title: Multicultural considerations in the use of advance directives.
abstract: OBJECTIVE
  To describe advance directives and the Patient Self-Determination Act (PSDA), to explore the European American sociocultural values underlying advance directives, and to describe the ethical and cultural issues that arise when attempting to encourage and use advance directives in culturally diverse populations.
  
  
  METHODS
  Research articles, case studies, and theoretical articles from clinical and bioethical literature.
  
  
  RESULTS
  An overview of advance directives and the PSDA is provided. The European American cultural values underlying advance directives are reviewed and contrasted with sociocultural values of culturally diverse groups to raise the question of cross-cultural applicability of advance directives and European-based bioethics.
  
  
  CONCLUSIONS
  The sociocultural values of many culturally diverse groups conflict with the values on which the use of advance directives is based. Thus, working with end-of-life decisions and advance directives for people from culturally diverse groups may be problematic.
  
  
  CONCLUSIONS
  Nurses should be sensitive to sociocultural beliefs that influence decisions affecting end-of-life care, especially the use of advance directives. Practitioners must incorporate this knowledge to increase flexibility of institutional practices and standards of care in the application of advance directives.
authors.affiliation: Pain Research Department, Swedish Medical Center, Seattle, WA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Ersek
authors.forename: M
authors.initials: M
authors.lastname: Kagawa-Singer
authors.forename: D
authors.initials: D
authors.lastname: Barnes
authors.forename: L
authors.initials: L
authors.lastname: Blackhall
authors.forename: B A
authors.initials: BA
authors.lastname: Koenig
mesh_terms: D016223:Advance Directives; D000368:Aged; D018864:Cultural Diversity; D005260:Female; D006801:Humans; D007723:Korea; D009859:Oncology Nursing; D019726:Patient Self-Determination Act; D014481:United States