Patient autonomy is a primary value in US health care. It is assumed that patients want to be fully and directly informed about serious health conditions and want to engage in advance planning about medical care at the end-of-life. Written advance directives and proxy decision-makers are vehicles to promote autonomy when patients are no longer able to represent their wishes. Cross-cultural studies have raised questions about the universal acceptance of these health care values among all ethnicities. In the current investigation, Bosnian immigrants were interviewed about their views of physician-patient communication, advance directives, and locus of decision-making in serious illness. Many of the respondents indicated that they did not want to be directly informed of a serious illness. There was an expressed preference for physician- or family-based health care decisions. Advance directives and formally appointed proxies were typically seen as unnecessary and inconsistent with many respondents' personal values. The findings suggest that the value of individual autonomy and control over the health care decisions may not be applicable to cultures with a collectivist orientation. © Springer Science + Business Media, Inc. 2005.

Ethics Health care communication end-of-life care Cross-cultural health

doctor patient relation Physician-Patient Relations immigrant patient information attitude to death critical illness interpersonal communication human ethics middle aged priority journal Bosnia and Herzegovina Aged family health informed consent United States Bosnia-Herzegovina Humans male female cultural factor Narration Article health care life Questionnaires adult migration physician patient participation patient attitude Advance Directives Emigration and Immigration Cultural Characteristics health care system living will decision making Focus Groups