Skip to ContentGo to accessibility pageKeyboard shortcuts menu
OpenStax Logo

Learning Objectives

By the end of this section, you will be able to:

  • Describe social and legal concerns associated with death and dying
  • Discuss emotional, spiritual, and practical concerns associated with death and dying
  • Discuss cultural considerations related to death and dying

Understanding the intricacies of human emotions and experiences is as crucial as any medical procedure or treatment plan. As caregivers, nurses navigate a variety of human emotions, encountering profound challenges that test not just their medical expertise but also their empathy and understanding. A profound and inevitable aspect of the human experience is the concept of death and dying. Nurses play a pivotal role in supporting clients and families through this deeply personal and challenging phase. According to Kübler-Ross’s theory, the stages of grief—denial, anger, bargaining, depression, and acceptance—guide individuals through the emotional journey surrounding death (Valliani & Mughal, 2022). Understanding these stages allows nurses to provide holistic care and support to clients and their loved ones during this delicate transition.

Social and Legal Concerns Associated with Death and Dying

Death and dying profoundly impact individuals, families, and communities because death is not solely a biological event but also a social and cultural phenomenon. Losing a loved one triggers intense grief reactions, which can have social implications. Death often carries societal stigmas and taboos, leading to varying degrees of discomfort or avoidance in discussing this inevitable facet of life (Dimitrov et al., 2022). Certain circumstances involving death—physician-assisted dying, abortion, and suicide—bring with them particular social and legal concerns of which nurses should be aware.

Generally, nurses play a pivotal role in ensuring compassionate care and support throughout any death and dying process:

  • Client advocacy and support: Nurses serve as advocates for clients navigating end-of-life decisions, offering empathetic guidance and support while respecting individual autonomy. They facilitate informed discussions, ensuring clients comprehend their options and rights and client wishes related to dying such as whether they wish to be resuscitated or not.
  • Ethical guidance and counseling: Nurses provide counseling to clients, families, and colleagues, fostering understanding of the moral, legal, and emotional implications surrounding death.
  • Collaborative care coordination: Nurses serve as a liaison between clients, families, physicians, and support services, ensuring coordinated care aligned with the client’s wishes and needs.
  • Compassionate end-of-life care: Nurses offer compassionate care to clients, focusing on pain management, emotional support, and dignified end-of-life experiences. A focus on palliative care ensures comfort and quality of life until the final moments (Demedts et al., 2023).

Physician-Assisted Dying

Intentionally ending a life to prevent further pain and suffering is considered assisted dying. Most people are familiar with the concept of euthanasia, which is when someone other than the individual aids the person’s dying through the administration of medication at the request of the individual (ANA, 2019). Euthanasia is illegal in the United States. It should not be confused with medical aid in dying. Physician-assisted, or medical aid in dying, is intentional assistance provided by a physician to enable an individual to end their own life by furnishing drugs for self-administration, always at the voluntary and competent request of the individual involved (Fontalis et al., 2018).

Physician-assisted dying is an emotionally charged and complex issue, and nurses face critical moral, legal, and ethical considerations. The laws on assisted dying vary globally, with only a few countries recognizing its legality (Emanuel et al., 2016). In the United States, it is legal in eleven states: California, Colorado, District of Columbia, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington. An example of how legislation is applied is the Oregon Death with Dignity Act, permitting dying Oregonians to voluntarily kill themselves by taking physician-prescribed lethal medications. This law has sparked debates on ethical, legal, and moral grounds, serving as a catalyst for discussions about end-of-life care, client autonomy, and health-care provider roles in assisted dying. It has influenced similar legislation in other states and countries, contributing to ongoing discussions and initiatives regarding end-of-life choices and physician-assisted dying (Oregon Health Authority, 2021). Under this act, nurses serve as primary educators, providing comprehensive information about end-of-life care options, ensuring clients possess informed decision-making capabilities. Nurses clarify procedural intricacies, explaining eligibility criteria and requirements, guiding clients through the process, and addressing inquiries to facilitate well-informed choices. In assessing client eligibility, they aid in documenting and communicating clients’ preferences, while also advocating for client autonomy, ensuring that their wishes are effectively communicated within the health-care team. Furthermore, nurses extend emotional support to both clients and families, offering compassion during decision-making and throughout the end-of-life journey (Oregon Nurses Association, 2015). Nurses must have knowledge of the existing legal framework in their location and adhere strictly to it to avoid legal repercussions (Bellon et al., 2022). According to the ANA position statement (2019), nurses are ethically prohibited from actively being involved in medical aid in dying, other than providing support to their clients.

Nurses need to be aware of and sensitive to the ethics of assisted death as well. Assisted death raises fundamental ethical issues, such as respect for autonomy, the sanctity of life, and harm prevention. Nurses should carefully reflect upon and navigate these ideas, considering the individual client’s wishes and the nurse’s values (Bellon et al., 2022). No matter the laws or ethical considerations, effective communication is critical. Nurses should be able to engage in open, sensitive, and respectful discussions about physician-assisted dying with clients and their families. They should also communicate effectively with other health-care professionals to ensure coordinated care.


As health-care professionals, it is crucial to explore and understand the complexities surrounding abortion to provide compassionate and nonjudgmental care to individuals facing this decision. According to the American Nurses Association (ANA), nurses have a professional and ethical obligation to respect the autonomy and dignity of clients and honor their right to make informed decisions about their reproductive health. The ANA emphasizes the importance of providing unbiased information, support, and access to safe and legal reproductive health-care services, including abortion (American Nurses Association, 2015).

Health-care professionals should approach the topic of abortion with sensitivity and respect, acknowledging the diverse perspectives and beliefs held by individuals, communities, and health-care professionals. Developing a comprehensive understanding of abortion empowers nursing professionals to deliver client-centered care, ensuring access to comprehensive reproductive health care, and supporting individuals in making informed decisions about their reproductive health (Schooley & Kratovil, 2023). When supporting individuals navigating this experience, it is crucial for the nurse to acknowledge the multifaceted nature of emotions involved, including grief. For instance, women’s emotional responses postabortion can vary widely. Some may experience relief, while others might undergo grief, sadness, or a sense of loss (Reardon, 2018). Additionally, research suggests that health-care professionals’ empathy and understanding play a vital role in supporting individuals dealing with abortion-related emotions (McLean et al., 2023). Techniques like active listening and creating a safe, nonjudgmental environment can aid in providing compassionate care (Tennant & Toney-Butler, 2022).


Suicide is a major public health concern, and health-care professionals, including nurses, play a critical role in its prevention. Nurses must understand the importance of effective communication, active listening, and therapeutic relationships in suicide prevention. The collaborative efforts of health-care professionals, clients, and their support networks are essential in creating a safety net of support and identifying appropriate interventions (World Health Organization, 2014).

The ethical considerations surrounding suicide require health-care providers to balance autonomy, beneficence, and nonmaleficence. Respecting a person’s autonomy means acknowledging their right to make decisions about their own life, while beneficence and nonmaleficence call for actions to prevent harm and promote well-being (Varkey, 2021). Furthermore, nurses must recognize the impact of their attitudes, biases, and stigma on the care they provide to individuals at risk of suicide. Developing a nonjudgmental and empathetic approach is crucial in establishing trust and promoting open discussions about suicidal ideation or behaviors (Saini et al., 2020).

Research underscores the importance of understanding the social determinants of suicide, emphasizing factors such as socioeconomic status, social support, and access to mental health services. Nurses, through their client interactions, can assess and address these determinants by advocating for improved access to mental health resources and facilitating social support networks (Robertson et al., 2022).

Nurses are also involved in the aftermath of suicide, providing support to bereaved families and communities, offering counseling services, and helping individuals navigate the complex emotions associated with loss (Andriessen et al., 2019). Suicide is discussed in more detail in Chapter 16 Mood Disorders and Suicide.

Emotional, Spiritual, and Practical Concerns Associated with Death and Dying

Emotional concerns associated with death and dying encompass various psychological and interpersonal challenges for both clients and health-care professionals. Understanding and addressing these emotional concerns is important for providing holistic and compassionate care during the end-of-life journey. Likewise, research by Kostka et al. (2021) highlights the range of emotions nurses may encounter, including sadness, grief, empathy, and sometimes even relief or a sense of accomplishment in providing comfort during a client’s end-of-life journey. Nurses often form strong bonds with clients and their families, which can intensify these emotions.

Furthermore, the Kübler-Ross model of the five stages of griefdenial, anger, bargaining, depression, and acceptance (Valliani & Mughal, 2022)—remains a foundational framework to understand not only the emotions experienced by dying clients and their families, but also those encountered by health-care providers, including nurses, as they navigate these challenging situations. Effective coping strategies for nurses are key, such as reflective practices, seeking peer support, and utilizing counseling services (Abdul-Mumin et al., 2023).

Nurses should cultivate empathy, active listening, and nonjudgmental attitudes to create a safe and supportive environment for clients and their families (Kim et al., 2020b). Open and honest communication fosters emotional connection, promotes understanding, and facilitates discussions about end-of-life wishes and concerns.

Psychosocial Considerations

Self-Care for the Nurse

Self-care practices in nursing encompass a spectrum beyond physical well-being, delving into the psychosocial aspects crucial for holistic health maintenance. As caregivers, nurses navigate emotionally demanding situations, underscoring the necessity for robust self-care strategies. Understanding the interplay between psychological and social components is pivotal in fostering self-care resilience within the nursing profession (Wang et al., 2022b). The areas where they intersect include the following:

  • Emotional intelligence: Nurses harness emotional intelligence to navigate stressors, foster empathy, and maintain professional boundaries. By recognizing and regulating emotions, nurses cultivate resilience amid high-pressure environments (Aghajani Inche Kikanloo et al., 2019).
  • Coping mechanisms: Utilizing effective coping mechanisms, such as mindfulness practices or reflective journaling, empowers nurses to process emotions and mitigate burnout (Malik & Annabi, 2022).
  • Social support networks: Building support networks within the nursing community aids in sharing experiences, seeking guidance, and nurturing a sense of belonging (Pereira et al., 2021).
  • Work-life balance: Striking a balance between professional commitments and personal life serves as a protective factor against burnout and enhances overall well-being (Putri et al., 2023).

Caring for the Nurses’ Needs

Incorporating psychosocial elements into self-care paradigms is essential for nurses. Addressing psychological well-being and nurturing supportive social structures not only fortifies individual resilience, but also cultivates a healthier work environment conducive to optimal client care.

Effective communication skills are essential in addressing emotional concerns related to death and dying.

Furthermore, self-reflection is important for nurses to recognize and manage their emotional reactions to death and dying. Engaging in reflective practices, such as journaling or debriefing with mentors or peers, can help nurses process emotions, gain insights, and promote personal growth. After all, providing care to clients at the end of life can evoke strong emotions and potential burnout. Engaging in self-care practices can help nurses process their feelings and maintain their mental and emotional well-being (Hussain, 2021).

Caring for Clients’ Emotional Needs

Mental and emotional needs are significant in caring for individuals and families facing death and dying. Recognizing and addressing these needs is crucial for nurses to provide holistic, client-centered care during this challenging period. One of the primary mental and emotional needs is psychological support. Clients and their families may experience a wide range of emotions, as referenced earlier, such as fear, anxiety, sadness, anger, and confusion. Nurses should cultivate effective communication and active listening skills to provide a safe and empathetic environment for individuals to express their emotions (Anderson et al., 2019). Offering emotional support, validation, and counseling services can help individuals navigate their feelings and cope with the challenges associated with end-of-life care.

Clients and families often have questions and concerns about the dying process, treatment options, and what to expect. Nurses can contribute to meeting these needs by providing clear and accurate information, discussing prognoses, and involving clients and families in care planning (Heyland et al., 2013). Equipping individuals with knowledge can help reduce anxiety and promote a sense of control and understanding.

Also helpful for addressing client emotional concerns is maintaining a peaceful and soothing environment. This includes controlling noise levels, providing appropriate lighting, and creating a calm atmosphere to facilitate relaxation (Zulueta Egea et al., 2022). Supporting the client’s preferred spiritual or cultural practices can improve their physical comfort. By recognizing and addressing the mental and emotional needs related to death and dying, nurses can provide compassionate, holistic care for clients and their families.

Spiritual Needs

Spiritual support is also important. Many individuals find comfort and solace in their spiritual or religious beliefs. Nurses should be sensitive to diverse spiritual and cultural practices and, when appropriate, facilitate access to spiritual or religious leaders for guidance (Zare et al., 2019). Creating an environment that respects and supports the spiritual needs of clients and their families can contribute to their overall well-being, coping, and sense of peace.

One of the key spiritual needs is the need for meaning and purpose. Clients may question the meaning of their lives, their values, and the significance of their experiences. Nurses can engage in open and compassionate conversations to explore these existential concerns, helping individuals use their spirituality to find purpose and meaning in their lives, even in the face of mortality (Zare et al., 2019).

Supporting religious and cultural practices is another important spiritual need. Many individuals find comfort and draw strength from their religious or cultural beliefs and rituals and involvement with a spiritual leader, such as a priest, pastor, rabbi, or imam. Nurses should be knowledgeable about diverse spiritual practices and willing to facilitate access to spiritual leaders, prayer, or religious texts as requested by clients and their families (Puchalski et al., 2014).

Maintaining hope is also a significant spiritual need. Hope can take various forms, such as physical healing, a peaceful death, or hope for reunification with loved ones. Nurses should foster an environment that nurtures and supports hope, allowing individuals to express their desires and aspirations (Puchalski et al., 2014). Encouraging clients and families to identify and focus on what brings them hope can contribute to their spiritual well-being.

Nurses should be aware of their own spiritual beliefs and biases and separate them from their care. Maintaining a nonjudgmental and inclusive attitude toward diverse spiritual perspectives is essential in meeting the spiritual needs of clients. Respecting and supporting individual beliefs, regardless of personal agreement, is crucial in providing client-centered care (de Brito Sena et al., 2021).

Practical Nursing Responsibilities in Death and Dying

Nurses also have a practical role to play in managing death and dying. One of the most critical responsibilities is effective communication. Nurses must be able to relay information concisely and compassionately to the dying client, their families, and the rest of the health-care team (Dionne-Odom et al., 2019). They should also be skilled at facilitating discussions about end-of-life decisions, including advanced care planning and do-not-resuscitate orders.

Pain and symptom management is another task. Nurses must help administer appropriate pain relief, monitor for adverse effects, and adjust treatments based on a client’s changing needs and preferences (Sinha et al., 2023). Nurses serve as advocates, educators, and compassionate caregivers in addressing the fear of pain and concerns about excessive pain medication in end-of-life care. Their role extends beyond administering medications, encompassing holistic care, empathy, and effective communication to ensure clients’ comfort and dignity during this critical phase (Twycross, 2019). Lastly, nurses often oversee postmortem care, which includes preparing the body for viewing, arranging for transport, completing the necessary documentation, and providing emotional support to grieving family members (Wang et al., 2021).

Death and Dying Cultural Considerations

When a nurse demonstrates understanding of and respect toward a client’s cultural background and beliefs, their end-of-life care can be more effective and compassionate (Six et al., 2023). Some cultures may have specific practices and rituals associated with dying and death. These can range from wanting family members present at the time of death to specific customs around handling the body post death (Givler et al., 2023). Understanding these practices can assist nurses in providing culturally competent care and promoting client and family comfort and dignity in death. Additionally, conversations around advance care planning and the process of dying can vary widely between cultures. For example, in some Asian cultures, discussing death is considered taboo (Givler et al., 2023). Conversely, many Western cultures advocate for open discussions about death and end-of-life care planning.

Nurses should be aware of these differences and approach the topic sensitively, engaging family members, cultural liaisons, or translators when necessary. Education, communication, and empathy are fundamental for nurses to respect clients’ cultural views on death, enhance their well-being, and fulfill their wishes (Busolo & Woodgate, 2015). The following cultural group examples are generalizations and may not apply to every individual.

Black Americans

For Black Americans, cultural considerations can significantly shape the experience of death, dying, and bereavement. Historically, Black culture values strong family connections and spiritual beliefs, often influencing end-of-life care perceptions (Givler et al., 2023). For many Black Americans, spirituality plays a critical role in coping with death and dying. They can rely heavily on faith, prayer, and the church community for support during illness or death (Collins et al., 2018). Nurses must understand the significance of these spiritual beliefs and respect their role in end-of-life decisions and coping mechanisms.

Additionally, Black Americans traditionally have a strong sense of community, which extends to the family’s involvement in health-care decisions. This collective decision-making process includes the immediate family, extended kin, and close friends. Therefore, health-care professionals must incorporate these family dynamics into care planning (Givler et al., 2023).

Furthermore, research suggests that Black Americans often prefer more aggressive treatment measures at the end-of-life compared with other groups (Orlovic et al., 2018). The preference for aggressive measures may be related to the historic mistrust of health-care providers and the legacy of disparate care experienced by Black Americans. This mistrust is deeply rooted in historical injustices and systemic biases, such as the Tuskegee Syphilis Study, that have significantly impacted health-care access and outcomes (Hostetter & Klein, 2021). In the Tuskegee Syphilis Study, researchers studied the effects of syphilis on Black men without collecting informed consent or offering treatment (CDC, 2022). Nurses should consider this while discussing end-of-life care options, ensuring they understand and respect the client’s wishes. To provide culturally competent care to Black clients at the end of life, nurses need to recognize the role of spirituality, value the collaborative decision-making process, and respect the preference for aggressive treatment.

American Indians/Alaska Natives

Understanding and respecting the cultural beliefs and practices of American Indians and Alaska Natives (AI/AN) surrounding death and dying is essential for health-care providers. Cultural beliefs and traditions in these communities are often influenced by a deep respect for the natural world and spiritual connections with ancestors and the afterlife (Colclough & Brown, 2014).

Many AI/AN communities perceive death as a part of the natural life cycle rather than an ending. This view can influence decisions regarding end-of-life care, where a focus may be on maintaining balance and harmony with the natural and spiritual world rather than prolonging life at all costs (Colclough & Brown, 2014).

Spiritual practices and rituals are essential components of the death and dying process in many AI/AN cultures. Ceremonies often involve the entire community, including prayer, singing, and using sacred items, such as eagle feathers or tobacco. Health-care providers should respect and accommodate these practices whenever possible (Isaacson & Lynch, 2018).

Family and community connections are highly valued in AI/AN cultures. In end-of-life care decisions, the client’s family and community often play significant roles (Dennis & Washington, 2016). Nurses need to understand this communal approach to health-care decision-making and include family and community members in discussions when appropriate.

It is important to remember that there is significant diversity among the AI/AN community. Each tribe or community has unique cultural beliefs, traditions, and practices surrounding death and dying. Therefore, nurses should not assume that all AI/AN clients share the same beliefs or preferences but should instead seek to understand the specific cultural context of each client.

Asian Americans

Asian Americans encompass diverse ethnic groups with unique cultures, languages, and beliefs. Therefore, attitudes toward death, dying, and end-of-life care can vary greatly among Asian American communities. Certain cultural values and practices are often shared, however, and they do influence how individuals and families approach end-of-life decisions (Lee, 2009). Respect for one’s parents, elders, and ancestors and family cohesion are fundamental concepts in many Asian cultures. These values often translate into collective decision-making processes for health-care decisions, including end-of-life care. Therefore, involving family members in discussions around the terminal prognosis and treatment decisions is crucial to culturally appropriate care (Lee, 2009).

Many Asian cultures emphasize respect for elders, which might influence decisions about disclosing terminal prognoses. Directly telling a client about a terminal prognosis can sometimes be seen as disrespectful or causing unnecessary distress, and thus, family members often prefer to receive the information first (La et al., 2021) and then determine if and how to relay that information to the person.

Spirituality and religion, such as Buddhism, Christianity, Confucianism, Hinduism, Islam, and Taoism, play a significant role in shaping views on death and dying among Asian American communities. For instance, beliefs in karma, reincarnation, or the afterlife can affect preferences for end-of-life care, mourning rituals, and funeral arrangements (Lee et al., 2018).

Health-care providers should also be aware of potential language barriers and the need for accurate interpretation services when discussing end-of-life care with Asian American clients and their families (Lee, 2009). Overall, nurses providing care for Asian American clients near the end of life should appreciate the significance of family decision-making, consider cultural attitudes toward disclosing terminal prognoses, respect spiritual and religious beliefs, and acknowledge the importance of language-accessible services. Following is a discussion of three groups of Asian Americans that have specific practices regarding death and dying.

Filipino Americans

Filipino Americans possess unique beliefs and practices surrounding death and dying stemming from their rich blend of indigenous, Spanish, and American influences. Appreciating these cultural nuances is critical in providing culturally competent end-of-life care. Family plays a central role in the lives of Filipino Americans, and this extends to health-care decisions. Many place a high value on kapwa (shared identity), emphasizing interconnectedness among family members. Consequently, decisions regarding end-of-life care often involve the entire family (Constante, 2022).

Spirituality, influenced predominantly by Catholicism due to Spanish colonization, profoundly impacts Filipino Americans’ perspectives on death and dying. Many may find solace in prayer and religious rituals and prefer receiving sacraments, such as the Anointing of the Sick, during end-of-life care (Lagman et al., 2014). Moreover, Filipino Americans may value pag-aaruga, or caring, expressed through a high level of physical care and presence by family members at the bedside of a dying loved one. This cultural practice reflects their commitment and love for their family (David & Okazaki, 2006).

In Filipino culture, direct communication about death can be considered disrespectful or distressing. Health-care providers may need to approach these conversations carefully, considering the client’s and family’s comfort with discussing death openly (Givler et al., 2023).

Language barriers can also be a concern, especially for older Filipino Americans. Providers should ensure the availability of appropriate interpretation services to facilitate clear and respectful communication (Lagman et al., 2014).

Japanese Americans

Japanese Americans have unique beliefs and traditions surrounding death and dying rooted in their Japanese heritage and experiences in the United States. Understanding these cultural nuances can improve end-of-life care for Japanese American clients (Matsumura et al., 2002). Collective decision-making is common in many Japanese American families. Maintaining familial unity and avoiding conflict are often emphasized in line with the cultural concept of wa, or harmony. End-of-life care discussions may involve the client and their family members, but as Japanese Americans become more Americanized, they may want more autonomy in their own decisions (Matsui, 2009).

Spirituality, particularly in the form of Buddhism, Shintoism, and Christianity, shapes perspectives on death and dying in the Japanese American community. Certain rituals, like chanting or prayer, may be important for some families. In addition, many Japanese Americans believe in continuing a spiritual relationship with their deceased loved ones, which is honored through practices like maintaining a family altar (Suzuki, 2012).

Communication around death can be indirect in Japanese culture, guided by the concept of honne (true feelings) and tatemae (public facade). This might influence disclosure and receipt of information about prognosis and end-of-life (Matsumura et al., 2002). Health-care providers also must be mindful of potential language barriers.

Vietnamese Americans

Vietnamese Americans also have unique cultural practices and beliefs surrounding death and dying, rooted in their Vietnamese heritage, and influenced by their experiences in the United States. Culturally sensitive health-care providers, including nurses, can enhance the quality of end-of-life care for Vietnamese American clients by understanding these cultural nuances (Tran et al., 2019).

The Vietnamese culture places a high value on the family unit. As a result, decisions about end-of-life care often involve collective decision-making, with family members playing key roles in discussing options and making final decisions (Tran et al., 2019). Spiritual beliefs are fundamental to understanding death and dying among Vietnamese Americans. These beliefs often incorporate a mix of Buddhism, Confucianism, Taoism, and ancestor veneration, all of which can influence preferences for end-of-life care, including pain management, life-prolonging interventions, and funeral rites (Tran et al., 2019).

Buddhism’s influence on end-of-life care emphasizes alleviating suffering and allowing the client to achieve a peaceful transition (Tran et al., 2019). Clients may prefer noninvasive treatments or palliative care to manage pain while maintaining mental clarity for spiritual contemplation. Funeral rites often involve rituals honoring the deceased, such as chanting or meditation, promoting a tranquil passage to the afterlife and comforting the bereaved (Kalra et al., 2018). Confucianism’s emphasis on family and societal harmony influences end-of-life preferences. Respect for elders and maintaining familial harmony guide decisions on care. Funeral rites emphasize honoring ancestors, with rituals focusing on proper ceremonies to ensure a peaceful afterlife transition (Badanta et al., 2022). Taoism’s approach to end-of-life care centers on harmony with nature and acceptance of the natural cycle of life and death. Funeral rites might include simplicity, embracing the natural order, and rituals to facilitate the departed soul’s journey into the Tao, fostering peace and harmony (International End-of-Life Doula Association, 2017).

Communication about terminal illness and death is often indirect in Vietnamese culture because discussing death may be perceived as disrespectful or as bringing bad luck. Health-care providers should consider this cultural sensitivity when discussing prognosis and treatment options (Givler et al., 2023). Potential language barriers also exist, especially among older Vietnamese Americans with limited English proficiency.

Jewish Americans

Jewish Americans have unique cultural considerations about death and dying, rooted deeply in their religious traditions and beliefs. Within the Jewish culture, there are diverse beliefs and rituals (JCFS Chicago, n.d.), but in general, the approach toward the end of life is one of acceptance and reverence, where the dying process is seen as a natural part of life. There is a belief in the sanctity of life until the very end, emphasizing the importance of quality of life. Medical treatments that prolong life are encouraged, but extraordinary measures to prolong life without meaningful recovery are generally discouraged, highlighting the value placed on the dignity and autonomy of the individual (Rosenberg et al., 2020).

The process of death in Jewish culture involves several rituals. Upon death, it is customary for the eyes and mouth of the deceased to be closed, the body covered, and a candle lit near the body, symbolizing the soul’s divine spark (Popovsky, 2007). The burial traditionally occurs as quickly as possible, usually within forty-eight hours of death. Practices, such as embalming and cremation, do not take place because of the belief in the sanctity and respect of the body. After the funeral, family and friends observe a seven-day mourning period, known as shiva, allowing for grief and remembrance (Rosenberg et al., 2020).

Mexican Americans

Death and dying hold significant cultural and religious importance for Mexican Americans. According to Mexican cultural tradition, death is perceived as a natural phase in life’s continuum. It is not considered an end but a part of a cycle of life and rebirth, influenced by the belief system and the dominant religion of Catholicism (Altamirano, 2018).

One significant aspect of death in Mexican American culture is the commitment to familial responsibilities and the idea of buen muerte (good death), which emphasizes dying at home surrounded by family (Ko et al., 2013). This reflects the strong cultural importance of family bonds and the collective approach to life and death. Many Mexican Americans uphold the Catholic belief in an afterlife, making spiritual care important at the end of life. Spiritual rituals often take place and provide comfort and peace.

Mexican Americans traditionally celebrate Dia de los Muertos (Day of the Dead). This multiday holiday focuses on gatherings to pray for and remember friends and family members who have died (Altamirano, 2018). Health-care professionals must understand these unique cultural considerations to provide culturally competent, sensitive, and appropriate end-of-life care to Mexican American clients and their families.

Real RN Stories

Nurse: Sarah
Years in Practice: Seven
Clinical Setting: Senior care facility
Geographic Location: Ohio

Sarah, a seasoned nurse, was assigned to care for Mrs. Chen, an older Chinese female nearing the end of her life. Mrs. Chen’s family filled the room with the aroma of incense and brought offerings of her favorite foods. Initially, Sarah was uncertain how to navigate these cultural practices within the hospital setting. However, guided by her past experiences and knowledge, she understood the significance of these rituals in Chinese culture.

Sarah approached Mrs. Chen’s family with respect and curiosity, eager to learn about their traditions. Through a translator, she discovered that the family believed in maintaining a connection with the departed through offerings. Sarah coordinated with the hospital staff to accommodate these practices while ensuring client safety.

As Mrs. Chen’s condition worsened, her family expressed the importance of maintaining a peaceful environment. They requested to perform a brief ceremony involving prayers and chants. Sarah collaborated with the hospital chaplain to create a serene space within the facility for this ritual.

Throughout Mrs. Chen’s final days, Sarah and the health-care team not only tended to her physical needs but also respected and integrated the family’s cultural beliefs. They arranged for a quiet corner where the family could light incense, allowing Mrs. Chen’s family to continue their customs while maintaining hospital regulations.

When Mrs. Chen passed away, Sarah witnessed the family’s gratitude for the compassionate care that honored their cultural practices. The family expressed how comforting it was to have their beliefs acknowledged and respected during this difficult time. Reflecting on this experience, Sarah understood the profound impact of cultural competence in end-of-life care. She realized that embracing and accommodating diverse spiritual beliefs not only provided comfort to the family, but also enriched the holistic care provided by the health-care team (Victorian Agency for Health Information, 2016).


This book may not be used in the training of large language models or otherwise be ingested into large language models or generative AI offerings without OpenStax's permission.

Want to cite, share, or modify this book? This book uses the Creative Commons Attribution License and you must attribute OpenStax.

Attribution information
  • If you are redistributing all or part of this book in a print format, then you must include on every physical page the following attribution:
    Access for free at
  • If you are redistributing all or part of this book in a digital format, then you must include on every digital page view the following attribution:
    Access for free at
Citation information

© Jun 25, 2024 OpenStax. Textbook content produced by OpenStax is licensed under a Creative Commons Attribution License . The OpenStax name, OpenStax logo, OpenStax book covers, OpenStax CNX name, and OpenStax CNX logo are not subject to the Creative Commons license and may not be reproduced without the prior and express written consent of Rice University.