End-of Life Preferences

Few studies have systematically examined the cultural needs of Asian ethnic minorities regarding end-of-life care. Filipino families may struggle with or avoid talking about advance directives and life support decisions when family members are seriously ill or dying. Culture and beliefs also dictate the rules for disclosure or truth-telling regarding terminal health diagnoses and prognoses. Filial obligation is imperative in the Filipino culture and is practiced to protect the patient, maintain hope, and ensure a good death. Discussions regarding end-of-life issues and advance directives should be approached cautiously, because discussing such sensitive issues may raise the fear that the discussion itself could lead to or invoke unwanted outcomes (Cantos, 1996).

Many Filipinos have fatalistic perceptions known as “Bahala Na” (what is destined or inevitable; illness is always “the will of God”) when confronted with serious or life-threatening illness (Mc Laughlin, 1998; Bigby, 2003; Vance, 1995). A descriptive, correlational, crosssectional study of 22 critically-ill Filipino Americans, aged 55 and older, and their family members regarding attitudes towards advance directives showed that overall attitudes towards advance directives were positive, especially among acculturated and highly educated families. Completion rates among the patients were low (10%), most probably due to their fatalistic belief that illness is destined or inevitable, thus rendering advance directives pointless (Mc Adam, 2005).

A large retrospective study was conducted of the last year of life of Asian-American Pacific Islander (AAPI) and white Medicare beneficiaries registered in the Surveillance, Epidemiology, and End Results Program. White (n=175,467) and AAPI (n=8,614) patients aged 65 and older who were dying with lung, colorectal, breast, prostate, gastric, or liver cancer were studied (Ngo- Metzger, Phillips & McCarthy, 2008).

The data showed that all Asian Americans including Filipino American older adults were less likely to enroll in hospice care. In a Filipino American and Cambodian American comparative study which involved three in-depth interviews over a 1-year period with 48 Cambodian Americans and 78 Filipino Americans, the subjects stated that they wanted to go back to their country of origin and die in their homelands (Becker, 2002).