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Culturally Appropriate Care Planning for Chinese Culture

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Chinese Americans represent the largest Asian group in the United States. In a 2013 American Community Survey, there were 4.3 million Chinese Americans, and this number is rapidly growing (Wong, 2013). Among all Chinese Americans, threequarters (76%) of adults are foreign-born (United States Census Bureau, 2010), with values and beliefs strongly shaped and influenced by the traditional Chinese culture.

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Advance care planning is a "process of communication among patients, their health care providers, their families, and important others regarding the kind of care that will be considered appropriate when the patient cannot make decisions". Advance care planning includes both communicating about as well as planning for, future illness, and one of its components is the advance directive. An advance directive or /~ng will is a wn'tten record of a person's wishes about treatment (Singer, 1991 ; Ernanuel, 1993). Aithough an advance directive is but one element of advance care planning, it ofien represents a culmination of the advance care planning process. Advance directives are completed by a person when he or she is competent or capable (ie, can understand and appreciate the consequences of treatment decisions), and used at a time when that person becomes incompetent or incapable. Advance directives fall into two categories: instruction directives and proxy directives.

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Taoism emphasises people’s connection to natural life forces and proposes that humans should seek harmony with nature rather than attempting to change it [ Cheng HC. 2005]. Confucianism provides a basis for the Chinese moral code and behavioural ethics, such as filial piety and familyism. Ethnic Chinese people are traditionally taught that the family should be considered before the individual and that they must properly care for older adults rather than discuss death-related concerns with or in front of them. Regarding Buddhist philosophy, samsara and karma are the two main beliefs. Under the influence of Buddhism, ethnic Chinese people traditionally believe that everything has been predetermined because of karma (cause and effect). The effects of karma can be attributed to an individual’s past life, and the results experienced in the individual’s current life as well as their effects on the next life are referred to as samsara [Hsiung YFY, 2007].

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In conclusion, in traditional Chinese culture, death was sensitive and mentioning it was sacrilegious and to be avoided. Many Chinese families object to telling the patient a "bad" diagnosis or prognosis, which may hinder the chance in advance care planning (ACP) discussion. While death remains an inevitable consequence of being born, as such, it is important that human beings recognize its inevitability and plan ahead of a good death. Advance care planning enables patients to assert their care preferences in the event that they are unable to make their own medical decisions.

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Wang SY. Study of the elderly Taiwanese patient’s medical autonomy and the relating factors [master thesis]. College of Medicine National Taiwan University, Taipei, Taiwan, 2010.

Cheng HC. Chinese philosophy of living. 1st ed. Taipei, Taiwan: Yang Chih; 2005.

Hsu CY, O’Connor M, Lee S. Understandings of death and dying for people of Chinese origin. Death Stud. 2009;33(2):153–174. doi:

Hsiung YFY, Ferrans CE. Recognizing Chinese Americans’ cultural needs in making end-of-life treatment decisions. J Hosp Palliat Nurs. 2007;9(3):132–140.

Huang C. Changed or unchanged for the structures of the four steps in the composition of a Chinese essay- opening, developing, changing and concluding. Chin Soc Sci Today. 2016.

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Culturally Appropriate Care Planning for Chinese Culture
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