Ethnicity and attitudes towards life sustaining technology

The ethical and legal implications of decisions to withhold and withdraw li fe support have been widely debated. Making end-of-life decisions is never easy, and when the cultural background of doctor and patient differ, commun ication about these issues may become even more difficult. In this study, w e examined the attitudes of people aged 65 and older from different ethnic groups toward forgoing life support. To this end, we conducted a survey of 200 respondents from each of four ethnic groups: European-American, African -American, Korean-American and Mexican-American (800 total), followed by in -depth ethnographic interviews with 80 respondents. European-Americans were the least likely to both accept and want life-suppo rt (p < 0.001). Mexican-Americans were generally more positive about the us e of life-support and were more likely to personally want such treatments ( p < 0.001). Ethnographic interviews revealed that this was due to their bel ief that life-support would not be suggested if a case was truly hopeless. Compared to European-Americans, Korean-Americans were very positive regardi ng life-support (RR = 6.7, p < 0.0001); however, they did not want such tec hnology personally (RR = 1.2, p = 0.45). Ethnographic interviews revealed t hat the decision of life support would be made by their family. Compared to European-Americans, African-Americans felt that it was generally acceptabl e to withhold or withdraw life-support (RR = 1.6, p = 0.06), but were the m ost likely to want to be kept alive on life-support (RR = 2.1, p = 0.002). Ethnographic interviews documented a deep distrust towards the health care system and a fear that health care was based on one's ability to pay. We concluded that (a) ethnicity is strongly related to attitudes toward and personal wishes for the use of life support in the event of coma or termin al illness, and (b) this relationship was complex and in some cases, contra dictory. (C) 1999 Elsevier Science Ltd. All rights reserved.