Cultural Nuances in Palliative Care

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Dec 18, 2016
by Chris Hamill-Stewart
Cultural Nuances in Palliative Care

Salzburg Global Fellows share their thoughts on the nuances involved in administering palliative care in their countries

Cultural nuances in palliative care
Participants of Rethinking Care Toward the End of Life agree on several important principles of palliative care. They all want to ease pain and suffering, ensure that care is focused on the needs of the patient, and they all aim to provide a “good death” – whatever that may look like. However, across cultural boundaries, the pursuit of these ideals may look vastly different, or face different challenges.

Over the past four days, participants have emphasized how the needs and desires of the patients, the challenges for doctors and nurses, and the attitudes and approaches of all those involved vary drastically across geographic and cultural boundaries.

As one of the major themes of discussion from the session, Salzburg Global explored this further. We spoke with the facilitators of the Culture Café event, examining the cultural nuances, different methods and approaches to palliative care, and the different attitudes from the citizens themselves towards death.

Nandini Vallath, from India, emphasized how the culture in India has affected peoples’ attitude towards death: “There’s a lot of death and dying acceptance in India – religion, history and culture contribute to this. The rituals of life talk about life and death as a cycle. There’s no fear of the finality of death – the belief is that death is a transition into another life,” she explains. In the case of India, a big issue is the dissonance between doctor and patient. “What is making palliative care more difficult is the doctor community. They talk the language of the modern science – there is a death-denying culture. Society is very accepting, but the professional community is not.”

Speaking about the Philippines, Liza Manalo explained how religion is an important factor in peoples’ attitude towards death and a “good death,” saying, “If you ask the average Filipino what makes for a good death, they’ll say faith and family make for a good death.” She continues, “We’re conscious that part of good palliative care and a good death is psychosocial support and spiritual care. By doing this, we take a holistic and spiritual approach to palliative care, and in this sense, we are very good at it.”

Religion as an important factor was a sentiment shared by Ivan Odiit Onapito from Uganda. However, he also emphasized the shared cultural history of the people. He told us: “Africa is an oral culture – we use stories to share experiences and to find meaning in things. We use this culture of storytelling, which has been with us for many centuries, as a tool to provide spiritual care.” He emphasizes how useful these stories can be in communicating with patients: “We learn about patients through the medium of stories, and, from this, we look at strengthening their support structures – usually their communities and their families.”

Kathy Kirkland, from the US, and Franziska Kopitzsch, of Germany, both implied that their respective cultures have difficulty outright confronting death. Kirkland explained how the US approach is much less community-based, and also told us: “The conversations that occur around dying are often separate, with health care providers having one conversation with each other, and families and patients having a separate conversation.” American doctors take an impersonal approach towards their patients, which may not always be in their best interests. Kopitzsch spoke about palliative care for those around the patient. She believes “[Germans] don’t know how to grieve.” She explained that there is “no tradition, ritual or celebration when people die.” Here, she touched on the wider issue of palliative care not just for the patient, but their family and loved ones. With less sense of a shared culture or religion, it seems that people find it more difficult to approach the topic of death, and to deal with the death of a loved one.

Yi-Jong Suh explains that in South Korea they are experiencing changes in attitudes towards death and palliative care. “Perhaps as a result of the traditional culture of Confucianism, we never used to talk about parents’ deaths and dying... We were always silent on these matters.” He also tells us how when people discuss their plans for end of life care for a family member, they often don’t include them in the conversation. However “Korean culture is changing, and we’re more willing to confront these issues.” Koreans are opening up to providing palliative care across the board, and people are becoming more “individualized” and willing to openly discuss these issues.

Ultimately, the facilitators of Culture Café have made it clear that history, religion, and culture all have a profound impact on the application of palliative care. Whether it is incorporating cultural aspects of communication into interactions with patients, avoiding the topic of death entirely, or in its effects on the people surrounding a palliative patient, the cultural differences that practitioners and social workers need to take into account when administering palliative care are an inescapable pool of opportunities and challenges.Download the full newsletter from Day 3 & 4


The Salzburg Global Seminar session Rethinking Care Toward the End of Life, part of the long-running series Health and Health Care Innovation, is being held in partnership with the Dartmouth Institute for Health Policy & Clinical Practice and the Mayo Clinic. Follow online on Twitter with the hashtag #SGShealth.