Chinese cultural dimensions of death, dying, and bereavement: focus group findings

PRACTICE AND RESEARCH IMPLICATIONS

Culture, religion, and social values shape the meanings attached to practices and beliefs systems. Consequently, culturally-sensitive interventions for terminally-ill patients and bereavement services are based upon service providers such as social workers' and healthcare professionals' knowledge about how to harness sociocultural concepts. When working with terminally-ill Chinese patients, service-providers need to ask themselves: To what extent does the family want to talk about or plan for the patient's death? Many traditional Chinese families believe it is bad luck to talk about death because talking about it make it more imminent or will dampen the spirit to live (McLaughlin & Braun, 1998). Service providers may need to listen to the types of euphemisms employed. If euphemisms are used, they are not necessarily indications of denial. Because talk about death is associated with bad luck, discussions about burial plots, living wills, and power of attorneys may evoke uneasiness and resistance.

The Chinese culture is collectivistic in their orientation, where family is paramount. Therefore, when working with terminally-ill patients, service providers must remember that decision-making will be group-oriented (McLaughin & Braun, 1998). Decisions about treatment and funeral arrangements will be made by the family, with the eldest son taking charge. Again, this does not mean that the patient is in denial or resistant. In addition, saving face" is a very important cultural value, and when family duties have not been adhered to, it perceived not only shameful but negative ramifications might occur since the ancestors are displeased. Therefore, the concept of obligation and guilt takes on a different nuance. Consequently, there is great importance attached to family members, fulfilling their obligations for the deceased. Family members may experience lingering guilt if they believe they have not fulfill these obligations (Lee, 1991).

Service providers should be knowledgeable about patterns of culturally accepted and prohibited responses following the death of the patient. For example, what is cultural permitted and what is not after the death of a loved on? Furthermore, service the providers need to assess the degree of acculturation of the family and the patient. Questions to consider include: To what extent does the family or patient what to adhere to more traditional ways beliefs? To what extent does the family or patient want to adopt more mainstream norms? Finally, to what extent do they want to maintain dual relationships that incorporate both the mainstream culture and their ethnic roots (Panos & Panos, 2000)? The Chinese immigrant and Chinese American population in the United States are very diverse. Education, level of acculturation, age-of-immigration, socioeconomic status, and religion contribute to this great heterogeneity. Even within a family: there will diversity due to inter, generational forces. The children may be more acculturated and Westernized than their parents, and some have been influenced by Protestant religion. Consequently, service providers will need to be knowledgeable not only to general beliefs about death and death rituals, but will also need to be attuned to intergenerational conflicts about funeral and burial arrangements.