Ethnic Differences Thwart End-of-Life Conversations

Virtually all doctors have difficulty talking to their patients about death, and those conversations are even harder when the patient's ethnicity is different from the doctor's, according to a study published Wednesday in the online journal Plos One.

Dr. VJ Periyakoil, author of the study, outlines a typical scenario that’s troubling to doctors. She describes a 65-year-old patient, an Asian woman who is smart and thinking clearly. But whenever the doctor asks her a question, it's always the patient's son who answers.

“As a doctor I would really struggle with what to do in a situation like that,” Periyakoil says, “where the patient has no voice, if you will.”

This is a common scenario Periyakoil confronts as the director of palliative care education and training at Stanford's School of Medicine. Her study confirms that 85 percent of doctors face a range of obstacles when talking about the end of life with patients from different ethnic backgrounds.

“The number one barrier was language and medical interpretation issues,” she says.

The second was religious and spiritual beliefs. Periyakoil describes another typical patient at the hospital, who is hours away from death. It's clear to the doctors that the ventilator he's connected to isn't helping, and is actually making him more uncomfortable. But when a doctor tries to talk to the family about turning off the ventilator and allowing for a more gentle death, they refuse to talk about it.

“The family might come back and say, ‘No one knows when a person is going to die. That's in the hand of God,’” Periyakoil says. “Or they might say, ‘We’re praying for a miracle, and therefore we cannot even entertain the possibility of withdrawing technological life support.’”

Sometimes even mentioning the word death is a complete cultural taboo.

“In many Asian cultures, it's not uncommon for the patient and family to feel that by talking about something you might be invoking it,” she says. “So, by talking about death, you might be tempting fate.”

Periyakoil says Stanford is experimenting with a solution. She’s asking patients to write letters to their doctor, in their own language, in their own words, about what matters most to them about the end of life.

“Sometimes we don’t want to talk about it, because nobody wants to die,” says Angie Bargares, a participant in the letter project. “But that’s the only thing that’s for sure, it’s certain we will die. So it’s important to talk about it before the thing will happen.”