Cultural Issues in End-of-Life Care: Nursing Implications

Introduction: Culture and End-of-Life Care

In this age of increased social diversity, the cultural aspects of end-of-life care have become increasingly important in the nursing profession. This importance is, however, complicated by technology and the cultural problematics of extended life care through artificial means. In the book Cultural Issues in End-of-Life Decision Making (Braun, Pietsch, & Blanchette, 1999), the crucial point is made that "providing cultural and spiritually sensitive care requires that nurses, physicians, social workers and others know and understand the implications of family members' beliefs about life and death, supportive rituals and other activities" (Review: Cultural Issues in End-of-Life Decision Making, 2004).

This book underlines the fact that cultural issues in end-of-life care have essential implications for nursing — particularly in that professional nurses should have knowledge of, or be cognizant of, the wider cultural and social context in which they work. This also implies the development of a particular sensitivity to the often complex cultural context of end-of-life patients. As the book notes, "culture shapes one's taboos about death and preferences with regard to terminal illness" (ibid). The study stresses that issues such as life support and other ethical areas depend largely on the cultural context of the patient.

Another study also emphasizes this point: "Advanced modern societies are characterized by cultural diversity and it is sometimes difficult for health professionals to know how to provide appropriate and culturally sensitive end-of-life care to patients in multi-ethnic communities" (Field, 2004). This study on multi-ethnic settings in Canada and the United States observes that most contemporary literature in bioethics stresses the importance of truth telling, the principles of autonomy and patient choice, and the value of advanced care planning. However, these principles run counter to the beliefs and values of many cultural groups in these societies (ibid). These are aspects that nursing staff must be aware of in order to provide the most effective and qualitative assistance to patients.

End-of-life care nursing requirements are in themselves complex, and an area in which more research is required. Research in palliative care has, over the last decade, focused on a holistic approach to the issue — one that includes the wider context of the patient's life, such as social, psychological, and spiritual needs. More recently, research in these areas has been extended to include an even wider range of contextual issues and a greater focus on the sensitive dynamics that culture plays in this form of nursing care.