As their elderly loved ones approach the need for end of life decisions, Native Hawaiian and Pacific Islander families frequently prefer to keep them in the home. In general, services such as home hospice and home care are welcomed. Because of the importance of ‘ohana, all family members may want to participate in discussions regarding end of life decisions. However, elderly Native Hawaiian and Pacific Islander patients themselves may be reluctant to discuss a living will and/or durable power of attorney issues due to fears that talking about the subject out loud will hasten death. Unfortunately, without these documents or family discussions about these issues, conflicts among family members can arise, particularly if some members of the family have been estranged or have lived away for a number of years.
Cultural beliefs may even keep Native Hawaiians from agreeing to donate or accept organ transplants. Culturally, it is believed that your spiritual essence (mana) resides in every part of your body and is to be protected. Allowing access to your mana, in this case through organ donation, empowers those receiving the organs and lessens yourself and your family. For similar reasons, some elder Native Hawaiians may be reluctant to be cremated.