title: Beyond cultural stereotyping: views on end-of-life decision making among religious and secular persons in the USA, Germany, and Israel.
abstract: BACKGROUND
  End-of-life decision making constitutes a major challenge for bioethical deliberation and political governance in modern democracies: On the one hand, it touches upon fundamental convictions about life, death, and the human condition. On the other, it is deeply rooted in religious traditions and historical experiences and thus shows great socio-cultural diversity. The bioethical discussion of such cultural issues oscillates between liberal individualism and cultural stereotyping. Our paper confronts the bioethical expert discourse with public moral attitudes.
  
  
  METHODS
  The paper is based on a qualitative study comprising 12 focus group discussions with religious and secular persons in the USA, Germany, and Israel (n = 82). Considering the respective socio-political and legal frameworks, the thematic analysis focuses on moral attitudes towards end-of-life decision making and explores the complex interplay between individual preferences, culture, and religion.
  
  
  RESULTS
  Our findings draw attention to the variety and complexity of cultural and religious aspects of end-of-life decision making. Although there is local consensus that goes beyond radical individualism, positions are not neatly matched with national cultures or religious denominations. Instead, the relevance of the specific situatedness of religious beliefs and cultural communities becomes visible: Their status and role in individual situations, for example, as consensual or conflicting on the level of personal perspectives, family relationships, or broader social contexts, e.g., as a majority or minority culture within a political system.
  
  
  CONCLUSIONS
  As the group discussions indicate, there are no clear-cut positions anchored in "nationality," "culture," or "religion." Instead, attitudes are personally decided on as part of a negotiated context representing the political, social and existential situatedness of the individual. Therefore, more complex theoretical and practical approaches to cultural diversity have to be developed.
authors.affiliation: Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073, Göttingen, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Schweda
authors.affiliation: Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073, Göttingen, Germany. silke.schicktanz@medizin.uni-goettingen.de.
authors.forename: Silke
authors.initials: S
authors.lastname: Schicktanz
authors.affiliation: Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Be'er-Sheva, 84105, Israel.
authors.forename: Aviad
authors.initials: A
authors.lastname: Raz
authors.affiliation: Department of Philosophy, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA, 94132, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Silvers
mesh_terms: D001293:Attitude to Death; D003469:Culture; D003657:Decision Making / Q000941:ethics*; D005006:Ethnicity; D005065:Euthanasia; D005260:Female; D017144:Focus Groups; D005858:Germany; D006801:Humans; D007557:Israel; D008297:Male; D009014:Morals; D036301:Qualitative Research; D012067:Religion; D012068:Religion and Medicine; D012931:Social Environment; D013240:Stereotyping; D017236:Suicide, Assisted; D013727:Terminal Care / Q000941:ethics*; D014481:United States
keywords: Advance directives; Assisted suicide; Attitudes toward death; Cultural diversity; Euthanasia; Focus groups