.com/inward/record.url?scp=70449529848&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=70449529848&partnerID=8YFLogxK
U2 - 10.1007/s11606-009-1115-5
DO - 10.1007/s11606-009-1115-5
M3 - Article
C2 - 19798539
AN - SCOPUS:70449529848
SN - 0884-8734
VL - 24
SP - 1240
EP - 1247
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
IS - 11
ER -