Clinical Assessment: End of Life Preferences (when appropriate

Preparation for Death and Advance Directives

Passing one’s knowledge and skills to family members and younger people through teaching is believed to be an important preparatory process for death. How an older adult speaks about death is highly diverse and depends upon the person’s cultural grouping. Yup’ik older adult may refer to death as a “loss of breath” or “no longer here” or “no longer a person.” Alaska Native Athabascan Elders within the Ahtna region believe it goes against the “great creator” to exercise extraordinary artificial measures to keep someone alive. There is a general belief that if your time has come, you must respect the process of dying. An acceptable introduction to the topic of advanced directives might be: “In case something happens to you and you are not able to make decisions about your care, we need to know what you want and how you feel about…” Death is seen as a natural part of the circle of life rather than an ending; the spirit will live on. If the individual has done good things in his/her life and lived a good life, he/she will be remembered, and in this way are still on earth. In some Alaska Native cultural groups, a child may be named after the deceased relative so that their spirit lives on.

Preferred Location for End of Life Care

Living out one’s life in the home would be an ideal arrangement. However, when this is not possible, connecting the Alaska Native older adult to the Alaska Native community can be incorporated into the treatment plan. When health care workers join or witness the rituals or ceremonies, their presence will be closely watched by the Elders in the community. The presence of the healthcare worker can have a positive affect on the trust and rapport within the Alaska Native community.

Ceremonies and Rituals

There is also great diversity among the cultural groupings. Some groups have feasting, 40-day potlatches. A potlatch is a festival or ceremony where a family or leader holds a feast for their guests. Potlatches are often observed one year after the death of a loved one as a way to honor the person who has passed on and to allow for mourning. Often, in rural communities, the body is cared for by identified people in the community, and the body is kept in the home before burial. During the ceremonies it is appropriate to tell funny/amusing stories and share positive memories.

Attitudes about Organ Donation and Autopsy

Some Alaska Native cultural groups do not believe in cremation or organ donation, while others do. When appropriate, it may be acceptable to bring up organ donation in a respectful, sensitive way. The cultural values “Share what you have” and “Take care of others” may be a source of motivation for donors and potential participation in organ donation programs or for providing community education programs on this subject.