Advance Directive in End of Life Decision-Making among Yoruba of South-Western, Nigeria

Abstract

End-of-life decision making is value-laden within the context of culture and bioethics. Also, ethics committee role is difficult to understand on this, thus need for ethnomethodological perspective in an expanding bioethical age.Anthropological approach was utilized to document Yoruba definition and perspective of death, cultural beliefs about end-of-life decision making, factors influencing it and ethics committee role. Interviews were conducted among selected Yoruba resident in Akinyele LGA, Oyo State, Nigeria. Content analytical approach was used for data analysis.Yoruba culture, death is socially constructed having spiritual, physical and social significance. Relationship between the dying and significant others influences decision making. Hierarchy of authority informs implementing traditional advance directive. Socialization, gender, patriarchy, religious belief and tradition are major considerations in end-of-life decision making. Awareness, resource allocation and advocacy are important ethics committees' roles.Further research into cultural diversity of end-of-life decision making will strengthen ethical practice in health care delivery.

Older persons’ perceptions about advanced directives and end of life issues in a geriatric care setting in Southwestern Nigeria

“…This is similar to a finding from studies conducted on issues related to death and dying, where old people accepted death as inevitable and almost all were happy with how well they had lived their lives [9, 13]. Likewise, in other studies, death was described as inevitable and a debt that everybody has to pay, sooner or later [13, 15]. From this study, discussants perceived that when some distinct traits are observed in an old person, the person is said to be dying.…”

“…The main languages spoken in the areas were English and Yoruba and were used for the interviews. For this study, advanced directives is defined as ‘a process of giving advance directive on what to do when individuals are not conscious to make informed decision about his will or how to go about his treatment [13]. Specifically, study participants were asked if they had ever heard of the term ‘advanced directives’ and to list what it entails as well as the importance of such instructions.…”

“…Furthermore, evidence from HIC suggests that patient’s personal values have a huge impact on the dignity of death and dying [9]. However, in the traditional African setting, dying and death have different connotations compared to the high-income countries [12, 13]. Patient involvement in decision making has been shown to increase the quality of life at the end of life [11].…”

“…Patient involvement in decision making has been shown to increase the quality of life at the end of life [11]. End of life decision making in previous studies have centered on the ability to die a peaceful death surrounded by loved ones, preferably at home [9, 13]. However, research shows that there are social predilections when it comes to decision making for advanced care planning and end of life decisions [8].…”

Good death: An exploratory study on perceptions and attitudes of patients, relatives, and healthcare providers, in northern Tanzania

“…Due to cultural perceptions of death as a taboo subject in northern Tanzania, there is a general avoidance of advance care planning conversations [10]. Similarly, in other comparable settings, planning for EoL care is not common due to strong prohibitions against talking about death, which is considered highly distressing and/or associated with the fear that death talk will accelerate death [11][12][13]. Furthermore, the ethical framework for modern advance directives was derived from Western principles, which place a high value on individual autonomy [14,15].…”