Comparison of Cultural Values

Anglo Culture: Axiomatic beliefs are based on the philosophies of free will, and objective materialism (i.e. scientific methodology).

Latino culture: Beliefs are based on the philosophy of fatalism/determinism and the religion of Christianity.

Free will vs. Fatalism/Determinism

In the States we consider each person to be a free moral agent that can take personal decisions that are consequential. We do not give much weight to good luck or bad luck, rather we attribute success and failure to a person's integrity, effort, ingenuity, and skill. The belief in free will reigns supreme and science can perform miracles, so doctors expect patients to be actively involved in the decisions that relate to their care.

In Latino culture, the prevailing perspective people have is heavily influenced by a blend of Christianity and fatalism, specially for individuals that have fewer resources or education. The thinking goes as follows: We are subject to forces much greater than us that we cannot control like sudden illness, accidents, and societal upheavals. We are here just trying to make the best of the situations we are confronted with. One may not understand it, but god has a special plan for each person. And this divine plan trumps and overrides any personal plan that an individual may have come up with for themselves. This sentiment is expressed in the bible quote "El hombre propone y Dios dispone" / "Man proposes and God disposes" (Proverbs 16:1).

Fatalism is a clear advantage for situations without remedy such as a late miscarriage, the amputation of a limb, paralysis, or a terminal diagnosis. The patient is much better equipped to accept the new situation, drastic as it may be. However, fatalism is a handicap when used for situations when being proactive, involved, and driven leads to better health outcomes. If the patient throws their arms up and gives up to soon, they would miss out on all of these opportunities: changing lifestyles to prevent diabetes, going through chemotherapy for a cancer that is contained or not very aggressive, or taking an experimental drug that has shown promise.

Objective materialism vs. Christianity

Though Christianity is undoubtedly part of the American outlook on life, over this last century objective materialism has eclipsed it in importance. 'Objective' means that information is obtained and validated from facts and evidence and not from private revelations, feelings, or anecdotes. 'Materialism' instead refers to the belief that the tangible world is the only reality that exists — there is no "other place". If something cannot be perceived directly with our senses or through instruments, for example gods, souls, purgatory, holy spirit, dream world, etc., it does not exist.

Though objective materialism paints the picture of an uncaring and meaningless world, it's a world that can be rationalized and predicted, and can therefore be analyzed by science. This is significant because science and the scientific method have provided incredible advances in the standard of living, recovery from disease, and longevity. So it is understandable why science occupies a very central place in the thinking of modern societies. However when it comes to end-of-life matters, at an emotional level, death is not seen as a natural phenomenon of life, it's an aberration and technology is put forward as the weapon of choice that can help us to fight it and postpone it at all costs.

Christianity instead espouses the existence of an infinitely good, knowing, and powerful god who created all that is, including human beings. Humans however, through their disobedience, lost their divine protection and as a punishment were banished from a Utopian environment, paradise, to Earth. This has two important consequences: Earth is not meant to be a pleasant place, and pain and suffering are an expected component of life.

Pain and illness are often seen as a tests of faith. If the patient faithfully endures their agony without cursing out their god, there may be a spiritual reward later. With regards to death instead, we are here for a finite amount of time and when it's time for us to go, it's time to go. The body is just a vessel used to prepare the soul for its eternal afterlife.

Examples of Cultural Misunderstandings

Scenario A

Situation: An oncologist informs her Latino patient and her family that the radiation therapy has shrunk the breast tumor but has not eliminated it, additionally, the cancer has spread to nearby lymphatic nodes and possibly to the liver. Further chemotherapy treatment will be needed.

The family has sees the patient in a lot of discomfort and have just been told that the cancer is still present. They are starting to see the writing on the wall and that it was not meant to be so they ask whether there are any palliative care options that would allow their relative to convalesce at home and live out the rest of her days. The doctor is confused and doesn't understand why the patient does not want to go through potentially life-saving chemotherapy. Why aren't they fighting this tooth-and-nail?

Mitigation: The oncologist clearly explains the probability that further treatment will result in recovery. Likewise, she explains in which instances personal involvement, tenacity, and determination by the patient will make a difference and when none of these will help. If provider can only increase the length of life but not the quality of life, they offer comfort care sooner in the course of events rather than dragging out treatment unnecessarily.

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Scenario B

Situation: After a very serious motorcycle accident, a comatose Latino teenager is placed on life support in the Intensive Care Unit. Unfortunately, the swelling in his brain cannot be controlled and neurosurgeons need to operate right away. Because of likely bleeding a nurse asks the teenager's parents to sign a consent form for blood transfusions. The devoutly Evangelical parents refuse to sign, notwithstanding the risk this represents to their son, because Jehovah's Witnesses are not allowed to receive blood. The surgeon attempts to persuade the parents by appealing to their sense of reason and reminds them that that internal bleeding during surgery could be fatal. The parents acknowledge this fact but counter that it makes no sense to save his body if this will condemn his soul.

Mitigation: Medical providers will be cognizant that patients make decisions based on rational arguments in conjunction with (and not despite) their spiritual beliefs, and that spiritual values and priorities may ultimately carry the day. A strategy that may work for this scenario is for the surgical team to get a social worker involved and have them contact the pastor for the church were the parents go. Determine through the pastor, a figure of spiritual authority for the parents, if there is any flexibility, i.e. if whole blood is off the table, can the patient receive plasma, or purified blood products like platelets? Can a blood recirculator be used during surgery to recover and reuse the patient's own blood? In addition to scientific arguments, spiritual ones can also be made, for example "If your son survives because he receives blood, he will have more time on Earth to do good deeds and server the Lord".

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This article is part of a series on Latino Culture and Healthcare.
View the main article here.