Chinese-Canadian attitudes toward end of life decisions

grantor: University of TorontoPurpose. The purpose of this study is to examine Chinese Canadian attitudes toward end of life decisions. While extensive information is available on attitudes towards end of life decisions in general, little is known about attitudes of specific cultural communities. Within Western health care, autonomy is the dominant value on which the intellectual and moral foundation of end of life decisions are based. At the heart of this value is the belief that everyone is entitled to free choice, self determination, and privacy. Vet for many people of non-Western origin the image of the self is based on his or her relations with others rather than individual free will. A Chinese sample has been selected because of the contrast this group represents in relation to an autonomy based perspective and because of the demographic significance of the Chinese in Canadian society. Methods. Three elements of end of life decisions are explored in this research project: (a) advance care planning, (b) truth telling, and (c) decisions to forgo treatment. Because of the complexity of phenomena at the intersection of attitudes toward end of life decisions in relation to culture, this research project is an ethnographic, qualitative study. The constant comparison method was used for analysis. Results. (a) respondents were indifferent or negatively disposed to advance care planning; (b) respondents perceived truth telling to be variable in its importance, potentially harmful, and a "process" rather than an "event"; (c) in relation to decisions to forgo treatment, respondents were focused on the importance of avoiding or alleviating suffering for the patient and others affected by the illness and minimizing burdens to the family, the health care system, and the government. Conclusion. From a moral and ethical perspective respondents' attitudes represent a 'world view' which deals with a concrete situation and focuses on such values as interdependence, comparison and protection in contrast to an autonomy based 'world view' which deals with abstract and hypothetical situations, and focuses on such values as individualism, self determination and rights. For respondents in this study, moral perspective appeared to reveal itself through context rather than universal principles.Ph.D