According to Eyetsemitan, the traditional African belief system is also referred to as ancestor worship and is based on an understanding that the life course is cyclical and not linear. Based on this system of belief, those who are dead are alive in a different world and can reincarnate (and return to this world) in new births. Death is considered a rite of passage for those who die at an acceptable (old) age. When death occurs in Africa, divination as to the cause of death is sought from dead ancestors, with death causes usually attributed to spiritual elements (witchcraft, offending one’s ancestors, or Gods) rather than medical or physical reasons. Furthermore, it is an African cultural belief that to be in the world of the dead confers supernatural powers over those in the world of the living, such as the ability to bless or to curse, and to give life or to take life among others.

After death, an individual lives in a spirit world, receiving a new body which is identical to the earthly body, but with the capacity to move about as an ancestor. Becoming an ancestor after death is thus a desirable goal of every individual and it is believed that this cannot be achieved if an individual did not live a meaningful life, or had his or her life cut short say through an accident or by an unnatural death. An African individual would, therefore, prefer a slow and lingering death that comes naturally, as they would not only be able to tidy up many issues such as making peace and saying farewell to relatives, but also they would also be admitted in the spirit world. Death in any group apart from the very old is considered unnatural and premature.

With the belief that the goal of life is to become an ancestor after death, a person is given a proper burial after death as failure to do this may result in the individual becoming a wandering ghost, unable to live properly after death, and constituting a danger to those who are still alive. Lending credence to the African concept of death, Dancy and Davis assert that death indicates the physical separation of the individual from other humans. Funeral rites and ceremonies serve to draw attention to this permanent separation, and particular attention is paid to the funeral rites to avoid undue offense to the dead. Death rituals and the mourning practices of Africans are varied because of the existence of so many religious and cultural practices. African societies are communalistic and do not acknowledge advance care directives which according to many Africans encourage “atomistic individualism.” Atomistic individualism refers to the idea that the isolated individual is the only fundamental reality and that the individual is the natural atom in artificial social composite. In Africa, individuals are brought up from childhood with a sense of belonging and relatedness with others. Individuals, thus, have a sense of obligation to a larger set of other individuals. This is one of the reasons why African tradition does not recognize the roles that advance care directives play in end-of-life decision-making for an incompetent patient. Instead, decision-making at the end-of-life period is left to the members of the family of the person concerned, an act which introduces unhealthy disagreement as events unfold. Africans do not like facing the reality of death and often do not encourage the contemplation of death, be it their own death or the death of their loved ones. It is somewhat a taboo to think of or discuss one’s death. Hence, people do not write their living wills or set aside money for their funeral while still alive, contrary to the practice in the western world. Death is also considered an enemy of life and Africans believe life should be preserved by all means even if the case is a hopeless one. The average African is not likely to discontinue life-sustaining treatment once it has commenced, and also do not favor any artificial termination of life. In the African culture, therefore, the elderly or aged may give verbal instructions to their children concerning their care at the end of their lives. Such instructions may include avoiding prolonged hospital stay, allowing them to die on their own beds and in their children’s arms at home, how to conduct the burial ceremony, where they are to be buried. Cultural and spiritual beliefs tend to make individuals, especially the middle-aged ones, avoid making end-of-life decisions while still alive and young. In addition, the practice of paternalistic medicine and its attendant effects on individuals after encountering physicians make such individuals even more resolute not to discuss pertinent personal issues with their doctors. This is because a paternalistic approach by the physician portrays a lack of empathy among others and this invariably diminishes any iota of trust the patient might have had for the physician.


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