It is presumed that one's culture plays a significant role in selecting a decision option concerning end-of-life care and is a greater influencing factor in the elderly than in the young. This research is a synthesis of research literature published between 1993 and 2006, which describes the relevance of cultural differences in four ethnic minority cultures concerning end of life decision-making. The primary purpose was to compile, review and analyze data from scientific research studies which examined culture and end-of-life decision-making. The investigators conducted an exhaustive search of published scientific articles from refereed journals and selected those articles which met the criteria for inclusion.  We identified the major areas of concern, assessed analytical contributions, noted problems related to cultural differences in decision-making, and determined implications for clinical practice. Sixty-two studies were examined and 16 studies met the criteria for inclusion. Summaries for studies were generated which indicated the ethnic minority group, purpose, study design, sample size, statistical analyses and outcomes. Results of this analysis revealed significant variability among ethnic minority groups with respect to use of life sustaining technology, hospice care, and development of advance directives. African Americans were more likely to want life sustaining treatment than whites, less likely to have written advance directives and had less hospice usage. There were mixed results concerning life sustaining treatment preferred by Hispanic Americans; however, they are more likely to use life sustaining methods than whites and hospice usage was low. Asian Americans use less hospice than whites, but the data is sparse.  European (non-Hispanic) Americans are more likely to forego life sustaining measures, have advance directives and have greater usage of hospice care. Additional research in this area is needed combining ethnographic approaches with carefully designed quantitative methods.