How We Die

Cultural beliefs and values vary

Americans have different ideas about how and where they want to die. Preferences on end-of-life issues tend to vary along racial, ethnic and gender lines, according to a focus group study conducted by researchers in the U-M Medical School.

Sonia Duffy Photo: Lin Jones

For example, many Arab Americans would prefer not to go to a nursing home as they near the end of their lives, but many African Americans are comfortable with nursing homes and hospitals. Many Hispanic people are strongly concerned about dying with dignity. Many white people don’t want their families to take care of them, but they — like members of other racial and ethnic groups — want their families nearby as they live out their last days. Hispanic men, in general, wanted little medical intervention at the end of life, while Hispanic women tended to favor extensive medical intervention. The split was similar between African American men and women.

“Our country’s medical system is based on Western values, and those values may not translate to other cultures,” says Sonia A. Duffy, Ph.D., R.N., a research investigator in otolaryngology and psychiatry at the Medical School who directed the study. “Deeply rooted cultural beliefs and values are difficult to influence.”

The 10 focus groups included 73 people who identified themselves as Arab Muslim, Arab Christian, Hispanic, black or white. They were all 50 years and older. They participated in exercises, scenarios and discussions about end-of-life issues, and they completed questionnaires that, among other things, helped measure how closely they were connected with their cultural group.

“One of the most important findings in our study is that there are so many different points of view, it is important for health care providers to treat everyone as an individual,” adds Duffy, who conducted the study with colleagues in the Center for Practice Management and Outcomes Research at the VA Ann Arbor Healthcare System.

The research was jointly funded by the Michigan Department of Community Health, Blue Cross Blue Shield of Michigan, and the Department of Veterans Affairs.

—Katie Gazella

For an expanded version of the story:
www.med.umich.edu/opm/newspage/2006/endoflife.htm

A comprehensive list of resources and information about end-of-life issues: www.nlm.nih.gov/medlineplus/endoflifeissues.html