Cultural Issues in End-of-Life Decision Making among Asians and Pacific Islanders in the United States

Growth in the size and wealth of the United States’ elderly population, coupled with a trend toward increasing patient autonomy, has created an environment for increased conflict in end-of-life decision-making. This chapter explores the required elements for making decisions at the end of life, including determination of medical decision-making capacity. Also discussed is the development of the legal reasoning that governs situations involving elderly patients who lack the capacity, but retain the right, to make medical decisions. The chapter describes the utility of the advance care planning process, by which elderly patients can make their preferences for medical treatment known in advance of conditions or illness that could result in cognitive impairment that would otherwise hamper their ability to participate personally in end-of-life decisions. Finally, a variety of forms of advance directives are described, critical tools in honoring the medical autonomy of elderly patients.

Download Full-text

Cultural Issues in End-of-Life Decision Making

Age and Ageing ◽

10.1093/ageing/afh033 ◽

2004 ◽

Vol 33 (2) ◽

pp. 212-213

Author(s):

S. Louw

Keyword(s):

Decision Making ◽

End Of Life ◽

Cultural Issues ◽

End Of Life Decision ◽

Life Decision

Download Full-text

End-of-life care in the intensive care unit: a challenge for nurses

American Journal of Critical Care ◽

10.4037/ajcc2001.10.4.230 ◽

2001 ◽

Vol 10 (4) ◽

pp. 230-237 ◽

Cited By ~ 37

Author(s):

PA Miller ◽

S Forbes ◽

DK Boyle

Keyword(s):

Decision Making ◽

Intensive Care ◽

End Of Life ◽

End Of Life Care ◽

Nursing Practice ◽

Care Planning ◽

Life Care ◽

Cultural Issues ◽

End Of Life Decision ◽

Life Decision

Results from several research studies combined with increasing public tensions surrounding physician-assisted suicide have fueled a growing awareness of the inadequacies of end-of-life care. Investigators also suggest that intensive care unit nurses have a limited role in end-of-life decision making and care planning. This article explores cultural issues influencing end-of-life care in intensive care units, explores factors surrounding the limited involvement of critical care nurses in end-of-life decision making and care planning, and offers recommendations for changing nursing practice. Because improving end-of-life care will require cultural changes, an understanding of the cultural issues involved is needed. Recommendations for changing nursing practice include a model of end-of-life care that incorporates the goals of both cure and comfort care, as well as a shared decision-making process. Nurses are essential to improving end-of-life care in today's intensive care units.

Download Full-text

End-of-Life Decision Making across Cultures

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.2011.00589.x ◽

2011 ◽

Vol 39 (2) ◽

pp. 201-214 ◽

Cited By ~ 43

Author(s):

Robert H. Blank

Keyword(s):

Decision Making ◽

End Of Life ◽

Ethical Issues ◽

The United States ◽

Special Issue ◽

The Past ◽

Life Saving ◽

Demographic Patterns ◽

End Of Life Decision ◽

Life Decision

As is evident from the other articles in this special issue, end-of-life treatment has engendered a vigorous dialogue in the United States over the past few decades because decision making at the end of life raises broad and difficult ethical issues that touch on health professionals, patients, and their families. This concern is exacerbated by the high cost related to the end of life in the U.S. Moreover, in light of demographic patterns, progressively scarce health care resources, and an expanding array of life-saving technologies, decisions at the end of life are becoming problematic matters of public and, thus, scholarly concern in most countries. Issues at the end of life are central not only to bioethics but also raise important ancillary policy dimensions.

Download Full-text