The influence of Latino ethnocultural factors on decision making at the end of life: withholding and withdrawing artificial nutrition and hydration.

In this article, the author reviews the legal precedents that underpin the policies and practices found in most medical settings in relation to artificial nutrition and hydration (ANH) as the context for exploring the end-of-life (EOL) care decision-making process of Latinos. The literature related to Latino beliefs and practices is reviewed. Specifically examined are the ways in which the values of familismo, filial duty, respect for authority figures, and personalismo play a major role in this group's decision-making process. Finally, the perspectives of ethicists who argue that Western bioethical approaches fail to recognize that cultural norms and values as well as religious convictions play a significant role in shaping moral deliberations, including the decision to withdraw ANH from individuals with a terminal illness, are explored. From a cross-cultural ethical perspective, it is important for health care providers to understand that in a pluralistic society, patients and their families bring multiple models of healing and decision making to clinical encounters based on different cultural and religious values.