Bringing Cultural and Spiritual Sensitivity to End-of-Life Care

The ethnic, cultural, and religious diversity that gives America its own unique background is also adding a new dimension to the special needs that healthcare practitioners must address when providing end-of-life care to members of these different communities.

"Because patients make medical decisions based on cultural and religious needs, those aspects must always be taken into account and those borders must not be violated when we are discussing terminal illness and end-of-life care," said M. Terrance Simon, DO, a family physician in Massillon, Ohio. He stressed the osteopathic medicine approach involves caring for the "whole" patient, from the beginning of life until the end of life. "Within that framework, DOs typically discuss quality of life with their patients, as well as their personal philosophy of how they want to mature, and ultimately how they want to approach the end-of-life process," he said.

Along with the more than 200 living languages spoken in the US comes a multitude of cultural attitudes and rituals regarding death, dying, and end-of-life healthcare that physicians must consider. For example:

In addition to its cultural diversity, America has more religions and faith groups than can be calculated. And each of these groups has specific rituals and approaches to dealing with death and dying, such as:

Religious or spiritual beliefs can have a powerful impact on end-of-life care and the outcome for a dying patient. In fact, the importance of addressing patients' spirituality is considered so important that a number of colleges of osteopathic medicine offer coursework on the topic of spirituality as it relates to end of life.

According to Dr. Simon, physicians need to be prepared for. and be open to. the spiritual and cultural differences of patients. Developing an approach to end-of-life care that respects patients' and their families' requirements requires open dialog between everyone involved. He said the following key areas should be addressed and considered regarding cultural and spiritual sensitivity:

Regardless of the patient's ethnic background, religious affiliation, or cultural beliefs, each individual's situation truly is its own culture. "That means the end-of-life caregiving team must always be sensitive to the issues at hand and then treat each individual case as its own," Dr. Simon said. "All people have their own unique beliefs and philosophy of how they will spend the last moments of their journey."

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