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Modules:

  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
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    Back to Module 13: Cultural Issues
    Tools for Diagnosing and Mediating Cultural Misunderstandings

    Touch and Gender
    Medical Subculture
    Suffering Traditional Medicine
    Depression
    Body Language
    Bad News
    Fatalism
    Surgery
    Food
    Literacy
    Meaning of Illness
    Alternative Medicine
    Pain
    Imminent Death

    Suffering

    Meanings of Suffering

    Victor Hugo wrote, “Men die and they are not happy.” It is hard to imagine that suffering does not drive out happiness. This depends on the meaning of suffering

    See Module 14: Religion, Spirituality, and End of Life Care to get some sense of how various religious traditions attempt to explain suffering

    Suffering -- and pain -- may be perceived as:

    • Something positive, as the way to earn a place in heaven
    • The morally neutral but unavoidable fate of all mortals
    • The punishment for past sins
    • The revenge of an angry god
    • The random mistake of an indifferent god

    People bear suffering with courage, good cheer, quiet resignation, stoicism, depression, rage, and panic depending on how they interpret it

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    Expressions of Suffering

    • Cultures generally do lay out an ideal model for how suffering should be borne. However, do not generalize from cultural stereotypes
    • Some families, some cultures, permit and encourage the sufferer to express their anguish and pain. It is this cultural permission that is sometimes misinterpreted as “excitability” by outsiders
    • Emotional expressions of pain and suffering may be shameful in some cultures
    • Failure to express pain would deny the patient’s claim for care and support in others. For them, dependency is a legitimate component of the sick role. (see the section on pain in this module for more information about how culture may influence interpretations and expressions of pain)
    • U.S. medical culture does not accept dependency graciously. Patients are expected to “work” at getting better. In palliative care, this may mean “working” at feeling better. Physical therapy, for example, may make little sense to someone who interprets dependency as a legitimate right for someone in the sick role
    • Passivity and dependence may be appropriate in your patient’s culture. If the family accepts it, so should you. You cannot change it in any case
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