Advance Care Planning can address racial disparities at end of life care

By Aisha C. Young

In March 2022, the Pew Research Center released its report titled “Black Catholics in America.” The statistics are salient for serving Black Catholics. The numbers in this report are mirrored in the Diocese of Colorado Springs in that Black Catholics are a “minority,” and by extension, there are fewer Black Catholics over the age of 65. Older Black Catholics have never been the sole focus of a study. Are we providing them with the best information about end-of-life decisions?

Few resources address Black elder care and end-of-life-issues. However, on Oct. 11, industry experts will address these issues at a symposium titled “Meet Me at the Crossroads: Advance Care Planning for African-Americans.”

This event will take place at the Lowry Conference Center, 1061 Akron Way, Denver, 80230. A notary will also be available on site at no charge for symposium participants. Space is limited and registration is required at https://bit.ly/MMAC2023. For more information contact aaig.org@gmail.com or (719) 581-9437.

There are many reasons why people are afraid to have conversations about death and dying. Some are afraid because of the belief that it may cause a dying person to lose hope and give up, while others feel like these conversations are disrespectful and offensive. Some believe that it may speed up the dying process. Others may want to only have these conversations with a priest or other clergy member. As Catholics, we know that the topics of death and dying are not often addressed in homilies, even though everyone will face death sooner or later.

It is important for people to be aware of Advance Care Planning (ACP) and why it is imperative, especially for people of faith. Advance care planning involves discussing and preparing for future decisions about one’s medical care in the case of serious illness or inability to communicate one’s wishes.

Advance Directives (ADs) are written statements of a person’s wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor. The Advance Directives recognized in Colorado are Medical Durable Power of Attorney, living wills, CPR directives, Medical Orders for Scope of Treatment (MOST), and Psychiatric Advance Directives. All these forms are available online at no cost.

Studies have shown differences in completion rates of Advance Directives by ethnic group. Whites, overall, are more likely to complete Advance Directives. Blacks are less likely to complete ADs than whites and other racial and ethnic groups and are more likely than whites to pursue aggressive care at the end of life. They are more likely than other ethnic groups to choose life support. These differences in care preferences persist even after people enter hospice. Blacks are more likely than whites to exit hospice to pursue aggressive care and are less likely to return.

Latinos also show lower rates of participation in advance care planning. According to the Institute of Medicine Report “Dying in America” (2015), Latinos are the least-studied population regarding care preferences and decision-making at the end of life. Latinos are less likely than whites to have an AD and to report having discussions about ADs. The study also indicated that Latinos were less likely to believe that a formal health care proxy was needed for family members. Few studies have included Asians and First Nation/ Indigenous people.

Other studies have shown that older adults are more likely to complete ADs than younger adults, and lower income has been associated with lower rates of AD completion.

Religion also plays a role. Individuals who completed ADs reported receiving less strength and comfort from religion than those who chose not to complete ADs.

Many cultural differences contribute to the racial disparities in hospice use, end-of-life care planning and palliative care services in general. African-Americans are less likely to discuss advance care planning and end-of-life care. As a result, they are less likely to use resources like hospice and palliative care. Churches can play a positive role in educating people about the ethical and moral issues involved in end-of-life care.

(Aisha C. Young is president of the Colorado Springs Council for Black Catholics.)