Author(s): Barbara A. Koenig, PhD; Jan Gates-Williams, PhD

Date Authored: September 5, 1995

Copyright: EthnoMed has been granted permission from the Western Journal of Medicine to post this article on our web site. This material may be protected by Copyright Law (Title 17 U.S. Code).

Woman in hospice
Photo by Beverly Yuen Thompson (cc license)


Experiences of illness and death, as well as beliefs about the appropriate role of healers, are profoundly influenced by patients’ cultural background. As the United States becomes increasingly diverse, cultural difference is a central feature of many clinical interactions. Knowledge about how patients experience and express pain, maintain hope in the face of a poor prognosis, and respond to grief and loss will aid health care professionals. Many patients’ or families’ beliefs about appropriate end-of-life care are easily accommodated in routine clinical practice. Desires about the care of the body after death, for example, generally do not threaten deeply held values of medical science. Because expected deaths are increasingly the result of explicit negotiation about limiting or discontinuing therapies, however, the likelihood of serious moral disputes and overt conflict increases. We suggest a way to assess cultural variation in end-of-life care, arguing that culture is only meaningful when interpreted in the context of a patient’s unique history, family constellation, and socioeconomic status. Efforts to use racial or ethnic background as simplistic, straightforward predictors of beliefs or behavior will lead to harmful stereotyping of patients and culturally insensitive care for the dying.

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Article posted with permission from Western Journal of Medicine. By Barbara A. Koenig, PhD, and Jan Gates-Williams, PhD. West J Med 1995; 163:244-249.

We are grateful to the Western Journal of Medicine for their cooperation and willingness to make this information available to the EthnoMed audience.