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  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
  • More About:

  • Hospice Care
  • Clergy and Faith Communities
  • Additional Links
    Site Index
    Back to Module 13: Cultural Issues
    Tools for Diagnosing and Mediating Cultural Misunderstandings

    Touch and Gender
    Medical Subculture
    Traditional Medicine
    Body Language
    Bad News
    Fatalism Surgery
    Meaning of Illness
    Alternative Medicine
    Imminent Death


    What is Fatalism?

    • Fate can be secular or spiritual
    • Fatalism means that people feel that their actions either cannot influence the future or that the future has already been determined
    • This does not imply passivity and beliefs about pre-determination do not imply a paralysis of will
    • Invoking fate, the will of God, in God’s hands, not playing God may reflect a positive adaptation to a situation in which patients or families feel helpless. Better God’s will than chaos
    • Hoping for miracles is tactically similar
    • Although free will is a Western, Protestant concept, neither are all Protestants in a frame of mind to seize initiative at the end of life
    • Conversely, Buddhism and Islam have both been described as the reason for “fatalism” but it is well to remember that both religions have sustained their believers through great feats of will


    Negotiating Fatalism and Choice When Decisions Must Be Made

    Specific circumstances, experience, knowledge and belief determine whether patients make active or passive choices about medical care. Fatalism is only a problem if the palliative care team feels thwarted in providing appropriate care by what appears to be obstruction or unwillingness to decide.
    If it is necessary to get a decision...

    • Present the options clearly
    • Be certain that the options are understood
        For Example
        “Just to be sure we’re on the same wavelength, could you explain to me what artificial feeding means to you?”
    • Explain your opinion
      • Explain clearly and truthfully why you believe a certain course of treatment is futile
    • Be receptive to second opinions
      • There is never any reason to object to a second medical opinion

      • Help the family obtain a second opinion. Most of the time it will confirm your assessment
    • Encourage spiritual support-seeking
      • You may invite the family to discuss it with their spiritual advisor (imam, monk, priest)

      • This may or may not help your case

      • In small communities there are few alternatives to the local religious leader. Sometimes this person is willing to work with you. Sometimes not. Do not antagonize him/her. Over time you may build a good relationship with him/her

    • Help the family to build on past successes
      • It is useful sometimes to review with the patient and family times when they did make active choices that helped them to survive and succeed

      • Remember that it took enterprise and courage for immigrants and refugees to survive long journeys, internment camps, hardship, and danger to get here and to start over in a strange place
    • Address fears of making the "wrong" choice
      • Sometimes it is useful to suggest that fate or God provide the choices. Consequently, the choice that they make is the one that is intended. They cannot fail
    • Empower the patient
      • Even within a family there be differing perspectives on fate
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