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Death is a part of medicine

Physicians inevitably encounter patient death as part of their practice
Death is stigmatized in American culture
Yet it is a normal process that everyone will experience

People experience it differently based on culture, religion, and ethnicity

Cultural Competence = being aware of your own cultural beliefs and values and how these may be different from other cultures—including being able to learn about and honor the different cultures of those you work with
Hospice and Palliative care must acknowledge practices of different cultures

We will now explore different cultures and how they cope with death

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Warning!

Just because death is normal, it does not mean physicians should accept it blindly

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Dr. Atul Gawande

““Being mortal is about the struggle to cope with the constraints of our biology…Medical science has given us remarkable power to push against these limits. But again and again, I have seen the damage we in medicine do when we fail to acknowledge that such power is finite and always will be. We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being up until death.

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Dia de los Muertos

Mexico, Spain

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Dia de los Muertos

Death is a celebration of life. It is a moment to honor the people who have contributed to society, raised families, and participated in culture.

Celebrated during Nov. 1^st – 2^nd
Ofrendas, Calavera, Pan de Muertos
Physicians must honor burial requests

Cremation or traditional burial

Positive view of death = easier psychological coping when grieving

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Fire

Water

Air

Earth

Elements of an Ofrenda

Candles guide the dead on their journey

Purifies the dead of evil spirits

Papel picado color sybolize different aspects of death

Pan de Muertos satiate the soul along their journey

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Language Barriers in Communication

Barrier to accessing healthcare

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Obon Festival

Japan

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Celebration

Considerations

Obon Festival

In a three-day festival, the souls of dead ancestors are invited by the living to revisit their homes. Families come together to welcome them by celebrating their life, spirit and legacy.

Paper lanterns, dancing, grave visits, and food offerings.

Buddhism is deeply rooted in this festival. Variations of Buddhisms are against anesthesia or medicine that clouds the mind. Insence may be lit, monks may be present in deathbed. Organ donation may not be preferred.

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Obon Festival

Pitru Paksha

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Pitru Paksha

India

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Hinduism

Celebration

Healthcare

Pitru Paksha or Sharaddha

Religious observance is filled with prayer offerings, abstinence, pilgrimage, and charitable donations to those in need – all in honor of lost loved ones

16 day celebration during mid autumn to honor three preceding generations. Believed to help free the souls and help them towards salvation.

Death ceremonies maybe requested. Cleaniliness of the bodies is valued. Embalming might be prohibited. Burial as close to death is ideal.

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Non-Festival Practices

Pitru Paksha or Sharaddha

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Non-Festival Practices

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Native American Practices

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Preparation

Variation

Burial

Grief

Native American Practices

Body preparation varies. Some tribes use yucca or salt to cleanse the body. Some dress the body with feathers and clothing. Physicians must accommodate these practices on the death bed.

Each tribe varies in death practices. A common theme is the belief in spirits and the need for them to walk the spiritual plane.

Many tribes practice cremation. Some conduct a tree or earth burial. Physicians must caution against disease spreading and provide resources for proper preparation.

The grieving process can involve rituals and ceremonies. Psychological evaluations must be regularly conducted to assess mental well-being.

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Funerals are decorated with indigenous art

Native Americans make up the highest proportion of PTSD and AUD cases

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Muslim Practices

Musims practice Islam, mostly in the Arabic language

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Burial

Grief

Muslim Practices

For souls to quickly enter the afterlife, burials must be taken quickly. This means post-mortem tests or autopsies are typically avoided. Cremation or other modifications can be considered as defiling the body. Suggesting these options can offend families.

There is large variety in how Muslims grieve. Physicians must offer unwavering support, especially in conservative families where death or mental health is a taboo topic.

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Afro-Centric Beliefs

Varies by generation

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Death

African American Beliefs

Unnatural Death

Cremation

Afro-Centric Beliefs

Death is a not considered to be the end of life, but continues in another realm.

Death is mourned but also celebrated with the community. Family and friends band together for support.

Adanced healthcare directives are considered unnatural deaths and are a disconnect from African beliefs. They are individualistic decisions

Some believe the soul roams for days before leaing to another realm. Cremation keeps the soul bound.

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Community Gathering

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MiM

LMSA+

The End

Thank you for joining us to celebrate!

Please enjoy Dia de Los Muertos!

Death is a diverse process that varies according to ethnicity, religion, and culture. It is our duty as future health professionals to be sensitive to these traditions and address the diverse pool of patients.

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REMINDERS

Death is a normal process. Embrace it!

Some cultures perceive the mention of death as taboo. Be wary of your patient’s comfort level.

Even though you may disagree, you must respect a patient’s relious beliefs.

Grief is an individual process. Some take weeks, some take months to heal.

Some people opt to die without aggressive treatment. This is where hospice steps in.

Some patients have a living will or a DNR (Do Not Resuscitate) that stipulate no aggressive treatments.

Suicide rates among older individuals are the highest of any age group. Please be wary of signs.

Reincarnation is the belief that you are reborn into another being after dying.

Cultural competency is the practice of acknowledging different backgrounds and traditions.

Although unlikely, depression can result from the grieving process. Temporary depression is common.

It is advised to not sugar-coat death. Euphemisms such as “in a better place” can be harmful.

There are 5 stages of grief: denial, anger, bargaining, depression and acceptance.

Many hospitals offer prayer rooms or clergy services for worship.

In some cultures, cremation is considered highly offensive.

Physician assisted suicide is only legal in certain states.

Respect your patient’s wishes, but comply with healthcare regulations.

Maladaptive coping of death can lead to burnout in the field. Don’t be afraid to talk it out!

One of our officer’s favorite film is Coco.