What is a good death? I imagine if I asked ten people this question I’d get ten different answers. But depending on the cultural context, there are still likely to be common themes.
In an individualistic society like the United States, where personal autonomy is important, a good death is one where we can make our own choices about our final days.
Palliative care focuses on relieving symptoms and improving patient and family quality of life either with or in place of life-extending treatments. Current approaches to palliative care are largely creatures of the US individualistic cultural context.
What happens when that individualistic society becomes increasingly multicultural?
Racial and ethnic minorities use less palliative care than whites, especially hospice care. The reasons for this are not clear, but there is some evidence that knowledge, cultural beliefs, and treatment preferences are contributing factors.
Dying well in some cultures may be less about autonomy and more about . . . well, other things.
The US is becoming increasingly diverse (a good thing in my opinion). If our approaches to palliative care are going to be patient-centered and effective for a wide range of patients we need to learn to communicate transparently with patients and families about care preferences and account for spiritual, religious, familial, and ethnic variation.
What are your thoughts about palliative care?