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Addressing Spiritual And Cultural Aspects Of End Of Life Discussions

A diverse panel of end of life care experts spoke about fostering end of life discussions between physicians and patients of various faiths and ethnic groups at the recent Hospice and Palliative Care Symposium at the Chicago Botanic Gardens.

The expert panel included Rabbi Samuel N. Gordon, vice-president of the Central Conference of American Rabbis, Deborah Millman, a social worker with Northshore Hospice, and the Rev. Peter Wojcik, a chaplain with the Roman Catholic Archdiocese of Chicago.

Deborah Millman
Social Worker Deborah Millman

According to Millman, Asian, Hispanic, and black Americans have a lower rate of filling out advance health care directives than whites. She said family dynamics– often patriarchal– can make such discussions seem inappropriate, especially for immigrants. Open communication between patients, family members and physicians can help make such discussions more comfortable, she said. Identifying the locus of the family– the individual making health decisions– and considering a patient’s wishes and values are vital to fostering end of life dialogue.

Every Jew is an expert. There may be an over-trust in the medical system.

“It is often considered to be– when you are working with different families– disrespectful to discuss these issues, or it may be harmful to the patient by provoking undue stress or anxiety or depression and eliminate their hope,” Millman said. “We need to know what their values and beliefs are and how they play into their ability to make decisions.” Because language can also be a barrier to successful advance care planning, she suggests that physicians find translators for patients who use English sparingly, often only in public as a second language.

Rabbi Samuel N. Gordon

Rabbi Gordon, who often works with Jewish families facing the loss of a loved one, said the diversity within the Jewish faith makes his work difficult. Unlike Roman Catholicism, which is much more centralized and cohesive in terms of doctrine and spiritual authority, Gordon said it is difficult to address concerns of Jews with different beliefs– such as those between the Orthodox and secular. “Many Jews deeply identify as Jews but live secularly,” he said. “Every Jew is an expert. There may be an over-trust in the medical system.”page1image21088 page1image21248 page1image21408

But the Rev. Wojcik said Catholicism is not as uniform as many assume. “Yesterday I was talking with a cardinal and he was telling me how in the last 50 years in Chicago he has been getting letters from people telling him not to listen to the pope… Now all of a sudden, after the new pope was chosen, people are saying, ‘Listen to the pope, listen to the pope!’ ”

For example, many Catholics still disagree about the teachings of Pope John Paul II regarding hydration and nutrition for some terminally ill patients and whether it prolongs death or lengthens life. “John Paul clearly said to his doctor, ‘Allow me to die, allow me to die,’ ” the Rev. Wojcik said. “The pope understood the complexity of the problem,” he said. “We need to help people see the nuances of language.”

The Rev. Peter Wojcik
The Rev. Peter Wojcik

The Rev. Wojcik suggests that physicians ask patients who and what is important to them in order to help them better understand patients’ end of life wishes. “People come from so many different cultures and can be so divided. For many Latinos and Poles, going to the hospital means prolonging life,” he said. “You have to say the word ‘death’ a lot to help them understand what is going to happen.”