Traditional Expectations Versus US Realities: First- and Second-Generation Asian Indian Perspectives on End-of-Life Care

Abstract

Traditional cultural values, such as duty to family, greatly influenced end-of-life care preferences and retained importance across generations. Clinicians caring for Asian Indian patients at the end of life may be better able to assess care preferences after exploring the complex interplay between traditional expectations and specific social realities for each patient. Particular attention should be given to attitudes toward death and suffering, family duty, and preferences for information disclosure and decision making.

Cultural implications of filial obligation and the Asian Indian American family caregiver

“…8 Lastly, Ravi's parents were financially dependent on him and his wife. His mom had never worked outside the home and his dad has been retired for several years.…”

Discussing and planning care for people approaching the end of their life

“…15 Having a care-planning conversation Communication A successful care-planning conversation requires sensitive communication. This should be an active listening process with a balance of sensitivity, honesty and careful exploration of emotional reactions.…”

Perspectives of Health Care Providers on US South Asians’ Attitudes Toward Pain Management at End of Life

“…Research has shown that attitudes toward a wide range of end-of-life considerations, such as information disclosure and care planning, vary among South Asians and may be particularly affected by the degree to which individuals have assimilated to American culture. 18 Broad interdisciplinary involvement may be appropriate in the provision of end-of-life care to South Asian patients and families. For example, chaplains may be useful in educating providers about specific South Asian spiritual beliefs and may be able to link patients and families with spiritual resources in the community.…”

“…20 A small but informative body of research has focused on South Asians' perspectives on end-of-life care in the United States. In a study conducted by Sharma et al, 18 research participants (mostly of Indian origin) reported that they believed South Asian cultures were more accepting of death than mainstream US culture, connecting this degree of acceptance to spiritual beliefs associated with Hinduism. They also pointed out how a strong sense of duty to family and prescribed gender roles influenced decision making and the provision of informal care within families.…”

“…29 Hindu patients may view suffering as a result of karma, the sum of a person's actions in one's current and previous lives that influence one's fate, and thus be disinclined to seek treatment for pain, 14 however, a belief in karma need not necessarily interfere with treatment of pain and suffering at the end of life. 18 Experts recommend that, as with all other aspects of end-of-life care, decisions regarding pain management should be based on a thorough biopsychosocial assessment and made by health care providers in partnership with patients and families, based on their unique needs and preferences. 30 …”