Addressing cultural incongruities of advance directives

Shared meanings and socially constructed realities have great significance to individuals and families facing critical illness, pain, suffering, or death. Actions are often based on the context of the professional and dominant societal culture. The concept of Advance Directives is consistent with the dominant value orientation in the American culture of self-reliance and individualism, which places a high premium on self-determination and control of one's own destiny. However, this value is not always consistent with the dominant cultural views of particular sick or dying individuals. Thus, at a time when individuals and their families need the most support, institutionalized care often creates incongruities and meaninglessness.