Dr. Crawley completed a research ethics fellowship at the Stanford University Center for Biomedical Ethics and is currently a lecturer in the School of Medicine there. She is the recipient of a Soros Faculty Scholars Award (1999-2001) for the Open Society Institute's Project on Death in America. This award builds on the Stanford Center for Biomedical Ethics' work on multi-cultural approaches to end-of-life decision-making and care and supports new projects to advance culturally sensitive end-of-life education. A graduate of Meharry Medical College, she has practiced medicine in the Indian Health Service and has published on her experience in providing culturally sensitive prenatal care on the Navajo reservation. Dr. Crawley also serves on the steering committees of the California Coalition for Compassionate Care and the UC Berkeley Center for Medicine, Humanities and the Law.

Understanding How Culture Intersects with Death and Dying
The decisions that individuals, families and health care providers face at the end of life--issues of disclosure of diagnoses or prognosis, decisions to limit treatment, and the use of advance directives, to name a few--are often complex and difficult. In the best of circumstances, these decisions are made in the context of a shared understanding of all the factors that are at play. When there is a shared understanding of and mutual agreement regarding the clinical course and treatment decisions, the risk of conflicts regarding end-of-life decision-making may be lessened. Moral conflicts may arise, however, when there is a clash among the underlying values.

Collaborative decision making involving ethical issues is a complex process of communication and negotiation between all parties. Central to this process is how medical information is understood in light of the values, beliefs, roles and identities of the patient, their family, and members of the health care team. Culture--the organizing framework around which shared values, beliefs, and practices are constructed--is an important influence on the processes involved in reaching a decision. It is important to realize that the medical world has its own culture that influences the way the health care professional understands and interprets medical and ethical situations.

The goal of ethics consultation is to assist an individual, family, and the health care team to find a common ground to participate in shared or collaborative decision-making. This process of negotiation requires not only ascertaining which values are in operation for both the patient or family and the health care providers, but also to seek an understanding of the intentions behind these values. The objective would then be to seek creative solutions that meet the underlying goals for care.

LaVera Crawley's Recommended Reading
The Stanford Center for Biomedical Ethics compiled an extensive on-line bibliography on these and related issues for the Robert Wood Johnson Last Acts Campaign. It can be found at http://www.lastacts.org/files/misc/la_diversity.htm