Cultural and religious differences between the patient and the medical team are an underappreciated barrier to negotiating a sensitive and dignified process of dying for the patient. Medical professionals often have little understanding of their patients' views about health care decision making, life-sustaining technology, and the definitions of life and death (O'Rourke 1992). Impaired understanding because of cultural differences can make an already difficult struggle harder.

Cultures differ about definitions of life, death, and dying. For example, on the island of Vanatinai, southeast of Papua New Guinea, people are thought of as dead whom we would consider merely unconscious. Thus, it is possible for a person to die a number of times. On Vanatinai, considering someone to be dead generally leads to what we would consider medical neglect, but this disregard fits the cultural view (Rosenblatt 1993). In Hinduism, living is more than being alive, and quality of life plays an important part in the Hindu definition of life and death (Crawford 1995). Although brain death is a commonly accepted definition of death in the United States, Orthodox Jews do not accept it, and removing life support from a person who is brain dead is seen as tantamount to murder (Paris et al. 1995).

In times of crisis and when facing one's own mortality, religious and familial/cultural values are sources of strength and comfort. Recently, authors have disagreed about whether the Western emphasis on autonomy and full disclosure is respectful of dying patients with different cultural traditions.