Sayid Ahmad Morad, Peled Raz Maya
University of Haifa, Haifa, Israel.
BMC Med Ethics. 2025 Apr 4;26(1):42. doi: 10.1186/s12910-025-01201-9.
End-of-life (EOL) decision-making involves complex ethical, cultural, and religious considerations, particularly within minority communities. In Israel, the Arab population, comprising approximately 21% of the country's population, remains underrepresented in EOL research. This study explores the EOL care preferences of elderly Arab individuals and their families, focusing on the interplay between cultural values, religious beliefs, and personal autonomy.
A qualitative study was conducted using semi-structured interviews with 24 participants, including elderly individuals (aged 60+) and their family members. Participants were recruited through purposive and snowball sampling in community settings across northern Israel. Data were transcribed, translated, and thematically analyzed to identify key patterns in attitudes toward EOL care.
Findings reveal a strong preference among elderly Arab participants for a peaceful and dignified death at home rather than in a medicalized setting. Quality of life was prioritized over life-prolonging treatments, with religious beliefs playing a significant role in shaping perspectives. However, cultural taboos and generational differences hindered open communication within families. Many younger family members assumed their elders preferred life extension, while elderly participants often desired comfort-focused care. Additionally, a lack of awareness of advance care planning tools limited the ability of patients to formally express their preferences.
A major challenge identified in this study is the absence of open discussions about EOL preferences, driven by cultural taboos, emotional discomfort, and fear. Many participants avoided such conversations due to beliefs that discussing death invites misfortune or imposes an emotional burden on loved ones. Younger family members, in particular, hesitated to engage in these discussions, leading to decisions based on assumptions rather than explicit patient wishes. Encouraging structured, culturally sensitive conversations and increasing awareness of advance care planning could help ensure that patients' preferences are recognized and respected.
Bridging the gap between assumptions and actual preferences requires culturally sensitive communication, increased awareness of advance care planning, and structured family discussions. These measures will ensure that EOL care respects both individual autonomy and cultural values, fostering a more inclusive and patient-centered healthcare approach.
临终决策涉及复杂的伦理、文化和宗教考量，在少数族裔社区尤为如此。在以色列，约占该国人口21%的阿拉伯人口在临终研究中的代表性仍然不足。本研究探讨了阿拉伯老年个体及其家庭对临终护理的偏好，重点关注文化价值观、宗教信仰和个人自主权之间的相互作用。
采用定性研究方法，对24名参与者进行半结构化访谈，参与者包括老年个体（60岁以上）及其家庭成员。通过在以色列北部社区进行目的抽样和滚雪球抽样招募参与者。对数据进行转录、翻译和主题分析，以确定对临终护理态度的关键模式。
研究结果显示，阿拉伯老年参与者强烈倾向于在家中平静而有尊严地离世，而非在医疗环境中。生活质量优先于延长生命的治疗，宗教信仰在塑造观念方面发挥了重要作用。然而，文化禁忌和代际差异阻碍了家庭内部的开放沟通。许多年轻家庭成员认为长辈更倾向于延长生命，而老年参与者通常希望得到以舒适为重点的护理。此外，对预先护理计划工具的缺乏了解限制了患者正式表达偏好的能力。
本研究中确定的一个主要挑战是，由于文化禁忌、情感不适和恐惧，缺乏关于临终偏好的开放讨论。许多参与者避免此类对话，因为他们认为谈论死亡会招致不幸或给亲人带来情感负担。特别是年轻家庭成员，他们犹豫是否参与这些讨论，导致决策基于假设而非患者明确的意愿。鼓励进行结构化的、具有文化敏感性的对话，并提高对预先护理计划的认识，有助于确保患者的偏好得到认可和尊重。
弥合假设与实际偏好之间的差距需要具有文化敏感性的沟通、提高对预先护理计划的认识以及结构化的家庭讨论。这些措施将确保临终护理既尊重个人自主权又尊重文化价值观，促进更具包容性和以患者为中心的医疗保健方法。
