Blacks, Whites divided on end-of-life treatment

Black patients are more likely than white patients to prefer life-sustaining care when confronted with an incurable illness or serious mental and physical disabilities, according to a study by University of Rochester Medical Center researchers.

Because the attitudes of black patients conflict with current prevailing views regarding end-of-life care, they may have difficulty obtaining medical care consistent with their cultural values and beliefs. Physician and health care institutions should develop policies sensitive to diverse approaches to death and dying, the researchers concluded.

An article on the research appears in the autumn issue of the journal Ethnicity & Disease.

"The main message is that there are a wide variety of opinions regarding how to handle care at the end of life, and many conflict with the prevailing medical ethic," said William Bayer, M.D., the lead author of the article and a clinical assistant professor of family medicine.

For the study, patients, who were 50 years of age and older, were recruited from a primary care practice in the city of Rochester and from a practice in a suburb of Rochester. They were asked whether they would accept or decline life-sustaining intervention in several scenarios, including a terminal illness, a chronic illness, dementia, coma and brain death. The interventions could include a ventilator to maintain breathing, a feeding tube and cardiopulmonary resuscitation.

The patients also provided information on religiousness, closeness of family, and experience with a health care proxy and a do-not-resuscitate order. In total, 77 patients were recruited for the study. Although the study was not large, the difference between black and white patients response was significant.

In a terminal illness such as cancer, for example, 72 percent of the black patients and 29.6 percent of the white patients said they would want life-sustaining treatment. In the case of coma, 53.2 percent of black patients would choose life-sustaining care but just 29.2 percent of white patients would make that choice. While about 51 percent of the black patients wanted life-sustaining treatment in a chronic condition and brain death, only 11 percent of the white patients preferred intervention.

"I was very surprised that 26 percent of blacks surveyed stated they would want continued life-sustaining care in the setting of a terminal illness and brain death while no whites would make that choice," said Bayer. "It was also interesting to find that religiosity did not correlate strongly with end-of-life decision making."

Having previously performed a health care proxy was related to wanting less care in end-of-life situations.

"There could be a lot of explanations for this, but I think the act of completing a health care proxy may in itself affect one's attitude toward treatment decisions. I think this would be an interesting area of further research," Bayer said.

The findings indicate the need for greater education of the public about brain death, coma and other conditions and a much more open process in end-of-life decision making, with the involvement of a broad multicultural team, Bayer said.