End-of-Life Care: Advance Directives

The strength of beliefs in previously mentioned taboo taboo is likely to affect the willingness to plan advance directives and to disclose a terminal diagnosis (Brotzman & Butlet, 1991). However, the findings of one study (Reid, 2007) indicate that some Hmong American elders are receptive to discussing advance directives.

The findings should be viewed with caution since only five elders consented to be interviewed, but are consistent with our understanding of how Hmong family and community members speak about death with each other. Findings indicated that:

• Elders did think about death, dying, and their funerals
• Were willing to discuss these issues with providers and family members
• Preferred end-of-life options that had the least amount of pain and suffering

Finally, Reid recommended that because Hmong elders came from an oral culture, it may be more appropriate and meaningful for the elder to record his/her wishes regarding advance directives using an audiotape recorder. Reid concludes that a tape-recorded voice has more veracity to Hmong elders than a written document. However, the use of audio taped messages may not meet the legal requirements in all states.

When discussing advance directives, we recommend that the most culturally responsive approach is to arrange a care conference with family members and a cultural interpreter who can act as a cultural broker. It may be helpful to acknowledge the sensitive nature of the topic and explain the obligation that health care providers have in understanding elder’s wishes (Gerdner, Cha, Yang, & Tripp-Reimer, 2007).

In addition, it may be helpful for providers to explain that they’re trying to empower the family by converting their family-based decision-making process into an American medical and legal document, which will ensure that family’s desires are respected when the time arises.