Peace and Conflict Studies - Spring 2014

Peace and Conflict Studies Volume 21, Number 1 52 account factors such as insurance status, age, income, and illness severity (Institute of Medicine of the National Academies (IOMNA), 2002; American Medical Association, 2009). This unequal treatment is also present in end-of-life care (Welch, Teno, & Mor, 2005). Many dying patients are subjected to unnecessary pain as a result of caregivers’ lack of knowledge of available pharmacological interventions and ignorance as to other available palliative care (Institute of Medicine (IOM), 1997; Krakauer et al., 2002). Furthermore, cultural biases and fears about death are a contributing factor in healthcare professionals avoiding dying patients and their families (IOM, 1997). Additionally, minority patients’ responses to physicians’ biases and their own biases may result in higher levels of mistrust towards clinicians and healthcare institutions when compared with white patients (Dovidio & Fiske, 2012). In an attempt to improve the communication skills of physicians with dying patients across cultures and reducing health care inequalities, cultural competence programs have flourished throughout the United States. Medical schools and residency programs in the United States are required to include in their curriculum CCT and education in end-of-life care (Chun, Yamada, Huh, Hew, & Tasaka, 2010; Sulmasy, Cimino, He, & Frishman, 2008; Graves, Like, Kelly, & Hohensee, 2007). Although research indicates that CCT has the potential for improving cross-cultural communication between physicians and patients, evidence linking minority healthcare disparities with lack of cultural competence is, at the most, meager (Stone, 2008; Yamada & Breckke, 2008). Herein I argue that dying patients, in particular minorities, in acute care facilities are victims of larger social forces (e.g., poverty, racism, and discrimination) who are either ignored or marginalized during their last days. I maintain that in order to address healthcare inequalities in end-of-life care, it is imperative to address the power structures that allow for health disparities to take place (Farmer, 2010; Farmer, Nizeye, Stulac, & Keshavjee, 2006). Blaming physicians’ lack of cultural competence for health disparities is at best, a cop-out strategy. Playing the blaming game provides a false sense of action and ignores the root causes of unequal distributions of power within the health care system. In many healthcare CCTs, culture has been reduced to a utilitarian variable, “a kind of quasi-analytical category used to explain variation in behavior” (Stephenson, 2001, p. 4). Minorities continue to suffer painful deaths in acute hospitals and their end-of-life care preferences are ignored because they are dying, immigrants, poor, non-white, and victims of racism; it is not because physicians lack cultural competency.