Koenig B A, Gates-Williams J
Stanford University Center for Biomedical Ethics, Palo Alto, CA 94304, USA.
West J Med. 1995 Sep;163(3):244-9.
Experiences of illness and death, as well as beliefs about the appropriate role of healers, are profoundly influenced by patients' cultural background. As the United States becomes increasingly diverse, cultural difference is a central feature of many clinical interactions. Knowledge about how patients experience and express pain, maintain hope in the face of a poor prognosis, and respond to grief and loss will aid health care professionals. Many patients' or families' beliefs about appropriate end-of-life care are easily accommodated in routine clinical practice. Desires about the care of the body after death, for example, generally do not threaten deeply held values of medical science. Because expected deaths are increasingly the result of explicit negotiation about limiting or discontinuing therapies, however, the likelihood of serious moral disputes and overt conflict increases. We suggest a way to assess cultural variation in end-of-life care, arguing that culture is only meaningful when interpreted in the context of a patient's unique history, family constellation, and socioeconomic status. Efforts to use racial or ethnic background as simplistic, straightforward predictors of beliefs or behavior will lead to harmful stereotyping of patients and culturally insensitive care for the dying.
疾病和死亡的经历，以及对治疗者恰当角色的看法，深受患者文化背景的影响。随着美国日益多元化，文化差异成为许多临床互动的核心特征。了解患者如何体验和表达疼痛、在预后不佳时如何保持希望，以及如何应对悲伤和失落，将有助于医护人员。许多患者或其家属对恰当的临终关怀的看法，在常规临床实践中很容易得到满足。例如，关于死后身体护理的愿望，通常不会威胁到医学科学的深层价值观。然而，由于预期死亡越来越多地是通过明确协商限制或停止治疗导致的，严重道德争议和公开冲突的可能性增加。我们提出一种评估临终关怀文化差异的方法，认为文化只有在患者独特的历史、家庭结构和社会经济地位背景下进行解读才有意义。将种族或民族背景简单地直接作为信仰或行为预测指标的做法，会导致对患者的有害刻板印象以及对临终患者缺乏文化敏感性的护理。
