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 Care• Reason:Taking a reasoned approach to settling disputes withinthe family or the community.• Reconciliation:The art of settling differences; that is, putting amatter to rest between two parties.26 picasThe Role of ReligionReligion is another core value among African Americans, just as it is among Hispanics. Historically,the church has been the center of the African American community serving as thesingle most important institution advocating improvements in health, education, and financialwelfare: 32As the center for the extended family, reinforcing the sense of self andself-esteem within the culture, the church offers opportunities for thewhole family’s development. 33While the majority of African Americans are Protestant Christians, a large proportion beingBaptist, some are Roman Catholic. 34 Certain African American subgroups, however, such as thosefrom Haiti, have beliefs in voodoo, hexes, curses, which will also have a direct effect on healthcare views and practices. The history of deportation from the African continent, slavery andoppression in the new world, coupled with their Christian heritage, have determined how AfricanAmericans view end of life decisions. Many believe in the God of the Old Testament, an allpowerfuland fighting God, who liberated the Hebrews from the oppression of the Egyptians, andwho liberated African Americans from slavery. From this comes the notion of divine rescue andthus the belief that God’s power can conquer all and that miraculous interventions can occurwhen all hope seems lost. 35 The notion of divine intervention and rescue might influence patientsto oppose continuing aggressive medical treatment, in order to allow “God’s will” to bedone. 36End-of-Life Care PreferencesHow does the African American experience influence end-of-life care preferences? Researchfindings indicate that African Americans are less likely than other groups to trust health careproviders, communicate treatment preferences, complete advance directives, and withhold/withdrawlife-prolonging treatments in the face of futility.Issues of TrustThe long history of past and even current discrimination has led African Americans to displaydistrust in the institutions established by the dominant Caucasian society, including those institutionsthat provide health care. This institutional distrust is not without foundation, as thereare several studies which document minorities’ lack of access to available health care. Studieshave suggested that certain procedures such as coronary bypass operations and organ transplantshave been performed less frequently on African Americans than on Caucasian Americans.37 A study documented lower survival rates in African Americans with Stage I lung cancer,the second most common cause of death among African Americans, and suggested that this was308U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau