This presentation will review the evidence in the area of cultural preferences and beliefs governing end of life care, with an emphasis on the decision-making process commonly used within various cultures. Preferences for life support within the critical care setting will be an area of emphasis, as this clinical area is one in which patients are frequently not able to participate in the decision-making process. In the ICU, decisions are commonly negotiated between surrogates/family and the physician, or simply made for the patient by the physician. Ethical dilemmas and conflict are frequent in this setting, especially when providers come from a different cultural background than that of the patient/family/surrogate. Preferences for autonomy in decision-making within various cultural groups will be discussed, as some cultures commonly use a shared decision-making model, in which individual preferences are less important than the needs and the desires of the group or family as a whole. Understanding this and similar concepts requires a major shift in perspective for providers from most Western cultures, where individual preference and autonomy in decision-making are commonly held values.
Spirituality and religious issues will be another strong thread within the presentation, as these issues are highly relevant to end of life care decisions in most cultural groups. Belief in miracles, God, or the wonders of modern technology can profoundly affect how patients and families make decisions regarding their care.