Although older American Indians may be less likely to have written Advance Directives, due to historical misuse of signed documents, distrust of the dominant system, and belief that families will take care of decision-making, many Indians know what their preferences are. A survey of 50 American Indian over the age of 55 years in a community clinic in a large urban area of California revealed that only one respondent had a written Advance Directives, “because he wanted to make sure a certain member of his family had no say” (Hendrix, 2000).
The heterogeneity of Indian tribal beliefs affects the provider’s ability to speak directly about negative outcomes in some situations (especially Navajo) as mentioned above. One way to work within this framework is to discuss with the family or spokesperson situations requiring decisions that have happened to others, come to an understanding with the treatment team regarding the patient’s wishes, and document the results of these discussions in the patient record.
Other American Indian tribal communities have no difficulty speaking directly about death or dying situations, and wish to have all the information available (e.g., some Pueblo, Lakota, Northern Plains, Midwestern, and Northeastern Tribes). These Tribes tend to look at death as a natural part of the circle of life, not to be feared, as it may include a reunion with the ancestors who went before.