There are many different cultural and religious practices, beliefs, and approaches to end-of- life. It is important for health care providers to understand and respond to the different cultural norms of patients and their families. Some Key Issues Are:

1. Aboriginal and Torres Strait Islander people

A key cause of the low proportions of Aboriginal and Torres Strait Islanders with ACDs is the general low rates of accessing services. However this is hard to address through the website.  key issue around developing an ACD is that, with a cultural history of being denied medical care, some people may be reluctant to select palliative or hospice care due to a perception of receiving poorer or low quality care. Also, some people may be suspicious that their wishes will not be followed.

2. Culturally and linguistically diverse communities

Death as a taboo subject

In many cultures, death is a taboo subject. If someone is ill, discussing their death may be seen as bad luck, disrespectful, or causing a loss of hope. Some people may prefer not to know that they have a terminal illness.

Collective decision making

Where Western cultures emphasise individual autonomy and decision making, the norm in many cultures is instead collective decision-making, with families and communities involved. Family decisions will be family oriented, and the collective is more important than the individual.

Pain

Culture can also influence how and whether people ask for pain relief. Pain may be seen as something positive – punishment, a test of one’s faith, or a sign that the body is fighting towards recovery. Some cultures (e.g. Cambodian, Somali) may wait to be asked if medication is needed, rather than asking for pain relief.

Who to speak to

There may be a need to ask who the person would like their health provider to speak to about their care. For example, while some families may have younger relatives who are more fluent in English and act as interpreters, it may not be appropriate for this person to know details about their relative or to tell them about their illness. In Muslim cultures a religious leader may be needed to facilitate the conversation between the family and a health provider.

An excellent, comprehensive resource is provided by Ethnomed, a Seattle-based joint program of the University of Washington Health Sciences Libraries and Harborview Medical Center’s Interpreter Services Department/Community House Calls Program. Available here: https://ethnomed.org/clinical/end-of- life/cultural-relevance- in-end-of- life-care

These recommendations were developed through:

  • Literature review of palliative care research and existing resources for the development of advanced care directives, and
  • Discussion with doctors and translation service providers (Turkish and Mandarin/Cantonese)