Varied Understandings of the Role of Health Professionals or Healers

Just as the appropriate role of parents or family members caring for a seriously ill person may vary, the families' expectation of the role played by health professionals may differ. In some societies, healers are expected to make a diagnosis almost magically, perhaps by feeling the pulse without asking any questions. Healers may exert considerable power and authority; they may expect and receive deferential behavior. Patients and families schooled in these traditions may be confused by the shared decision-making ideals of Western practice. They may lose confidence in physicians who do not appear to know unequivocally the correct course of action but instead ask for the patient's views.

In many societies the roles of healer and religious specialist intersect. "Each religious tradition has its own images and ideals of the doctor, in which the individual engaged in healing is defined as enacting some of the highest ideals of the tradition itself" (Barnes, Plotnikoff, Fox, and Pendleton). The healer's role at the end of life may be particularly meaningful, or it may be proscribed to take on the care of those not expected to survive, as in the Hippocratic tradition.

Families who have been denied access to healthcare providers may also question the trustworthiness of the "establishment" health system, worried that those in power do not have their best interest at heart. The disparities in morbidity and mortality across U.S. populations suggest that often African-American patients receive less intensive care. The irony is that research on end-of-life decision making in adults reveals that minority patients may actually desire more aggressive care near the end of life (Caralis, Davis, Wright, and Marcial; Tulsky, Cassileth, and Bennett).

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