Cultural issues surrounding end-of-life care

SummaryAccording to census data approximately 8% of the UK population is classified as an ethnic minority. This is greater in Britain's urban areas and given associations between inner-city living, low socio-economic status and ill-health it is inevitable that staff throughout the National Health Service will have to deal with critically ill patients from ethnic minorities. Invariably some of these contacts will involve the possibility of end-of-life care on an intensive care unit. Any ingrained values within western culture and medical practice have the potential to clash with the values of other cultures, at best through innocent misunderstandings and at worst through a conscious failure to engage. Such differences (real or perceived) can lead to open conflict and hostility, which if associated with end-of-life care can hinder the provision of effective palliative care and create lasting negative impressions for both staff and relatives. A need to understand cultural differences exists. Such a need is a two-way process and from the perspective of healthcare workers in the critical care unit faced with “end-of-life” decisions it encompasses consideration of factors such as ethnicity, religion and/or spirituality, age, socio-economic status and interpretations of autonomy.