ABSTRACT
Culture has been suggested to encompass an even broader contextual overlay of variables such as spirituality, religiosity, age, gender, sexual orientation, socio-economic status, and health/disability status (Hayslip, Hansson, Starkweather, & Dolan, 2009). The degree of acculturation to the dominant group’s values adds further nuances; a Muscogee Creek Indian, for example, may integrate into mainstream culture for employment and social group while a member of his or her family speaks only his or her native tongue. Cultural diversity is highly complex, especially in relationship to end-of-life decisions, and there may be much more variation within than between groups. Kagawa-Singer and Blackhall (2010) recommended “finding a balance between cultural stereotyping and cultural empiricism…by neither disregarding culture nor assuming one is part of a list of stereotypical characteristics” (p. 331).
