Bioethics and end-of-life care in multi-ethnic settings: Cultural diversity in Canada and the USA

This paper addresses cultural dimensions of end-of-life care in Canada and the USA. In both countries contemporary health care providers commonly encounter patients with quite variable understandings of what constitutes compassionate end-of-life care. Participation in particular ethnic and religious groups can have a significant effect upon how patients and their families communicate with health care providers, make decisions about treatment alternatives, engage in advance care planning, and frame moral deliberations. Much of the contemporary literature in the field of bioethics emphasizes the importance of truth telling, the principle of autonomy and the significance of patient choice, the value of advance care planning, and the right to have treatment withdrawn or withheld. However, a growing body of scholarship on the cultural dimensions of end-of-life care reveals a plurality of attitudes towards what constitutes appropriate forms of communication and decision making. While there are limits to the kind of social practices and moral claims that should be accommodated in liberal democracies, health care providers should take steps to ensure that they are providing culturally sensitive end-of-life care.