Cultural and religious influences on decision-making

 

Respecting and being sensitive to people from diverse cultural and linguistic backgrounds and their community ties is integral to the delivery of quality care at the end of life (PCA, 2008).

 

Quality care at the end of life is realised when it is individualised to meet the person’s needs and upholds their preferences which are based on many factors, including individual cultural beliefs.

The basic values, principles and assumptions of Western medicine are themselves culturally determined and may not reflect the same values, principles and assumptions of patients from different cultural backgrounds.

 

Views may vary between cultures and religions on issues such as:

• the preferred place of treatment;

• communication of diagnosis and prognosis. For example, in certain cultures it is not appropriate to inform the patient of a ‘terminal’ diagnosis or to even discuss death;

• the role of family/relative/friends in caring for the patient. For example, the designation of a decision-maker for medical treatment. In certain cultures, it is not customary for a competent patient to make their own treatment decisions, particularly regarding life-sustaining treatment;

• the role of health professionals and volunteers, for example, whether or not they may be welcome in the home;

• attitudes to pain relief, whether certain medicines are ‘taboo’;

• attitudes to euthanasia;

• ‘taboo’ words. For example, in certain cultures it is inappropriate to use ‘cancer’ or ‘death’;

• handling of the body. For example, in certain cultures, only family members of the same sex as the deceased may handle the body;

• the expression of grief and bereavement.

 

The process of dying, perhaps more than any other moment in the course of medical care, can accentuate cultural differences between patients, families, and providers (Krakauer E, 2002).

Quality care at the end of life is realised when strong networks exist between specialist palliative care providers, primary generalist, primary specialist and support care providers and the community – working together to meet the needs of all people.

 

The consequences of culturally inappropriate care can include psychological distress and unnecessary suffering for the patient, family, carers and community.

 

There can be issues with translators and medical interpreters where they do not feel able to honestly relay information due to their own cultural beliefs.

 

The needs of older people from culturally and linguistically diverse communities and new and emerging communities raise broad equity and access issues.

 

All health professionals must have a proactive engagement in culturally and linguistically diverse issues, and therefore need a level of cultural competence when caring for people from different cultural backgrounds and the knowledge of when and how to consult further cultural expertise when required.