The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 14: Culture and Caredecisions about using life support. Instead, the researchers found that Mexican and KoreanAmerican elders were more likely than African and European American elders to want familymembers to make these decisions. 1926 picasThis study also found differences among Mexican Americans by income, degree of acculturation,and age; that is, younger and more acculturated respondents and those with higher incomeswere more likely to favor truth-telling about the diagnosis. 19 In a series of focus groupsexploring general medical treatment decisions with a random sample of 50 Mexican Americanelders in San Antonio, Talamantes and Gomez found that 46% of the elders wanted their doctorto make these decisions, 24% would prefer to make their own decisions, and 18% would discussthe decision with their families. When asked whether it bothered them to talk with their familiesabout these issues, 84% said that it did not. 20Advance DirectivesThe aforementioned Los Angeles study on patient autonomy among Mexican, Korean, Africanand European Americans also compared knowledge on completion of advance directives. Theyfound that while Mexican and European Americans were significantly more knowledgeable thanKorean and African Americans on advance directives, only 22% of the Mexican Americans actuallypossessed advance directives, in comparison to 40% of the European Americans. They alsofound that the Mexican Americans who had advance directives were more highly acculturatedthan the ones who did not. 21 Three years earlier, at the University of Miami in Florida, Caralis,Davis, Wright, and Marcial had conducted a multicultural study examining the influence ofethnicity on attitudes toward advance directives, life-prolonging treatments and euthanasia.Regarding advance directives, the researchers found that Hispanic Americans, the majority beingof Cuban heritage, were less knowledgeable than African and non-Hispanic white Americansregarding living wills. 22Life-Prolonging TreatmentsWhen it came to the issue of life-prolonging treatments at the end of life, Caralis, et al. foundthat Hispanic and African Americans were more likely than non-Hispanic whites to report wantingtheir doctors to keep them alive regardless of how ill they were (42% and 37% vs. 14%, respectively).Furthermore, only 59% of Hispanics and 63% of African Americans agreed to stop lifeprolongingtreatment, compared to 89% of non-Hispanic whites. 22 This disparity may have beendue partly to the Bible commandment “Thou shalt not kill;” a religious Christian might interpretwithdrawing or withholding treatment as an infraction of this commandment.HospiceA few studies have suggested that Hispanics are low users of hospice services. This may be dueto unfamiliarity with hospice, insurance coverage issues, language barriers, unpleasant experienceswith or distrust of the health care system. 23 In addition, Wallace and Lew-Ting proposedthat the low utilization of hospice among Hispanics may be due to physician referral patterns;that is, a physician might not refer Hispanic patients to hospice because they observe familiesproviding care themselves and believe that hospice might be unnecessary or culturally inappropriate.24304U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau