Culture, Socialization, and End-of-Life Decision Making

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Culture is multi-faceted, multi-dimensional, and embedded in time and history. A complete definition is difficult to articulate, but culture involves a series of interactions and adjustments, negotiations and agreements of a person, or group of people, with her/their environment. Interwoven into culture is a series of expectations, perceptions of “rightness” regarding sources of power, values, social structures, religion, etc. Socialization involves learning the rules, beliefs, and expectations within a particular society, many of which are influenced and/or defined by culture. Attributing a list of characteristics to particular groups is a tempting way to simplify culture, but the concept reaches beyond ethnic origin, race, or nationality to embrace heritage, family, experiences, and resulting belief systems. Kagawa-Singer and Blackhall (2001) recommended “finding a balance between cultural stereotyping and cultural empiricism…by neither disregarding culture nor assuming one is part of a list of stereotypical characteristics” (p. 2995). In sum, there may be much more variation within than between groups. Any terms used in this chapter referring to a particular group are used with the following assumptions: (a) there may be only a few commonalities among the group members, and (b) the group is likely to contain numerous subgroups. The purpose of this chapter is to examine how culture and the socialization process affect the end-of-life decisions a person makes. We begin with a discussion of the dominant values of the U.S. healthcare system and move to a summary of the socio-historical context of five major cultural groups while encouraging independent study of additional groups or subgroups. Next, we review pertinent literature on specific end of life decisions and conclude with suggestions for practitioners.


chapter in book, Handbook of Thanatology, ISBN: 978-0-206-76730-6