In my patient’s high-context culture, he viewed the discussion of hospice care as a form of unspoken abandonment. Being in a large power distance culture, he was not conditioned to challenge the authority in the large health institution. His only choice seemed to be agreeing with what he was offered and not uttering a word of disagreement. Nodding is a gesture of politeness but was mistaken as an indication of understanding. Because of his collectivism and low level of tolerance to uncertainty, he followed the advice from his circle of family and friends of the same ethnicity and transferred his care to an entirely unfamiliar health system, which ultimately led to delay instead of expedition of his care.
My mind came to rest when I understood why he had made his decision and what had led to his disturbing end-of-life path.
Author: Liu, Sheng