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Ethnicity Needs Living Will Legal Document For End-of-Life Care

When it comes to end-of-life care, researchers have known for some time that ethnic groups have different perspectives on how they'd wish to be treated.

Now, a small study suggests there's a gender gap even among people of the same ethnicity.

Interviews with focus groups in Michigan revealed that female African-Americans and Latinos are more likely to want doctors to pull out all the stops to keep them alive. In contrast, men say they'd prefer to be allowed to die, said lead author Sonia Duffy, research investigator with the Ann Arbor VA Medical Center and the University of Michigan.

The researchers also found that Arab-Americans and African-Americans have starkly different expectations of where they want to spend their last days.

"For Arabs, going to a nursing home is the worst thing that could happen to you. The strong expectation is that your family takes care of you," Duffy said. "But African-Americans were more comfortable going to a nursing home, as they did not want to 'burden' their families."

The findings appear in the January issue of the Journal of the American Geriatrics Society.

Duffy cautioned that the study is small. Researchers interviewed 73 Michigan residents in 10 focus groups divided by ethnic or racial group -- white, black, Latino and Arab-American -- and gender. Their average age was 67.

Despite the study's size, the findings suggest doctors need to consider ethnic, racial and religious factors when they talk to families about end-of-life care, Duffy said.

The researchers asked focus group participants how they'd wish to be treated if they had six months to live.

Individuals differed greatly on the role of medical technology in extending life. According to Duffy, there were big differences among men and women in the African-American and Latino groups.

"The men generally did not want extensive intervention done. Dying with dignity was very important, and they didn't want to be a 'vegetable,' " she said.

Duffy added that many men appeared to feel that being dependent at the end of life was a threat to their masculinity.

By contrast, "women were more hopeful that God might intervene and things might change."

These types of gender differences suggest that spouses need to understand where each other stands on end-of-life issues, Duffy said. "It's important to get couples talking," especially since women tend to live longer and often find themselves making decisions for their partners.

One end-of-life specialist said the findings show differences between the genders on this issue are significant, but not too wide. Kenneth Doka, professor at the College of New Rochelle, in New York, and senior consultant to the Hospice Foundation of America, said it does make sense that some men might be more resistant to life-extending efforts.

"That generally runs on the assumption that many males define themselves in term of productivity. If they can't be productive, then they may place less value on being alive if they're dependent," he said.

As for differences between racial and ethnic groups, another specialist said it's important to understand how people from different backgrounds look at the world of medicine. African-Americans, for example, are often wary of doctors, said Dr. Michael Preodor, a palliative-care physician at Northwestern Memorial Hospital in Chicago. Indeed, some black participants in the study expressed distrust of the medical profession.

In some cases, "they don't trust a word out of the mouths of the provider," Preodor said. "They're afraid they're being abused, experimented upon. It just makes it very hard to develop the relationship that you need to discuss these matters effectively."

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