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Though this New York Times story is a few years old, I am inspired by it. In many ways, this is community-based care at its best…with a true integration of patients’ world views or beliefs and top quality health care practices.

With Poem, Broaching the Topic of Death
by Ben Daitz, MD, published January 24, 2011

Navajo seamless colorful tribal pattern with quotes on labels, from

The article features Ms. Mitzie Begay, who at the time was the cross-cultural coordinator for the home-based care program at the Fort Defiance Indian Hospital in northeastern Arizona. Her role was to help Navajos deal with health care decision-making at the end of life.

The Challenge?

 “Navajos value the principle of autonomy or self-determination…..But their cultural taboos — you can’t think negatively, or it will happen — restrict their ability to autonomously plan for their end-of-life care, since the planning itself requires such negative thinking.

So it is up to Ms. Begay and her colleagues to find ways to teach people (many with little or no English) about things like living wills, durable powers of attorney, do-not-resuscitate orders, electroencephalograms, feeding tubes and ventilators.”

In sum, the health care professionals needed a way to communicate with their patients about end-of-life care within the context of their beliefs about life.

The Solution?

A poem. – “When that time comes, when my last breath leaves me, I choose to die in peace to meet Shi’ dy’ in” — the creator. 

“Using the poem and open-ended questions allows nuanced and respectful solutions to this problem because it gives people the opportunity to discuss end-of-life planning impersonally. It’s a compassionate approach, and it’s in accord with the twin values that Navajos share with mainstream American culture — individual autonomy and personal dignity.”

To Learn More About

[tabby title=”End of Life Care”]

[tabby title=”Cultural Competency”]

  • Clear Communication – Cultural Competency, National Institutes of Health
  • What is Cultural Competency?, Office of Minority Health, US Department of Health and Human Services
  • Culture, Language and Health Literacy, Health Resources and Services Administration, US Department of Health and Human Services