ABSTRACT:

The Indian population, which includes those who denote themselves as “Asian Indian,” “Indian,” or “East Indian” on the census, represents the second largest group of Asians in the United States. Despite our growing numbers, research suggests that adequate health care is lacking for this community. The challenges caused by this insufficient care are amplified at the end of life, where intergenerational, culturally derived values and concerns collide to shape expectations. This essay uses Atul Gawande’s Being Mortal (2014), which addresses palliative care and end-of-life decision-making, as a launching point for analyzing the role of Indian culture in end-of-life care and discussing implications for providing culturally competent medical practice. The role of intergenerational expectations of care and familial duty are key themes in Gawande’s text, and the book represents a missed opportunity to explicitly discuss these values in a clinical context. Three guiding concerns are suggested as addenda to end-of-life care discussions: eliciting the patient’s thoughts on advanced directives, on the roles of family members, and about preferences for disclosure regarding serious diagnoses.

摘要：

印度人口，包括在人口普查中自称为“亚裔印度人”、“印度人”或“东印度人”的人，是美国第二大亚裔群体。尽管我们的人数不断增加，但研究表明，这个社区缺乏足够的医疗保健。这种护理不足造成的挑战在生命结束时被放大，代际、文化衍生的价值观和担忧相互碰撞，形成期望。这篇文章使用了 Atul Gawande 的《Being Mortal》（2014 年），它解决了姑息治疗和临终决策，作为分析印度文化在临终关怀中的作用和讨论对提供具有文化能力的医疗实践的影响的起点。照顾和家庭责任的代际期望的作用是 Gawande 文本中的关键主题，这本书代表了在临床背景下明确讨论这些价值观的错失机会。建议将三个指导性问题作为临终护理讨论的附录：引出患者对预先指示、家庭成员的角色以及关于严重诊断的披露偏好的想法。