Another source of conflict in end-of-life disputes is the differences in cultures between patients and physicians. Culture strongly influences the way families and patients view illness and death, how much control over health decisions can or should be exercised, how bad news should be communicated, and how decisions should be made. In terms of autonomy, Western and non-Western cultures have very different views. A Western concept of autonomy reflects a belief in an individual's uniqueness, dignity, sovereignty, and sanctity of life. It is more important to the individualistic and self-directed American cultural majority to receive clear information about illness and prognosis and have the opportunity to voice preferences clearly and directly (Akah, 2016). Interdependence is often valued over autonomy in non-Western cultures (Karnik & Kanekar, 2016). Western healthcare professionals believe that the person with the illness is the best person to make health care decisions. Families in non-Western cultures have the right to make decisions about patient care and communicate with the healthcare team (Karnik & Kanekar, 2016). It is not the individual but the family who is the primary decision-maker. Patients should be largely unaware of the illness, so that they are not distraught. As a result, many Asian-Americans do not speak as bluntly about death and dying as the topic is considered taboo, sensitive, and impolite. Communication is much more subtle and contextual than found in Western communications. In addition, non-western cultures often have extensive non-verbal communication compared to Western communication (Karnik & Kanekar, 2016).
When coping styles differ, discussing death may cause conflict. Families often pass down communication and coping styles from generation to generation. The patterns of communication from previous generations impact how the patient and other family members communicate. Families relate differently based on their patterns of relating, including over-involvement, detachment, or hostility. Especially as they deal with their emotional reaction to an impending loss, family members may react negatively to individuals expressing distress. As well, insecure attachment styles are likely to affect family members' interactions with one another (Lichtenthal and Kissane, 2008). Conflict can arise when family members feel that the burden of taking care of the patient is unfairly divided. There may also be feelings of guilt or complaints about the burden, causing unspoken frustration with family members who don't seem to carry their share (Lichtenthal & Kissane, 2008). Lastly, family dynamics and family history influence end-of-life decisions (Bowman, 2000; Lichtenthal & Kissane, 2008). Divorce or separation disputes, for example, can exacerbate conflicts about end-of-life decisions. Mediation in bioethics requires the mediator to be aware of all potential sources of conflict that could arise.
Thank you for your interest in this ongoing series. In the next blog I’ll be considering special issues and limitations in end-of-life disputes.
Michele M. Davda has a B.S in Psychology and an M.S. in Neuroscience. She taught Biomedical Science at the STEM secondary level for a decade. She is a board member and committee member of the Montana Mediation Association (MTMA).
This blog is meant to promote and increase awareness of Mediation, as well as to discuss the role that Mediation plays in conflict resolution. This blog series does not provide legal, medical, or psychological advice, and it should not be taken as a substitute for professional advice or treatment.
Bowman, K. W. (n.d.). Communication, negotiation, and mediation: Dealing with conflict in end-of-life decisions. Journal of Palliative Care. Retrieved September 17, 2021, from https://pubmed.ncbi.nlm.nih.gov/11075529/.
Akah, H. (2016). Expanding the scope of bioethics mediation: New opportunities to protect the autonomy of terminally ill patients. Knowledge Base. Retrieved October 5, 2021, from https://core.ac.uk/display/161946911.
Karnik, S., & Kanekar, A. (2016, May 5). Ethical issues surrounding end-of-life care: A narrative review. Healthcare (Basel, Switzerland). Retrieved September 17, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934577/.
Lichtenthal, W. G., & Kissane, D. W. (2008, February 1). The management of family conflict in palliative care. Progress in Palliative Care. Retrieved September 17, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767457/.