A Review of Latinos’ Multiculturalism:
How it Influences Death, Dying and Bereavement
Ana Bendaña MST, BHSc, RN, CHPN
(thanatology.bendana@gmail.com)
National Hospice and Palliative Care Organization (NHPCO)
16th Clinical Team Conference and Pediatric Intensive
Grapevine, Texas
October 16th, 2015
Learning Objectives
Upon completion of this presentation, participants will be able to:
•
Identify different cultural values and beliefs amongst Latinos related to death,
dying and bereavement
•
Describe three examples of funeral rituals and mourning practices in Latino
culture
•
Discuss strategies that can be used when caring for Latinos that incorporate core
cultural values, religious practices and beliefs; and recognize approaches to
designing culturally effective plans for Latino end-of-life care.
Introduction
People’s cultures determine how people live and die, and there exists a great
diversity of customs and rituals observed by people around the world during the death
and dying process. The cultural diversity encountered in the US today, is such that,
without proper cultural knowledge and competence, different traditions and beliefs could
not be observed and respected, especially as death approaches. Thus, inadvertently
thwarting genuine compassionate care and a person’s opportunity to a “good death”.
Without proper understanding of cultural diversity, it is easy to misunderstand or
misinterpret essential aspects of patients’ dying process, as well as families’ bereavement
practices. DeSpelder and Strickland (2011) posit, “death is a universal human
experience, yet our response to it is shaped by our cultural environment” (p. 85).
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The Latino Population in the U.S.
According to the US Census Bureau (2014, September) as of July 1st, 2013, the Hispanic
population of the United States was 54 million people; making it almost 17% of the total
population. Only two other Latin American countries, Brazil (195 million) and Mexico (113
million), have larger Hispanic population than the U.S. (Pew Research Center, 2014, Nov 13).
The U.S. and World Population Clock estimated the U.S. population at 320,596,470, as of March
29 (2015). Of this, approximately 72.4 percent consider themselves White or EuropeanAmerican, 12.6 percent consider themselves African-American, 4.8 percent consider themselves
Asian American, and 16.4 percent consider themselves Latino or Hispanic.
Latinos of Mexican (10.3%), Puerto Rican (1.5%), and Cuban (0.6%) descent or origin,
remain the nation’s three largest Latino country-of-origin groups (LatinLife, 2014). Latinos of
Central American ancestry or origin comprises 1.3 percent of the total population.
US Population
White ~ EA
African American
Asian American
Latino American
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Latino Core Cultural & Religious Values
The majority of Latinos are religious or spiritual people, and religion/spirituality plays a
significant role in everyday life. Health is highly regarded as a gift from God. Failing of health or an
unfortunate accident, is viewed as sent by God and accepted as His will (Chong, 2002). This acceptance is
commonly known as fatalismo. Prayers, religious amulets, visits to church and shrines, as well as, the
lighting of candles are common day practices, which symbolize religious offerings and remembrances to
God. Many homes have pictures of Jesus, the Virgin Mary, saints, religious icons, and such. Catholic
Latinos venerate the Virgin Mary not only as the Mother of God, but also as an intermediary between
humans and the Lord. Our Lady of Guadalupe (Nuestra Señora de Guadalupe) is considered not only a
religious symbol, but a cultural symbol as well. The Basilica of Our Lady of Guadalupe in Mexico City is
the most visited Catholic site in the world, and the third most visited sacred site in the world (Orcutt, 2012).
Many saints are also prayed for intercessional favors between humans and God (Campesino & Schwartz,
2006), for example, San Judas Tadeo, or St. Jude Thaddeus, Patron of the Impossible.
The Pew Research Center (2014) conducted a survey in 18 Latin American countries, Puerto Rico,
and the Caribbean between October 2013 and February 2014. Sixty-nine percent (69%) of people in Latin
America consider themselves Catholic. Between 1900 and 1960, 90% of the population considered
themselves Catholics. Due to its majority, the focus on religious rituals will be mainly Catholic. As part of
any thorough patient assessment, religious or spiritual preferences should be discussed so as to avoid
stereotyping.
Anointing of the Sick. According to Valladares (2014), a priest has the duty to assist “the sick,
the old and the dying to make reparations for their sins, to offer themselves as a sacrifice for the conversion
of sinners, and for the good of the Church, and if its God’s will, to be healed and restored to health” (p. 11).
The anointing of the sick provides patients and families with a sense of hope and healing.
Funeral Rites. Funeral rituals carry significant meaning to those in mourning. Funeral rites
include the wake, which is usually conducted at home or funeral home, the funeral mass and rite of
committal. To some Latinos, funeral rites provide a beginning to “closure.” The wake, or Vigil Service, is
a time to gather with family and friends to remember and recall memories of life with the deceased. The
funeral liturgy, called the Mass of Resurrection, is held at a church before burial. It is during the funeral
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liturgy that the congregation “pleads for God’s mercy for the deceased and gives thanks for the hope of
eternal life with God” (Portland Diocese, n.d., p.4). This hope of eternal life with God is first
acknowledged in the Catholic faith through the baptismal rites. The Rite of Committal, or committal
prayers at the cemetery, is carried at the place of committal or place of interment. With this rite, the
community expresses faith in the glory of resurrection (United States Conference of Catholic Bishops,
2015). Latinos also celebrate anniversary masses for their dead and remember loved ones on their birthday
and special dates. Latinos maintain an ongoing relationship with the deceased through prayers, mass, and
celebrations like Día de Los Muertos.
Latinos tend to exercise a paternalistic view of medical care called paternalismo. They value and
highly trust the physician’s opinion and usually base their decision-making on the doctor’s
recommendations (Bougere, 2010). There is a preference for non-direct communications regarding the
patient’s prognosis, or secrecy (Kreling et al., 2010). Secrecy stems from the responsibility family feels of
shielding their loved one from the pain of knowing their poor prognosis or imminent death.
Hospicio
(What does the word hospice mean in Spanish?)
According to wordreference.com, hospice or hospicio (in Spanish), is defined as “asylum where
shelter and education is given to poor, abandoned, or orphan children. A house designed to accommodate
pilgrims and the poor.” When using a bilingual dictionary, the word hospicio is translated as “a poor
house; orphanage for children.” Wikipedia in Spanish defines hospice as, “public houses where they
collect the helpless poor and are maintained at the expense of public welfare or income product that has
been endowed by the burning charity of some citizens, making the poor work in compatible trades
according to their health and disposition.” It is not a surprise then, that many Latinos have the
misconception that hospice is a place of substandard care for the destitute, deprived, or handicapped people
(Kreling, Selsky, Perret-Gentil, Huerta, & Mandelblatt, 2010). Another common myth among Latinos is
the belief that hospice care incurs extra expenses. Even worse, many do not have any knowledge of
hospice’s philosophy or palliative care.
The Real Academia Española dictionary, defines hospice as “asylum for the needy” in Bolivia,
Chile and Perú; “asylum for the elderly and demented” in Chile and Ecuador; and “houses that religious
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communities have to accommodate people of their order.” The word hospicio was not found in the
Argentinian dictionary. Consequently, to Latinos, the word hospice does not connote a positive philosophy
or environment for their loved ones. Much less, it does not suggest interdisciplinary care aimed at relieving
the suffering of people with a terminal diagnosis or life-limiting illness. Thus, hospice education within the
Latino community needs to begin by asking questions pertinent to their understanding of the word
“hospice” and whether they have had any experience with hospice care before.
Strategies for Culturally Competent Care
Culture dictates the rules for respectful, compassionate and individualized care. It is important to
keep in mind that a new breed of rituals may be the result of mixing and assimilation of ethnic
backgrounds, cultures, and traditions in the US. Culture is not static, and in the field of death, a person’s
culture is as essential as in every other aspect of human life. Following are a few strategies to remember
when caring for Latino patients:
-
Be respectful, especially to elders. Ask permission. Ask questions and pay attention to body
language, facial expressions, and tone of voice. Avoid stereotyping; each patient and family is
unique.
-
Do not deliver direct communications until after inquiring what their understanding of the
prognosis is and how much information they want (Avoid Yes/No questions). Talk to the MPOA,
spouse, or adult child beforehand, to find out how to best communicate with the patient and
family. Remember, to a majority of Latinos, God has the last word!
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If the patient speaks only Spanish or prefers Spanish, Title VI of the Civil Right Act mandates any
health or social service organization receiving federal funds MUST provide effective language
assistance (professionally trained medical interpreter).
-
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Provide brochures and medical literature in Spanish. Review them with patient and family, don’t
just hand out!
Remember Latinos’ highly value and respect, physicians’ opinions. Teach in order to empower!
Be mindful of personal values and beliefs; do not impose them on others.
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Strengthen spiritual assessment. Because of cultural religiousness and fatalism, symptom relief
might not be a priority for a Latino patient/family. However, how to carry the emotional and/or
spiritual suffering (carry their cross) God has entrusted them, might be.
As healthcare professionals, death education must be a priority within the community. With Latinos,
the following education is critically needed:
-
-
-
-
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Hospice & Palliative Care ~ what it is / family centered care / unique to each individual and family
Finances ~ who covers hospice care expenses
Written Material ~ should not be translated literally from English to Spanish (it might not make
sense or may be detrimental to accurate death education)
Enhance relationship and communications amongst health care practitioners and patient/family
Improve communications with local churches and religious leaders in the communities served.
Offer to provide grief and bereavement education support to pastors, priests, elders, deacons,
ministers, chaplains and such, and the communities they serve
-
Cultural awareness and competence are a must!
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References
Bougere, M. H. (2010). Culture, grief and bereavement: Applications for clinical practice. Retrieved from
http://www.minoritynurse.com/culture-grief-and-bereavement-applications-clinical-practice
Campesino, M., & Schwartz, G. (2006). Spirituality among Latinas/os implications of culture in
conceptualization and measurement. Advanced Nursing Science, 29(1), 69–81.
Chong, N. (2002). The Latino Patient. Boston, MA: Intercultural Press.
DeSpelder, L., & Strickland, A. (2011). The last dance: Encountering death & dying. New York, NY:
McGraw-Hill.
Institute of Medicine. (2013). Committee on transforming end-of-life care. Retrieved from
http://www.iom.edu/Activities/Aging/TransformingEndOfLife.aspx
Kreling, B., Selsky, C., Perret-Gentil, M., Huerta, E. E., & Mandelblatt, J. S. (2010). The worst thing about
hospice is that they talk about death: Contrasting hospice decisions and experience among
immigrant Central and South American Latinos with US-born White, non-Latino cancer
caregivers. Palliative Medicine, 24(4), 427-434. DOI: 10.1177/0269216310366605
LatinLife. (2014). Latino Nationalities in the USA. Retrieved from
http://www.latinlife.com/article/135/latino-nationalities-in-the-usa
Orcutt, A. (2012). World’s most visited sacred sites. Travel and Leisure. Retrieved from
http://www.travelandleisure.com/articles/worlds-most-visited-sacred-sites
Pew Hispanic Center. (2012). The 10 Largest Hispanic Origin Groups: Characteristics, Rankings, Top
Counties. Retrieved from http://www.pewhispanic.org/files/2012/06/The-10-Largest-HispanicOrigin-Groups.pdf
Pew Research Center. (2014, November 13). Religion in Latin America: Wide spread change in a
historically Catholic region. Retrieved from http://www.pewforum.org/2014/11/13/religion-inlatin-america/
Portland Diocese. (n.d.). Catholic Funeral Planning Guide. Retrieved from
www.portlanddiocese.org/docs/2288.PLANNINGGUIDE.pdf
United States Census Bureau. (2011). The Hispanic Population: 2010. Retrieved from
http://www.census.gov/prod/cen2010/briefs/c2010br-04.pdf
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United States Census Bureau. (2014, September 8). Facts for features: Hispanic heritage month 2014:
Sept. 15-Oct. 15. Retrieved from http://www.census.gov/newsroom/facts-for-features/2014/cb14ff22.html
United States Conference of Catholic Bishops. (2015). An overview of Catholic funeral rites. Retrieved
from http://www.usccb.org/prayer-and-worship/bereavement-and-funerals/overview-of-catholicfuneral-rites.cfm
Valladares, J. (2014, August). Sacrament of the sick: An incalculable blessing. The Priest, 10-12.
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