Advance Directive in End of Life Decision

Abstract

Increased capacity of health care professionals, armed with improved medical technologies, to sustain life even when there is no hope of recovery has created more need for decision making than ever. With the advancement in medical technology the question of when to let patients die is a subject of debate among physicians, philosophers and theologians – “the dilemma of modern medicine†what men value is closely connected with how they view the universe, with their “Weltanschauung†which affects biomedical field because. Value as perceived in the field enters mightily into decision-making and influence things how people make decisions. End-of-life decision making is value laden arising from the norms and values of society. In Africa, little is known about end-of-life decision making within the context of bioethics. Hence, it is difficult to understand what role ethics committees have played. This paper examines the ethnomethological perspective of this issue in a rapidly expanding bioethical global age

Methodology: The study utilized an anthropological approach to documenting contemporary issues in end-of-life decision making in Yoruba culture of Nigeria. Specifically, it aimed at examining the concept of death, cultural beliefs about end-of-life decision making, factor influencing end-of-life decision making and the role of ethics committees in end-of-life decision making. Thirty In-depth Interviews were conducted among young and adult male and female in two selected Yoruba communities. Content analytical approach was used for data analysis.

Result: In Yoruba culture, death is socially constructed being interpreted as “Iku†(meaning: end of existence). It has spiritual, physical and social significance. Hierarchy of authority is the basis of implementing traditional advance directive. Socialization, gender, form of marriage, property, patriarchy, religious belief and tradition are the major considerations in end-of-life decision making. Education, public engagement, resource allocation and advocacy are important roles for ethics committees.

Conclusion: Further research into end-of-life decision making strategies will illuminate the diversity of cultural practices about end-of-life decision making and strengthen clinical practice.