title: Discussing dying in the diaspora: attitudes towards advance care planning among first generation Dutch and Italian migrants in rural Australia.
abstract: Western cultural practices and values have largely shaped advance care planning (ACP) policies across the world. Low uptake of ACP among ethnic minority groups in Western countries has been interpreted with reference to cultural differences. This paper adopts a life-history approach to explore attitudes towards ACP among older, first-generation Dutch-Australian and Italian-Australian migrants. Thirty people participated in extended ethnographic interviews (N = 17) and group discussions (N = 13) during 2012. Transcripts were thematically analyzed and interpreted using a Foucauldian perspective on knowledge and power. Migration experiences, ongoing contact with the native country and participation in migrant community support networks influenced attitudes towards ACP. Dutch participants framed ACP discussions with reference to euthanasia, and adopted a more individualist approach to medical decision-making. Italian participants often spoke of familial roles and emphasized a family-based decision making style. The importance of migrant identity has been neglected in previous discussions of cultural factors influencing ACP uptake among ethnic minority groups. The unique migration experience should be considered alongside culturally appropriate approaches to decision-making, in order to ensure equitable access to ACP among migrant groups.
authors.affiliation: Rural Clinical School of Western Australia, Australia; University of Western Australia, Australia. Electronic address: craig.sinclair@rcswa.edu.au.
authors.forename: Craig
authors.initials: C
authors.lastname: Sinclair
authors.affiliation: Rural Clinical School of Western Australia, Australia; University of Western Australia, Australia.
authors.forename: Jessica
authors.initials: J
authors.lastname: Smith
authors.affiliation: University of Western Australia, Australia.
authors.forename: Yann
authors.initials: Y
authors.lastname: Toussaint
authors.affiliation: Rural Clinical School of Western Australia, Australia; University of Western Australia, Australia.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Auret
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001315:Australia; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007558:Italy / Q000208:ethnology; D008297:Male; D009426:Netherlands / Q000208:ethnology; D036301:Qualitative Research; D012424:Rural Population / Q000706:statistics & numerical data; D014171:Transients and Migrants / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Advance care planning; Australia; Cross-cultural; End-of-life; Foucauldian; Migration