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Ethical Issues Surrounding End of Life Care: A Perspective From the Chinese Culture

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Ethical Issues Surrounding End of Life Care: A Perspective From the Chinese Culture By Ingrid See, RN BSN MED Clinical Practice Leader Vancouver Home Hospice – PowerPoint PPT presentation

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Title: Ethical Issues Surrounding End of Life Care: A Perspective From the Chinese Culture


1
Ethical Issues Surrounding End of Life CareA
Perspective From the Chinese Culture
  • By Ingrid See, RN BSN MED
  • Clinical Practice Leader
  • Vancouver Home Hospice

2
Uniqueness of Culture
  • Each person has his/her own philosophy about
    health and illness
  • Understand the experiences, traditions, and
    values that shape each individuals views about
    health and illness
  • Important to find out about the individuals
    perception of health problems, treatments, and
    goals

3
Is There An Easy Recipe?
  • No cookbook for any culture

4
Long ago, in a galaxy far, far, away..
5
The universe was in a state of chaos, without
form, force, or substance
6
Negative Positive Forces
7
Balance Harmony
8
Universe Man
9
5 Elements
10
Yin Yang Theory
  • Health exists when balance occurs in yin and
    yang, therefore, the body is in harmony

11
Yin
  • Passive
  • Dark
  • Inside
  • Quiet
  • Negative
  • Feminine
  • Night
  • Cold

12
Yang
  • Active
  • Light
  • Outside
  • Noise
  • Positive
  • Masculine
  • Day
  • Hot

13
Qi
  • Known as the vital energy that pervades the
    entire universe
  • eg. Heat, light, sound
  • Regulates circulation of blood, process of
    digestion, autoprotection of organisms and vital
    activities

14
Human Body
  • A person has certain amounts of Qi at birth
  • Qi is depleted by ADLs, and augmented and rebuilt
    by food and air

15
Illness
  • Depletion or imbalance of Qi causes ill health

16
Absence of Qi Death
17
Western Philosophy
  • Looks at diagnosis, causes of disease,
    treatments, and symptoms

18
Yin Yang Philosophy
  • When vital forces of the body are in balance,
    positive health occurs
  • Diseases occurs when imbalance is present and is
    seen as a struggle between Qi and disease

19
6 ExcessesDiseases Originating from Outside the
Body
  • Wind diseases that arise suddenly and changes
    quickly
  • Cold Part of the body or whole body feels cold
    which causes fluids to congeal in the body

20
Excesses (cont.)
  • Heat Part of the body or whole body feels hot.
    Heat injures the body
  • Dampness damp weather or comes in contact with
    moisture for a long time

21
  • Dryness attacks fluids of body
  • Summer heat pronounced fever and sweating.
    Dampness always accompanies this excess

22
7 Excessive EmotionsDiseases arising from inside
the body
  • Happiness
  • Anger
  • Pensiveness
  • Sadness
  • Fear
  • Anxiety
  • Worry

23
Yin Yang Perception of Illness
  • Looks at signs and symptoms to find energetic
    imbalances
  • Looks for disease originating from outside the
    body
  • Looks for diseases originating from inside the
    body
  • Emotions are linked to the five elements excess
    results in illness

24
Nature of FoodHot
  • Lychee
  • Cookies
  • Mango
  • Sugar/candy
  • Beef
  • Chili/pepper
  • Lamb
  • Ginger
  • Deep fried foods

25
Cold Foods
  • Honeydew
  • Tomato
  • Banana
  • Pear
  • Melon
  • Cucumber
  • Seaweed
  • Cold drinks

26
Neutral Foods
  • Apple
  • Grape
  • Papaya
  • Rice
  • Flour
  • Chicken
  • Milk
  • Soy drink
  • Tea

27
End of Life IssuesA Cultural Perspective
  • Chinese culture is very hushed about talking
    about illness and death
  • Seen as a weakness
  • To openly discuss death and dying is taboo and
    disrespectful
  • Important not to generalize the culture

28
To Tell or Not to Tell
  • Dont want to cause worry/anxiety
  • Dont want to cause fear
  • Worried that the person will give up hope and be
    upset
  • Stigma of the illness
  • Person will become depressed and stop eating

29
Strategies
  • Focus on the hope of getting better but prepare
    for the worse
  • Take the persons perspective ie. what happens if
    the client doesnt see him/herself get better?
    This adds to more worry/anxiety because person
    has been told he/she would get better
  • Use non-threatening terms ie. tumor instead of
    cancer

30
What If I Get Asked?
  • Family has requested that health care provider
    does not tell client that he/she has a serious
    illness
  • Ethical dilemma should health care provider
    tell the client if asked by the client?

31
Strategies
  • Ask yourself, what is your agenda?
  • Let the family know that you will not talk
    directly about the illness but if asked, you will
    ask the client what he/she understands
  • Paraphrase the clients words
  • Also, ask client what he/she wants to know
  • If client indicates information regarding
    illness, ask client Who do you want to hear the
    information from?

32
And if the family continues to choose not to tell?
33
SO WHAT?
34
Talking About the Illness
  • Illness is very private. Cancer is seen as
    contagious by many of the elderly
  • Talking about illness brings the spirit down
  • Talking about illness can lead to depression
  • Illness is seen as a weakness

35
Strategies
  • Try to get the clients understanding of the
    illness.
  • Assess what the clients past coping mechanisms
    were for other illnesses.
  • Find out what the clients goals are.
  • Assess how they perceive you can help them.

36
DNR
  • Greatest fear is that health care professionals
    will do nothing (ie. no treatment) to help loved
    one
  • Fear that health care professionals have given up
    hope when family still has hope

37
Strategies
  • Explain that DNR does not mean Do Not Treat
  • Explain that all will be done but after one dies,
    no CPR will be performed. Give specific examples
  • Support the use of home remedies, medicines

38
View of Health Care Professionals
  • Chinese view doctors an an authority figure
  • Some do not question the views of doctors and
    will go by what he/she says
  • Nursing is not viewed as an honourable profession
    because it is dirty.
  • Focus of the medical profession in HK/China is on
    cure.
  • Nurses in HK/China are trained differently than
    here (different philosophy)

39
Strategies
  • Assist clients to understand what the roles are
    of your various team members
  • Clients often will listen to you but may check
    your information with GP or family member who is
    a physician
  • Communication within your team is important so
    that the same message is being given

40
Involving Children
  • Education commitments outweigh being with
    parents. Children are encouraged to visit but
    not to take on tasks because it may interfere
    with school
  • School is a strong value in the Chinese culture
  • Doing well in school maintains integrity and
    parents peace of mind
  • Good grades and success save the face of the
    family

41
Strategies
  • Children may be reluctant to talk to health care
    professionals as they are viewed as outsiders.
    Involve school counselors, public health nurses
    with permission of the parents (and children if
    old enough)
  • Honor the value of education. Be careful of your
    own judgements and the judgements of staff if the
    children do not visit very much.
  • When children do visit, parents tend to find
    tasks that they can help with
  • Feel out if the children want to talk to you

42
Family Structure
  • Many elderly people choose to live with the
    eldest son
  • Role of eldest son is to look after the parents
  • Role of D-I-L is to help look after the in-laws
  • Daughters are expected to help out because the
    sons work must not be disturbed

43
Decision Making
  • Related to the family structure. In a
    traditional Chinese family, the eldest son is
    responsible for decision making
  • Son may be overseas, therefore, decisions may not
    be made here. Other sibling(s) will often
    contact oldest son to make decision
  • If son is a child, husband may defer decision to
    clients brother or a relative who may be in the
    medical profession

44
Strategies
  • Assess for a clear overview of the family
    structure. Spokesperson may not be the same
    person as the decision maker
  • Find out what services are appropriate when
    planning discharge to home
  • Assess who is living at home and roles that they
    play ie. children
  • Females may often have to do the personal care as
    the male client may not want strangers

45
To Feed or Not to Feed
  • Value of food is so important to maintain
    yin/yang balance
  • Guilt suffered by family if the client is not
    eating
  • Withholding food and water contradicts the need
    to replenish Qi

46
Strategies
  • Find out what the client and familys
    wishes/goals are
  • Help family feed the client for as long as
    possible
  • Tube feeds and IVs - discuss pros and cons and
    let family decide
  • Be aware of your own agenda and values
  • Key is providing options, negotiating with client
    and family, and supporting them with their
    decisions

47
Death
  • Death is a bad omen
  • Death is not perceived as part of the natural
    life cycle seen as the enemy
  • Bad luck to die at home
  • If chooses to die at home, client can only die in
    the sons home (preferably the eldest)
  • Cannot die in the daughters home
  • Family cannot visit other peoples homes or give
    gifts until a month after the death

48
Strategies
  • Prepare client and families for the emotional,
    spiritual, and physiological changes during the
    last days/weeks of life
  • Provide options where the client may die
  • Support the family in their decisions
  • Refer family to resources in community/hospital/re
    sidential care

49
After-life
  • Those who are Buddhist may follow the tradition
    that the body may not be moved for 8 hours (some
    for several days)
  • Rituals ie. special clothing for the deceased,
    money, jewelry, comb to accompany body
  • 7 days post-death spirit comes home turn on all
    lights in home, leave food out
  • 49 days wear white or blue flower in hair to
    display grief and mourning
  • To honor guests that come to the service, give
    white envelopes with money and candy provide a 7
    course meal

50
Strategies
  • Ask family if any special rituals or religious
    requests after client dies so you can help
    prepare the unit ahead of time or if at home,
    help family keep their loved one there until
    transport to funeral home
  • Ensure privacy and allow the family to spend time
    with their loved one
  • Allow time for questions regarding the death

51
Summary
  • Be aware that many philosophies of illness exist
    within cultures and within individuals
  • Important to do an accurate cultural assessment
    of each client, each family member
  • Be aware of your own values/judgements when
    supporting families at end of life
  • Find out whats important to the client and the
    family and help them move towards their goals
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