End-of-Life Care: Care of the Dying Person

Dying at Home

Dying at home may be particularly important for Hmong-American elders who retain traditional beliefs of animism / ancestor worship (Bliatout 1993). This preference is primarily due to the presence of the household spirits (dab qhuas) particularly the dab xwm kab (house spirit altar) which is maintained by the eldest male. The altar is intended to serve and appease the household spirits charged with the welfare of the home and its residents (Cha, 2000).
Hmong American elders who have converted to Christianity may also prefer to die at home, surrounded by family the home to which an elder has died is considered to acquire good fortune for its inhabitants (although some families are concerned about the resale value of their house, if a new buyer finds that someone has died there).

Nonetheless, the gathering of family and friends provides support for both the dying person and their family. In addition, it is believed that the dying person will impart “wisdom and blessings”, especially during their last words, to those who listen (Bliatout, 1993; Culhane-Pera, 2003a).

Hospice

Hospice care may be an option for Hmong Americans with terminal illness, but some hospice philosophies have been a source of conflict. For example, the hospice practice of requiring patients to refuse life-prolonging interventions have been experienced by some family members as being disrespectful and the underlying hospice value of helping people face and accept death has been viewed as antithetical to healthy family relationships (Culhane-Pera, 2003b; Vawter & Babbit, 1997).

Hospice care is reported to be an underused resource in the Hmong-American community. This has been attributed to a lack of understanding and communication between both the consumer and the health care provider (Benson, 2004).

Ancestral Attire

Traditionally as death approaches, the elder is dressed in khaub ncaws laus (ancestral clothes, a euphemism for burial clothes, as one is going to join their ancestors in the land of the spirits. The details of the ancestral clothes vary depending upon the person’s gender, age, social status, family, clan, White or Green Hmong, and geographic area or origin in Laos, but generally are in a style that ancestors wore.

For some Hmong, the attire is a loose-fitting robe made of black or natural hemp or cotton. The man’s robe may be designed with a narrow stand-up collar, whereas the woman’s robe has a dab tsho (elaborate collar) hanging from the posterior neckline (Gerdner, Cha, Yang, Tripp-Reimer, 2005). For others, men wear shirts with a dab tsho and women wear multiple layers of White or Green Hmong hemp skirts, which they, their mothers or their daughters made (Morgan & Culhane-Pera, 1993).

Conflicting Views. There are conflicting views within the Christian Hmong-American community as to whether ancestral attire is appropriate for Christians. Differing opinion are also held by leaders within the various denominations. Some Christians choose to adhere to this practice, believing the funeral attire is symbolic of culture rather than specific spiritual beliefs.

For example, some Catholic families have adopted the traditional White Hmong robe by trimming it with embroidered religious symbols (e.g., cross). Others may prefer to be dressed in newly purchased Western clothing (i.e., a new suit for a Hmong man) at the time of death (Gerdner, Cha, Yang, Tripp-Reimer, 2005). It has become increasingly common for the Hmong to layer their dead in both traditional and Western attire.