Friday, September 1, 2017

Why are African-Americans not completing advance directives?

First a disclaimer. As a Caucasian, I have only personal anecdotal impressions from the African-American patients I have cared for. To me their approaches to end of life decisions were not uniform by any means, but there was clearly often more initial trust in their Pastor than in a white male doctor. Yet, once I gained trust I felt a real bond. I loved the caring and support that their community provided. I've been on a constant learning curve over time and still have much to learn about cross cultural medical care.

In the end-of-life planning sessions I've given over the years, most of the attendees are white with only a few minorities on occasion. The reasons are complex and historical.

African-American professionals are beginning to try to address the under-utilization of Hospice, Palliative Care and the POLST form. It should be no surprise that there is often distrust of the predominantly white medical establishment - the tragedy of the Tuskegee Syphilis experiment and segregated wards are in recent memory.

PBS has a useful video essay below discussing the problems and some attempts to improve trust and communication. We unfortunately still have echoes of racism and discrimination. Trust will only come over time with positive leadership echoing the values of Martin Luther King, Jr.

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