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

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ABSTRACT

BACKGROUND

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.

OBJECTIVE

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

DESIGN AND SUBJECTS

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.

MAIN RESULTS

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.

CONCLUSIONS

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.

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Acknowledgments

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.

Author information

Authors and Affiliations

  1. Division of General Medicine, Department of Medicine, The University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA

    Henry S. Perkins M.D.

  2. Intercultural Development Research Association, 5835 Callaghan Road, San Antonio, TX, USA, 78228-1102

    Josie D. Cortez M.A.

  3. Division of Clinical Epidemiology, Department of Medicine, The University of Texas Health Science Center, San Antonio, TX, USA

    Helen P. Hazuda Ph.D.

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  1. Henry S. Perkins M.D.
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  2. Josie D. Cortez M.A.
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  3. Helen P. Hazuda Ph.D.
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Corresponding author

Correspondence to Henry S. Perkins M.D..

Additional information

Presentations at professional meetings: The results we report here were presented at the Eighth Annual David C. Thomasma, Ph.D., International Bioethics Retreat, Freije Universitat, Amsterdam, the Netherlands, 24 June 2006; and at the annual meeting of the Southern Region, Society of General Internal Medicine, Atlanta, Georgia, 04 March 2006. The results were also accepted for presentation at the national meeting, Society of General Internal Medicine, Los Angeles, California, 26–9 April 2006.

Grant Support: 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 sponsors played no role in any part of the study.

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Perkins, H.S., Cortez, J.D. & Hazuda, H.P. Cultural Beliefs About a Patient’s Right Time to Die: An Exploratory Study. J GEN INTERN MED 24, 1240–1247 (2009). https://doi.org/10.1007/s11606-009-1115-5

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  • DOI: https://doi.org/10.1007/s11606-009-1115-5

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