Culture in End-of-Life Care.

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.