Cultural Beliefs About a Patient’s Right Time to Die: An Exploratory Study

  • Henry S. PerkinsEmail author
  • Josie D. Cortez
  • Helen P. Hazuda
Populations at Risk



Generalist physicians must often counsel patients or their families about the right time to die, but feel ill-prepared to do so. Patient beliefs may help guide the discussions.


Because little prior research addresses such beliefs, we investigated them in this exploratory, hypothesis-generating study.


Anticipating culture as a key influence, we interviewed 26 Mexican Americans (MAs), 18 Euro-Americans (EAs), and 14 African Americans (AAs) and content-analyzed their responses.


Nearly all subjects regardless of ethnic group or gender said God determines (at least partially) a patient’s right time to die, and serious disease signals it. Yet subjects differed by ethnic group over other signals for that time. Patient suffering and dependence on “artificial” life support signaled it for the MAs; patient acceptance of death signaled it for the EAs; and patient suffering and family presence at or before the death signaled it for the AAs. Subjects also differed by gender over other beliefs. In all ethnic groups more men than women said the time of death is unpredictable; but more women than men said the time of death is preset, and family suffering signals it. Furthermore, most MA women—but few others—explicitly declared that family have an important say in determining a patient’s right time to die. No confounding occurred by religion.


Americans may share some beliefs about the right time to die but differ by ethnic group or gender over other beliefs about that time. Quality end-of-life care requires accommodating such differences whenever reasonable.


attitude toward death end-of-life cross-cultural comparison terminal care hospice 



Others besides the authors made important contributions to this manuscript. Sarah Piper McMahon, M.D.; Caroline McGee-Jones, M.D.; and Alisa Meny, M.D., helped analyze the data. Drs. Piper McMahon and McGee-Jones were students at The University of Texas Health Science Center at San Antonio, and Dr. Meny was a student at Harvard University when they participated in the study. Charles Cavazos from the Intercultural Development Research Association provided computer support. Susan Bagby made editorial suggestions about early drafts of the manuscript.

The John A. Hartford Foundation; the American Federation on Aging Research; and the Mexican-American Medical Treatment Effectiveness Research Center, the Aging Research and Education Center, and the Medical Dean’s Office at The University of Texas Health Science Center at San Antonio all contributed funds for this research. The authors thank all these people and funders for their help.

Authors’ Conflict of Interest Statement

Henry Perkins, Josie Cortez, and Helen Hazuda collaboratively conceived and designed this study, analyzed and interpreted its data, and prepared the manuscript reporting the results. The authors have no conflicts of interest to disclose.


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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Henry S. Perkins
    • 1
    Email author
  • Josie D. Cortez
    • 2
  • Helen P. Hazuda
    • 3
  1. 1.Division of General Medicine, Department of MedicineThe University of Texas Health Science CenterSan AntonioUSA
  2. 2.Intercultural Development Research AssociationSan AntonioUSA
  3. 3.Division of Clinical Epidemiology, Department of MedicineThe University of Texas Health Science CenterSan AntonioUSA

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