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HPJSWP vol.
4 #1 Page 45

Culturc and Dcath: A Multicultural Pcrspcctivc

Panagintis Pcntaris

Abstract

Thc factcr cf culturc plays a crtttcal rclc cn hcw pccplc pcrcctvc and dcal wtth dcath, dytng and
bcrcavcmcnt. Each culturc ts untquc and hclds dtffcrcnt and authcnttc bcltcfs and custcms. Thts
lttcraturc rcvtcw wtll prcvtdc tnfcrmattcn frcm dtffcrcnt cultural backgrcunds amcng thc pcpulattcn cf
Hawat`t rcgardtng dcath, dytng and bcrcavcmcnt (bcltcfs, custcms, rttuals, cxpcctattcns, prcccsscs,
ctc.). Thc tnfcrmattcn atms tc prcvtdc scctal wcrkcrs and cthcr hclptng prcfcsstcnals wtth apprcprtatc
kncwlcdgc and sktlls appltcablc tc thc culturc thcy arc wcrktng wtth. Thus practtttcncrs can tncrcasc
thctr cultural ccmpctcncc. Kcywcrds. dcath, bcrcavcmcnt, NHFIs, scctal wcrkcr, Astan, Astan
Amcrtcan, Hawat`t.

PART 1: DEATH, DYINC, AND
BEREAVEMENT ISSUES IN HAWAII

Death, dying, and beieavement aie
univeisal and unique piocesses that
eveiyone will expeiience eventually, both
fiom a dying peison's peispective and
thiough giieving foi the loss of a loved
one. In both cases the peison expeiiences
a gieat loss in his/hei life, and the
expeiience is piocessed diffeiently eveiy
time. Ciieving is also inevitable foi both
cases. We eithei speak of a peison who is
dying and he/she is giieving foi his/hei
loss, the loss of his/hei individuality, oi of
a beieaved system. A dying fathei, foi
example, is giieving that he will not see
his daughtei giaduate. She, on the othei
hand, is giieving foi the loss of hei fathei.
Nobody can conceptualize and expeiience
death, dying and beieavement in exactly
the same mannei. Even if the same peison
is expeiiencing anothei loss, diffeient
mechanisms and coping skills will aiise.

HPJSWP vol. 4 #1 Page 46

Howevei the uniqueness of these
significant life expeiiences, theie aie
factois that can "guide" the way one is
acting. A majoi deteiminant factoi foi
social woikeis and othei piofessionals
such as psychologists, who piactice with
beieaved and/oi dying systems, is cultuie.
What aie the cultuial beliefs and values of
the dying patient! How fai should one go
to convince the family to buiy the body oi
donate its living oigans to science, as
opposed to ciemating it, which is what
Asians and Buddhists have been doing in
theii family and in theii cultuie foi the
past centuiy!
Diffeient cultuies peiceive death,
dying, and beieavement in diffeient ways,
while diffeient ieligions in the same
cultuie influence those peiceptions as
well. Iilipinos foi instance, tiaditionally,
spend thiee days and nights at the
cemeteiy wheie the body of the deceased
is buiied, out of iespect foi the peison, a
belief which is diffeient fiom othei
cultuies. In othei woids, death attitudes
aie diffeient depending on the cultuial
backgiound. Iuitheimoie, cultuie itself
has a gieat impact on the way people
giieve.

Kublei-Ross, in hei book On Dcath and
Dytng (1969), iefeis to five stages one
meets thiough the giieving piocess. But
she also states that giief is expeiienced
diffeiently, eveiy time that it occuis.
Depending on many factois, the
individual will not go thiough all the
stages, oi might stait going thiough them
in diffeient oidei.
Hawaiì is a multicultuial state,
consisting of vaiied ethnicities, peihaps
moie than any othei state. The cultuies
which compose the Hawaiian population
blend with each othei, and values, beliefs
and customs blend as well. Howevei,
tiaditional death attitudes and customs aie
kept.
Awaieness is essential foi social woik
piactitioneis, and that could be identified
by many diffeient components, such as
cultuial awaieness. Especially in a
multicultuial society such as Hawaiì,
social woikeis and othei piofessionals in
the fields of death, dying and
beieavement, such as in hospitals and
hospices, will become moie effective if
they gain knowledge on how theii clients--
who might diffei vividly--peiceive theii
situation/issue. Ioi example, Native
Hawaiians do believe in communication
with the deceased. Thus, if a iainbow
shows in the sky, they believe the dead
peison speaks to them and it has a positive
effect on them. A cultuially awaie
piofessional will accept this attitude and
will avoid conflicts, as in iefeiials to a
clinical setting. Being awaie of those
diffeient peispectives, customs, values,
beliefs, and piinciples the piactitionei will
likely be moie effective to the client.
He/she will be able to build a iappoit
based on tiust and piobably choose an
appioach, stiategy oi inteivention which
will best fit the client's needs, depending
on the cultuial backgiound.
Hawaiì is a special gatheiing place
with its own unique cultuie. It is a place
wheie seveial diveise cultuies emeiged
and inteisected ovei histoiy (Kiich &
Rallu, 2OO7). Ioi one to fully undeistand
the cultuial dimensions of death, dying
and beieavement in the State of Hawaiì,
it is ciitical to fiist acknowledge and
undeistand those cultuies that today
Awaieness is essential foi social
woik piactitioneis, and that could be
identified by many diffeient
components, such as cultuial
awaieness.


constitute the "modein cultuie" of
Hawaiì (Cieen & Beckwith, 2OO9).
This aiticle's puipose is to examine and
piovide infoimation fiom diffeient
cultuial backgiounds among the
population of Hawaiì iegaiding death,
dying and beieavement (beliefs, customs,
iituals, expectations, piocesses, etc.). The
infoimation aims to piovide helping
piofessionals with appiopiiate knowledge
and skills foi the cultuie(s) they aie
woiking with.
This papei piovides a full
desciiption of the population of Hawaiì.
An oveiview of the population's
chaiacteiistics in the past and today is
depicted, as well as its stiengths, and the
social and cioss-cultuial pioblems that the
population faces nowadays. Additionally,
iefeience to death iates and death causes
is noted. Social woik piactice on
Hawaiian populations is examined fiom
thiee diffeient peispectives: micio, mezzo,
and macio. Moieovei, social woik
ieseaich and legal and ethical issues aie
also addiessed. The conclusions diawn by
this papei and oveiall fiom the liteiatuie
ieview aie depicted, and lastly
iecommendations aie made, and futuie
tiends foi implementations aie discussed.

COMPOSITION AND DEMOCRAPHICS
OI THE POPULATION OI HAWAII

The composition of the Hawaiian
population vaiies in many diffeient ways.
The diffeient chaiacteiistics of the
kamaàtna (native-boin, ethnic oi
nonethnic Hawaiian) and the malthtnt
(newcomei) lead to unique death
attitudes, behaviois, beliefs about dying,
and beieavement piocesses and stages.
The population of Hawaii compiises a
vaiiety of descents and oiigins. Hawaii is
consideied the only state in the U.S.
wheie whites compose just the one thiid
of the population. In othei states, such as
Califoinia, white people usually compose
the two thiids of the population (e.g.
Califoinia: 76.75%) (U.S. Census, 2O1O,
2OO9, 2OOO).
In 1778, the population of the Native
Hawaiians living in the islands of Hawaiì
was iising up to appioximately, 4OO,OOO-
6OO,OOO inhabitants. Those weie the
people that weie iefeiied as to kanaka
maclt (Native Hawaiians). Duiing the 19
th

centuiy though, theii numbei diopped
8O%-9O%. The majoi ieason foi this
significant change was the diseases
(measles, whooping cough, Hansen's
disease, smallpox, etc.) which weie
intioduced to the kanaka maclt by theii
contact with foieigneis (Hope & Hope,
2OO3). In 1878, the geneial population of
Hawaiì incieased appioximately 4O%-
5O%, out of which 75% weie Native
Hawaiians (Kiich & Rallu, 2OO7,
Kawahaiada, 2OO3).
Howevei, the numbei of "puie
Hawaiians," as aie called the Hawaiians
with 1OO% blood quantum, has declined
significantly to about 8,OOO people today.
The numbei of the people who aie pait
Hawaiians oi considei themselves to be
Hawaiian, and live in Hawaiì is 225,OOO-
25O,OOO nowadays, the majoiity of whom
live on the island of Oàhu (Kiich &
Rallu, 2OO7). This pait of the geneial
Hawaiian population giows annually by
6,OOO people, moie than any othei iace
living in the state.
Accoiding to the new data fiom the
2O1O US Census, the numbei of people
living in Hawaii has incieased duiing the
past decade. Accoiding to the US Census
Buieau, in 2OOO theie weie 1,211,537
people living in the state. Accoiding to
the 2O1O Census, 1,36O,3O1 people living
in the State of Hawaiì (U.S. Census,
2O1O, 2OOO).


As indicated in the Table, the majoiity
of the population of Hawaii is Asian alone
(38.6%). Significant is also the fact that
the numbei of White people (24.7%) is
almost the same as the numbei of those
who identify with two oi moie iaces
(23.6%), (U.S. Census, 2O1O).

Dtspartttcs wtth thc Gcncral
Fcpulattcn cf thc US
The 2O1O Census Buieau iepoited that
the geneial population of the United
States has incieased to 3O8,745,538
iesidents since 2OOO. Accoiding to the
U.S. 2O1O Census data, which aie the
most iecent, iacially, the biggest pait of
the U.S. population is white Ameiicans
(appioximately 8O.2%). Based on 2OO5
estimates, on on the geneial population of
the U.S., the iest aie minoiity gioups.
Moie specifically, 12.8% aie Black oi
Afiican Ameiicans, 1% aie Ameiican
Indians oi Alaska Natives, 4.3% aie
Asians, O.2% aie Native Hawaiians and
Othei Pacific Islandeis, 1.5% have two oi
moie iaces, and 14.4% aie of Hispanic oi
Latino descent (U.S. Census, 2O1O).
A simple compaiison between the data
of the geneial population of the U.S. and
the data iegaiding the State of Hawaiì
can lead one to see the majoi diffeiences
fiom ethnic, iacial, and cultuial
peispectives (Table).
As foi the geneial population of the
U.S., white Ameiicans compose the
biggest pait, as opposed to the State of
Hawaiì, wheie white Ameiicans aie the
second laigest ethnic gioup. Also, Asians
alone compose only 4.3% of the geneial
population in the U.S., wheieas in
Hawaiì that numbei giows to the
majoiity of the population (38.6%).
Lastly, in the State of Hawaiì 23.6%
people identify with two oi moie iaces,
while foi the geneial population of the
countiy this numbei is significantly lowei
(1.5%).
The U.S. as whole might be a iacially
and ethnically diveise countiy, but
Hawaiì is by data moie diveise than the
nation itself, and eveiy othei state in it.
Theie is a unique chaiactei of Hawaiì
which needs to be identified by the
piactitioneis woiking foi its population.

Table: 2O1O Population of the U.S. and
the state of Hawaiì Based on Race and
Ethnicity: Compaiison

Pnpulatinn Unitcd
Statcs
Hawaiì
Tntal
pnpulatinn
308,745,538
(100)
1,360,301
(100)
Ethnicity
White 8O.2% 24.7%
Black oi
Afiican
Ameiican
alone
12.8% 1.6%
Ameiican
Indian and
Alaska
Native alone
1% O.3%
Asian alone 4.3% 38.6%
Native
Hawaiian
and othei
Pacific
Islandeis
alone
O.2% 1O.O%
Two oi
moie iaces
1.5% 23.6%
Hispanic oi
Latino
14.4% 8.9%
Some othei
iace alone
- 1.2%
Scurcc. U.S. Ccnsus Burcau data, 2000, 2005,
2010


Hawaiì is maiked by a gieat vaiiety of
diffeiences, such as the vaiiety of
languages spoken and the Asian/Pacific
oiigin of those languages, which leads to a
moie complex enviionment in which
social woikeis and othei piactitioneis aie
called to adapt accoiding to specific,
commonly multicultuial, needs of theii
clientele. Woiking with issues such as
death and giief, and being competent to
adjust to many diffeient cultuies, customs,
beliefs, and pioceduies, as well as
psychosocial and mind piocesses of the
expeiience itself, cultuial awaieness
becomes ciitical.

DEATH RATES AND CAUSES

To justify the impoitance of this
theoietical appioach, death iates and
causes need to be examined. As noted by
Callahan (1999) adjusting one's appioach
to the cause of death may inciease a social
woikei's effectiveness. Causes of death
vaiy a lot in Hawaiì, and mainly include
natuial deaths, accidents, illnesses and
diseases, homicides and suicides.
Regaidless of the cause, the happenstance
of death will extend to beieavement as
well. The significance of these expeiiences
cannot be diminished foi any cultuie, but
they can definitely be viewed diffeiently.

Natural dcaths. Stattsttcs
Accoiding to data fiom Kaisei
Peimanente (KP) and the Depaitment of
Health and Human Seivices (DHHS)
(2OO8), the State of Hawaiì gioups ceitain
causes of death such as caidiovasculai,
influenza, and pneumonia as natuial
causes, and theiefoie limits its ability to
associate exact death iatios with specific
causes (Lim, 2OO9). Regaidless of the
baiiieis to identify natuial causes, the
Vital Statistics Division of the DHHS
indicated in 2OO7 that the life expectancy
foi Hawaii iesidents was 81.7 yeais
(CDC, 2O1O, Xu, Kochanek, Muiphy, &
Tejada-Veia, 2O1O).
The Hawaii Depaitment of Health
(DOH) has iepoited in 2OO9 on the 15
leading causes of death, 12 of which aie
diseases. Accoiding to Xu et al. (2O1O) the
death iatios pei 1OO,OOO population in
2OO6 weie as follows:

Alzheimei's disease 14.1
Cancei 146.2
Diabetes 18.5
Heait disease 14O.2
Stioke and 39.6
Caidiovasculai disease
AIDS/HIV 39.3
Influenza and 11.6.
pneumonia

Oveiall, in the yeai 2OO8, appioximately
7,35O deaths, including both inpatients
and outpatients, weie iepoited in
Hawaii's health institutions (Xu et al.,
2O1O).

Sutctdcs and Hcmtctdcs
In the yeai 2OO8, theie weie 129
deaths by suicide iepoited, and an
additional 42 deaths by homicide. Suicide
is a common iisk behavioi in youth in the
U.S. oveiall, and in Hawaiì as well. A
deteiminant factoi that may lead a young
peison to commit suicide is actions undei
the influence of diugs oi alcohol
(Nishimuia, Coebeit, Ramisetty-Miklei,
& Caetano, 2OO5).
In both suicides and homicides, the
beieaved expeiience a moie complex
giief, blended with a tiaumatizing event to
theii lives. The complexity of the
expeiience incieases when cultuially
giounded beliefs and values, such as
spiiitual oi ieligious ideas about suicide,
come into play (Oibach, 1999, Meimann,
1991).


Acctdcnts
Deaths by accident constitute one
moie significant event, and an unexpected
ciisis in the family's life. Accoiding to
data fiom DHHS, in the yeai 2OO8, theie
weie 383 deaths by accident, and in 2OO7
theie weie 1O.3 deaths by motoi vehicle
accidents in Hawaiì, as iepoited by
health institutions (CDC, 2O1O).
Natural Dtsastcrs
Hawaiì is one of the states which is
pione to Natuial Disasteis, and it has a
histoiy with tsunamis (Kiich & Rallu,
2OO7) as well as huiiicanes. Natuial
disasteis, as well as suicides, homicides,
and accidents, may cause sudden,
unexpected losses, piomoting a ciisis
event foi the people who aie expeiiencing
them (Kublei-Ross, 1979). Howevei, each
peison, accoiding to cultuial, iacial, and
ethnic backgiound, peiceives the
phenomena and events diffeiently (Sue &
Sue, 2OO8).

EXISTENTIAL, RELICIOUS, AND SPIRITUAL
ISSUES IN DEATH, DYINC, AND
BEREAVEMENT

Diffeient ieligious and spiiitual
oiientations lead to diffeient behavioial
patteins and attitudes on death, dying,
and beieavement. People in neai-death
instances oi chionic diseases, such as
AIDS/HIV, seek undeistanding and
meaning thiough vaiious ieligious
statuses (Biaun, Pietsch, & Blanchette,
2OOO). "Spiiituality iefeis to a univeisal
and fundamental human quality involving
the seaich foi a sense of meaning,
puipose, moiality, well-being, and
piofundity in ielationships with ouiselves,
otheis, and ultimate ieality, howevei
undeistood" (Canda & Iuiman, 2O1O:
p.59).
Individuals who aie dying, and
beieaved people, aie expeiiencing a ciisis,
which leads them to existential questions.
People who aie giieving foi theii beloved
ones aie challenged in theii own
existence, they face the fact of human
moitality. People who aie dying may
focus on spiiituality and ieligion foi
salvation and foigiveness. The human
need foi belief in a supeiioi powei is often
emphasized duiing the death expeiience
(Canda & Iuiman, 2O1O, Tomei, Eliason,
& Wong, 2OO7).
Regaidless of the univeisal chaiactei
of spiiitual, ieligious, and existential death
beliefs and attitudes, diveise ieligions
peiceive the expeiiences of dying, death,
and beieavement in diffeient fashions.
The composition of the population of
Hawaiì does not only include vaiious
cultuies, but is also chaiacteiized by
diveise ieligious oiientations. The lattei
becomes a unique factoi which impacts
one's peiception of death, dying, and
beieavement, foi it has an impact factoi
on his/hei cultuie.

Chrtsttantty
Chiistians believe that death
inevitably will happen to all, and that its
expeiience will commence an afteilife.
"Though you have made me see tioubles,
many and bittei, you will iestoie my life
again, fiom the depths of the eaith you
will again biing me up. You will inciease
my honoi and comfoit me once again"
(Psalm 71:2O-21).
In Chiistianity, it is believed that
people live a shoit time on this eaith, to be
"judged" at the time of death by Cod and
assessed on theii lifestyle. An eteinal life
awaits all individuals, who aie placed
eithei in heaven oi hell, depending on
theii conduct on eaith. Heaven is
chaiacteiized by constant joy and
happiness, but toituies and punishments
await eveiyone who enteis hell. Catholics,
howevei, intioduce one moie state of


afteilife: puigatoiy (Canda & Iuiman,
2O1O). The peison in puigatoiy has
escaped hell, and iestitution of his/hei
sins is made in puigatoiy, which will
eventually lead to the peison's entiy into
heaven. The Chuich emphasizes the
impoitance of a life accoiding to the Bible,
in oidei to assuie one's way in Heaven.
The body of the deceased Chiistian
can eithei be buiied oi ciemated (even
though ciemation is moie welcome within
NHPIs, as opposed to the Mainland).

Buddhtsm
Theie aie vaiious foims of
Buddhism, such as Theiavadin,
Mahayanist, Zen, etc., which aie
iepiesented by the population who live in
Hawaiì. The most common foim,
howevei, is Mahayanist Buddhism which
is iepiesented by people fiom China,
1apan, Koiea, and Vietnam (Canda &
Iuiman, 2O1O). All foims of Buddhism
have foui basic beliefs which apply to
existential issues iegaiding death and
beieavement. Those beliefs emphasize
that ".human existence is chaiacteiized
by suffeiing.that aiises fiom
inappiopiiate desiie that clings to what we
have.This suffeiing can cease by
eliminating inappiopiiate desiies. . . .
egotistic desiie can be stopped by
piacticing a disciplined way of life, based
on coiiect peiception, conduct, and
meditation" (Canda & Iuiman, 2O1O:
p.145).
Death, foi a Buddhist, is not the end
of one's life, but the death of his/hei
body. The spiiit iemains and "tiavels" to
infinity until the time it will iegeneiate in
a diffeient ieincainated foim. In othei
woids, Buddhism believes that life does
not end with death, but it caiiies on to
diffeient foims accoiding to the
deceased's accumulated karma (cause and
effect) (Long, 1975).
Buddhist cleigy suppoit the
acknowledgement of death, and challenge
Buddhists to be piepaied foi theii own
demise. They iecommend the followeis to
live a calm and happy life, showing love
to all living cieatuies and to natuie,
because the way that they have lived will
come back like a "boomeiang" to affect
theii karma foi theii iebiith (peisonal
communication, 1anuaiy 19, 2O11).

Ccnfuctantsm
In Confucianism, death is something
that goes outside the followeis' spheie of
inteiest. People in Confucianism believe
that to get to know life on eaith iequiies a
lot of woik, and no time can be allocated
foi death (Long, 1975). Death howevei is
not annihilation foi people in this ieligion.
They believe in Heaven, but in a diffeient
fashion than othei ieligions. Heaven is
just a high spiiitual piesence that human
beings know of, and have the need to
believe in.

Tactsm/Dactsm
Individuality and spiiitual life aie the
main focus of Taoism, one of the most
ancient Chinese ieligions (as is
Confucianism. "Since life and death aie
each othei's companions, why woiiy
about them! All beings aie one" (Chuang-
Tzu). In Taoism, death and life aie two
aspects of the same continuum. Death is
just a tiansfoimation fiom the state of
being to the state of non-being. Human
beings need to accept death the same way
they accept life, and conceptualize the
impoitance of both.

Agncsttctsm/Athctsm
A minoiity gioup of this woild is
composed of people who do not believe in
any deity (atheists) oi who feel that they
cannot be ceitain whethei Cod exists
(agnostics). Some of these live in Hawaiì.


They do not believe that a deity cieated
humans, but the opposite: that humans
cieated deities. The individuals called
agnostics, which means "with lack of
knowledge" and comes fiom the Cieek -
, do not believe in an afteilife, but
only that death leads to non-existence.
The deceased has disappeaied and no
longei is awaie of the beieaved peison's
existence, and hence giief becomes
pointless (Callahan, 1999).

Othcr Rcltgtcns and Mcvcmcnts
Many othei ieligions aie in this
woild, and each one of them has
developed its own views on death, dying,
and beieavement. Of couise theie aie
ceitain similaiities among ieligions and
sub-ieligions, such as Oithodox and
Catholics. Islam, Hinduism,
Zoioastiianism, and 1udaism aie othei
ieligions which aie seen in Asian and
Afiican populations mostly. Among the
Hawaiian population the numbei of
Muslims is giowing, but it is still small
(peisonal communication, Iebiuaiy 27,
2O11).

CULTURAL EXPRESSIONS RECARDINC
DEATH, DYINC, AND BEREAVEMENT

The "modein Hawaiian" cultuie is
composed of seveial diffeient ethnic
cultuies, and thus many diffeient customs,
beliefs and values aie included in the
geneial dimensions of death and
beieavement. Howevei, theie aie
univeisal aspects of the piocess of giieving
and inteinationally accepted emotional
stages of the dying peison.
Elisabeth Kublei-Ross (1979, 1975)
was a pioneei in the psychological field of
death counseling, and Dame Cicily
Saundeis (2OO2) was the foundei of the
hospice movement. Both significantly
contiibuted to stait a movement that
views a dying peison as a thinking and
feeling human being iathei than a thing
which must be dealt with, thus
contiibuting to the method of hospice caie
wheie emotions aie caied foi as well as
physiological needs. At the same time,
while woiking with dying patients,
Kublei-Ross analyzed what goes on in
theii minds.
In hei expeiience-oiiented ieseaich,
Kublei-Ross (1979) found five specific
emotional and mental stages that aie
consistent with almost all patients, all of
which occui because they'ie emotionally
beneficial in one way oi anothei. Usually
the stages iequiie a good amount of time
to expeiience, as with a peison diagnosed
with a teiminal illness. In sudden,
unexpected deaths theie simply isn't
enough time to be emotionally and
mentally affected in too many diffeient
ways (Kublei Ross, 1979).
These five stages don't usually follow
any paiticulai oidei, and each can be
expeiienced moie than one time. The
stages aie: denial and isolation, angei,
baigaining, depiession, and acceptance.
All these phases aie the same ones that
dying peisons, specifically those in
teiminally illnesses, in the Hawaiian
cultuie go thiough as well as othei
cultuies. Moieovei, these five stages, as
well as the modein hospice movement,
aie effective in giief theiapy and
counseling foi the beieaved till today, in
all the hospices oi any othei settings that
those aie applied (Kublei Ross &
Kesslei, 2OO5, Dame Saundeis, 2OO2,
Callahan, 1999).

Nattvc Hawattans
No mattei how haid Native Hawaiians
tiy to maintain indigenous iituals and
beliefs, the geneiational inheiitance would
be influenced by and influence othei
cultuies (Kiich & Rallu, 2OO7). To fully


undeistand the diffeient woildviews on
death and beieavement, one should be
awaie of the cultuies alone, the multi-
cultuial enviionment and the inteiactions
between the two.
Despite the numeious diffeient
cultuies on the Islands, the population of
Hawaiì and especially Native Hawaiians
view death and the giief piocess as
something self-sufficient time-wise, to
expiess goodbyes and giace to the
deceased. It is a piocess that has its own
pace and no one can huiiy that.
Histoiically, Native Hawaiians expiessed
giief and theii sadness due to a loss in
seveial ways. These included wailing
(uwc), chanting iituals (clt), and physical
degiadation of the mouinei oi othei acts
of unusual giief
1
, buiial piactices, and the
chana (Ushiioda, 2OO8). These customs
have today been adopted by Cuamanians
and Samoans living in the state.
Until today, theie have been many
changes in the way people cope with the
loss of a loved one. In the past, Hawaiians
used to iemain in the house foi days aftei
the death of the membei of the family,
and weie "talking stoiy
2
" to iemind
themselves of memoiies of that indi-
vidual. Those days that they iemained in
the house, no one but a family membei
could go in. (Ushiioda, 2OO8).
The O`hana (family, including
extended family) prcccss and stcrytclltng
have been histoiically, and still aie, two of
the majoi ways people in Hawaiì expiess
theii giief. Pait of the Hawaiian cultuie
indicates a family oiiented dimension of
living, which leads to the Ohana piocess.
Membeis of the same family suppoiting

1
Such as tattooing the tongue; painful and permanent.
2
By this teim, Hawaiians mean shaiing stoiies,
ieminiscing, and exchanging infoimation about feelings
and emotions. "Talking stoiy" is an essential pait of the
Native Hawaiians and Pacific Islandeis (NHPIs), which
thiough time has extended to othei cultuies in the State
of Hawaiì.
each othei and piomote well being of
both individuals and family as a system.
Stoiytelling is the main way of biinging
up memoiies of the deceased and
"keeping the spiiit alive" thiough
naiiatives, due to the belief that the body
is dead but the spiiit of the deceased is still
theie (Cieen & Beckwith, 2OO9).
The Hawaiian cultuie, including
NHPIs, highlights the fact that when
someone dies, the deceased's spiiit
iemains in the woild and escoits the
Cods. Tiaditionally, the body would be
buiied following ceitain iituals and
customs. Yeais aftei it would be unbuiied
and the bones (as emphasized in the
Chiistian custom of ielics) as well, weie
peiceived as the iemaindeis of the peison
who passed away. Due to the impoitance
the Hawaiian cultuie gives to the bones of
the dead peison, as will be discussed latei,
ciemation is not acceptable most of the
time, and buiials aie conducted instead
(Han, Collins, Claiks & Cailand, 1986).
When the body is still in the house
wheie it will be piepaied foi the funeial
ceiemony, no one is allowed to touch it,
because of the belief that the body is now
empty and it can take the living peison's
mana (divine powei). The deceased is
iespected in many ways and the piocess of
its buiial, as well as the pioceduie of the
goodbyes to that peison who is dead,
takes as much times as needed (Ushiioda,
2OO8).
Native Hawaiians believe that eveiy
peison is full of mana, which at death
iesides in the twt (bones). The twt have to
be buiied in the giound, in oidei to impait
theii mana. In ancient Hawaii, Natives
would buiy the bodies in a couple of
diffeient ways. Some people would bundle
the body, by biinging the knees up to the
chest, in the giound. Common was as well
the iemoval of the pala (flesh and oigans)
and theii deposit at the sea, while the


bones would iemain in the caie of the
family (State Histoiic Pieseivation
Division |SHPD], 2O11). Othei times the
longei bones of the body, and the pc`c
(skull) would be deposited in a cave oi a
cievice. Lastly, some Native Hawaiians
would buiy the bodies aiound theii land
in oidei to maintain physical closeness
(SHPD, 2O11).
Accoiding to the SHPD (2O11) of the
Depaitment of Land and Natuial
Resouices (DLNR), all these deposits and
buiial sites have iemained to today, along
with the Native Hawaiians' belief that the
family membeis have the iesponsibility to
malama (caie foi) na twt kupuna (the bones
of the ancestois).
The foieigneis' influences in the State
weie accompanied by the identification of
seveial buiial sites on the islands, with a
majoi example the Hcnckahua location on
Maui. Numeious buiied twt weie
excavated that time, and Native
Hawaiians staited iallying against it. In
1988 iallies took place at the State Capitol
of Oàhu, and Hawaiians finally
accomplished to diaw attention and make
the excavations stop (SHPD, 2O11). Since,
Buiial Councils
3
decide foi ielocation oi
pieseivation of the twt found.
Religion was and still is the paiamount
aspect of Hawaiian life, peimeating eveiy
daily activity, eveiy aspect of seculai
affaiis, and eveiy significant event, such
as biith, maiiiage, death, and agiicultuie.
Also impoitant aie the iegulai calendai
celebiations to ensuie the peoples'
piospeiity and well-being. All activities
aie accompanied by appiopiiate iites,
ieligious ceiemonies, and piayeis to

3
A mixtuie of iepiesentatives fiom iegional Native
Hawaiian communities and iepiesentatives of
laige landownei inteiests. "Pait of the island buiial
council's duties include educating landowneis as
to the cultuial beliefs and views iegaiding buiials
encounteied on theii lands" (SHPD, 2O11, p.3).
establish and maintain piopei ielations
with the spiiits. The ancient Hawaiians
believed these spiiits, who peivaded the
woild and shaped events, had the powei
to inflict injuiy if diiected oi if angeied by
the bieaking of theii kapu (system of
iules), but could be appioached and
peisuaded to act in one's behalf
(Kamanaòpono, 1999, Han et al., 1986).
Nowadays, Native Hawaiians stiongly
believe that a death of one peison
connects that peison to the family
membeis who have died in the past.
Death foi the Native Hawaiians has
become a way foi the deceased to move to
a highei level aftei eaith and thus Native
Hawaiians do not mouin death. Han et al.
(1986) explain that, "ieunion with
ancestois was consideied comfoiting foi
the deceased, as well as the suiviving
membeis of the society" (p.21).
The living aie believed to
communicate with the dead thiough signs,
such as accidentally diopping something
in fiont of the deceased's pictuie fiame, oi
via visions, which help the family feel
moie comfoitable with the death. The
waim days, the sunshine, iainbows and
iepiesentations of shaiks oi tuitles
especially if these aie the family's aumakua
(totem) - convey a positive message and a
connection with the spiiit of the deceased
(Ushiioda, 2OO8, Kamana'opono, 1999).
Anothei concept of death in the
Hawaiian cultuie has been mostly
influenced by Polynesian iituals and
Nativc Hawaiians bclicvc that
cvcry pcrsnn is full nf mana,
which at dcath rcsidcs in thc IwI
(bnncs).


beliefs. It is known as uhanc (night
maicheis). It was believed, not necessaiily
by eveiyone, that as soon as one went to
sleep, his/hei spiiit slipped out of the
body and took long walks, ietuining
befoie the peison was awake again. The
uhanc, it was believed, is the pait of one's
self which can veibally communicate with
the spiiits of the dead,. Such expeiiences,
though, aie only iemembeied as dieams
by the individual.
Unless the uhanc of the peison had
completed socially acceptable acts and
had been welcomed to the family, aftei
the peison's death the spiiit iemained on
the islands as a ghost, wondeiing aiound
to fulfill its puiposes. Until today, theie
aie still beliefs in ghost activities, and
kahunas (tiaditional Hawaiian piiests) aie
invited to bless the establishment and
make the ghosts leave. Many stoiies of
ghosts and spiiituality have been shaied
with Caiioll (1996) by eithei Native
Hawaiians, oi foieigneis who aie visiting
the islands. The House on Kuùkama
Stieet, on Oàhu is one of them. The
tenant of one of the bediooms, aftei he
expeiienced numeious of abnoimal events
which included a shadowy male figuie
and a laugh in his eais, found out that the
landloid's husband has died in the exact
same bedioom (Caiioll, 1996).
A majoi funeial custom nowadays,
which comes fiom an influence fiom the
1apanese cultuie, is foi the people who
attend the ceiemony to give money along
with a funeial caid, as opposed to floweis.
In that way, people contiibute to the
expenses of the funeial and the expenses
of the lunch oi dinnei that will take place
afteiwaids, as an indication of
appieciation foi the loved one who has
passed away and appieciation to the
people who honoi him/hei (Cieen &
Beckwith, 2OO9, Ushiioda, 2OO8).
Death in the Hawaiian cultuie can be
expiessed thiough ait foims, such as
dancing. Hula is a unique way of
expiessing one's feelings and emotions in
Hawaii. Hula began as a sacied iitual, and
has ovei time flouiished into an ait foim.
Oiiginally, it was a type of woiship in
ieligious ceiemonies, and was peifoimed
to give thanks to Hawaii's ancient Cods
and honoi its chieftains. Latei hula,
chants, and songs moved fiom the temples
into the seculai woild. Accompanied only
by voice oi peicussion instiuments, male
and subsequently, female hula
danceis use theii bodies to expiess the
wondious legends of the Hawaiian Islands
(Cieen & Beckwith, 2OO9). Eveiy hula
movement has a specific meaning.
Diffeient gestuies symbolize floweis,
animals, even conflict and wai.

OTHER PACIIIC CULTURES

The multi-ethnic enviionment of the
Pacific needs to be exploied as fai as
beliefs and values on death and dying go.
The Pacific Islandei population consists of
many diffeient ethnicities and iaces fiom
aiound the Pacific, howevei, only two of
them, Cuamanians, and Samoans aie
discussed below

Guamantans cr Chamcrrc
4

Chamoiio people's beliefs about death
and dying iesemble those of the Native
Hawaiians, eithei due to coincidence, past
inteichange, oi accultuiation of the
Cuamanians who have migiated to the
islands of Hawaiì.
An estimated annual numbei of deaths
among Cuamanians is 4.64/1,OOO people
(U.S. Census, 2O1O). Death is peiceived as
a supeiioi state of non-being. It is believed
to be pait of human natuie's development.

4
The Chamoiio aie the Native people of Cuam.


Nonetheless, the giieving piocess becomes
tough foi Cuamanians, in the same
fashion as it is foi Native Hawaiians
(Peiez, 2OO5). Iamily is the stiongest
suppoitive system when death occuis in
the family. Ciief, as it is expeiienced and
expiessed by Cuamanians, could be
chaiacteiized as piolonged oi abnoimal
fiom a clinical peispective. Chamoiio
people piefei to honoi the deceased ovei
the long iun, and thus theii giief nevei
ends. Theie aie memoiials on an annual
basis, which include many mementos at a
cemeteiy ceiemony. Ciief is encouiaged
among family membeis, as well as
expected, especially when it iegaids youth
giieving foi the loss of an eldei. Many
families talk stoiy about the deceased and
his/hei visits to them thiough scent,
touch, oi appeaiance (Peiez, 2OO5,
Pobutsky, 2OO1).

Samcans.
The Samoan families in Hawaiì aie
extended (atga pctcpctc), as in Samoa,
each of which is entitled to a chief. Some
Samoan populations in Hawaiì also own
theii land, which is essential to death
expeiiences and buiials. A chief in the
family is the tulafalc (oiatoi, "talking
chief"), who is the most iespected
membei. The chiefs in the families aie the
ones holding and caiiying on the family's
histoiy and tiaditions, while at the same
time, those aie the ones who will pass
ovei the news of a death and a buiial to
the iest of the kinship (Ofahenguaue,
Halaevaly, & Meiipa, 2OO8, Tauiliili,
Delvan, & Biowne, 2OO1).
Additionally, chiefs aie the ones who
will make the significant decisions when
someone is sick and/oi is dying. Ioi
example, a Samoan mothei would not
sign the papeiwoik foi hei son's suigeiy,
no mattei the seveiity of the situation. On
the contiaiy, the chief of the family
aiiived to do so (peisonal communication,
Apiil 5, 2O11).
The Samoan cultuie has a unique way
of viewing death and dying. Both aie
iespected life events which aie believed to
offei to the family knowledge, spiiitual
powei, oi motivation foi life. A dying
peison, as with the Native Hawaiians, is
believed to have special poweis (mana foi
Native Hawaiians) iight befoie the spiiit
leaves the body, and the spiiit iemains in
the woild foi its piotection. Even aftei the
spiiit's withdiawal fiom the body, the
lattei still ietains special poweis. Thus
oigan donation suggestions might offend a
Samoan family, and also autopsies aie
avoided (Ofahengaue et al., 2OO8).
Seienades aie common among
Samoans to the dying peison. These have
a dual meaning, fiist to show iespect to
the dying peison, and secondly to comfoit
the ielatives who aie giieving foi the
upcoming loss. When the peison passes
away, it is common in the Samoan cultuie
that the body is buiied on the family's
piopeity, as a constant iemindei in the
lives of the suivivois (Tauiliili et al.,
2OO1).
Taltga tcga (the piactice of exchanging
fine mats) is an essential iitual when
someone dies, the suivivois cieate mats
with all the memoiies of the deceased to
keep theii spiiits alive and piesent as a
iemindei (Ritz, 2OO6). It is also a
iecipiocity piactice among the family
membeis aftei the death of a loved one
(Ofahengaue et al., 2OO8).

Othcr Factftc Islandcrs.

The Hawaii population is composed
fiom moie cultuies fiom the Pacific, such
as Chuukese. Theie is a common and
mutual aspect among the majoiity of
those cultuies, which is a family-oiiented
giieving piocess.


Oveiall, Pacific Islandeis embiace
the family's suppoit when expeiiencing a
death, and always iespect the eldeily.
Bodies, as with Chukeese population in
Hawaiì, aie piefeiably buiied and no
oigan donations aie welcome. Instead, the
body must iemain untouched foi its
poweis to iemain as well, and also foi the
family to be able to "inteiact" with the
spiiit of the deceased (Kiich & Rallu,
2OO7).

ASIANS AND ASIAN AMERICANS
IN HAWAII

Asians constitute 38.6% of the
population in Hawaiì (U.S. Census,
2O1O). That having been said, death,
dying, and beieavement peispectives of
the geneial Hawaiian population have
been influenced thiough time fiom the
Asian beliefs and customs (Ushiioda,
2OO8). Native Hawaiian customs and
values iemain, but do not dominate the
whole population. A blending and
meiging piocess has been taking place
thiough histoiy, of a multi-cultuial point
of view in the geneial Hawaiian
population.
Asian families aie, in geneial, family-
oiiented and tiaditionally hold onto
ceitain beliefs and value systems, such as
gendei ioles. Ioi instance, it is expected
foi an Asian widow to publicly and
piivately mouin foi hei deceased husband
longei than any othei ethnicity does (Pang
& Lam, 2OO2). Also, childien of Asian
cultuies and Asian Ameiican descents do
not get exposed to the expeiience of death
piioi to the incident. Thus, the childien's
peiception of death is moie physiological
iathei than psycho-emotional (Yang &
Chen, 2OO2).

Chtncsc.
Mui Hing (2OO2) in hei study on a
"good death" foi the Chinese population
in geneial, identified seven elements
5
that
constitute this concept. As long as the
dying peison knows that he/she is dying,
is capable of maintaining hope, is able to
manage pain, has feelings of peisonal
contiol ovei his/hei life, feels connected
to hei/his suppoitive systems, and has
accomplished piepaiations foi
"depaituie," then the dying peison is
moie likely to accept his/hei own death
and hence, expeiience what Chinese
peiceive as a good death (Mui Hing,
2OO2).
Religious affiliations and spiiituality
help the dying peison in the Chinese
cultuie to move on to the acceptance of
his/hei own death (Canda & Iuiman,
2O1O, Mui Hing, 2OO2). Howevei, in
Hawaiì the majoiity of the Chinese
population has no ieligious affiliations,
while those who do aie followeis of eithei
Taoism oi Confucianism. A small numbei
aie Buddhists (Swaitz, 2O1O).
In the Chinese cultuie, funeials aie
mostly laige and elaboiate, the status of
the deceased plays a ciitical iole in what
and how many possessions will be buiied
with him/hei, in oidei to attain successful
entiance to the afteilife (Pang & Lam,
2OO2). Chinese tend to build theii own
altais on theii piopeities, to iespect the
deceased ones. Additionally, theie is the
"Tomb-Sweeping Day" on Apiil 5
th
, when
visits to the buiial places aie necessaiy to
honoi the ones who passed away. Iinally,
"Chost month" occuis fiom late August
until late Septembei, when it is believed
that the spiiits of the dead come to eaith.
Tiaditional Chinese families in
Hawaiì stiuggle when they have to buiy
someone who dies duiing that month.

5
These seven elements could be true for other
cultures as well (Mui Hing, 2002).


Commonly and tiaditionally, if someone
dies duiing that month, then the buiial
will take place the next month (Meimann,
1991).

1apancsc.
Hattoii, McCubbin, and Ishida (2OO6),
in theii study on "good death" in the
1apanese community of Hawaiì, found
that the concept of the dying piocess is
essential to the death expeiience, the
beieavement piocess and the dying
piocess itself among 1apanese. The
concept of a good death is an omen foi
family satisfaction and a positive
beieavement piocess.
In the 1apanese cultuie, the family
membeis aie the ones who will make all
the impoitant decisions iegaiding end-of-
life issues, and also the dying peison is
piotected fiom the heaiing of bad news.
As long as the lattei is accomplished, it is
believed that a concept foi a good death
has been set as well (Bell et al., 2OO9,
Hattoii et al., 2OO6).
As noted eailiei iegaiding Hawaiian
customs and beliefs, distiibution of money
duiing funeials as an indicatoi of iespect
foi the deceased is emphasized in
1apanese cultuie. The money is given to
the family membeis in oidei to covei the
expenses of the ceiemony and/oi buiial.
Bcn-Odcrt (Bon Dance) is a 1apanese
tiadition, which comes fiom Buddhism in
China. Bcn means welcoming the souls of
ancestois and holding memoiials foi them
(Yokomizo, 2OO1, Van Zile, 1983). Eveiy
yeai, duiing August oi Septembei in
Hawaiì, Bon festivals takes place, undei
the Young Okinawas of Hawaiì
6
(YOH)
leadeiship. The festivals last foi a week,
and aie the place and time when all the
ielatives of the family will gathei to honoi

6
Information available at:
http://www.bondance.com/2010/09/young-
okinawans-of-hawaii/
theii ancestois. People dance to
tiaditional 1apanese music, which has to
be "happy music," foi the ancestois' souls
to come out. 1apanese believe that the
souls of the people who have passed away
only come out duiing the night and to
"happy moods" and music (Yokomizo,
2OO1).

Etltptnc.
Regaidless of theii devoutness duiing
theii lifetime, when death occuis Iilipinos
become ieligious, specifically following
Catholic iituals and customs, and embiace
spiiituality (Shimabukuio, Daniels, &
DÀndiea, 1999). A stiong belief is that
death is Cod's decision and act, and if
someone has stiong faith then death can
be thwaited. If the lattei does not happen,
the beieaved may stait feeling guilty foi
not having had a stiong enough faith to
have saved the deceased (Biaun &
Nichols, 1997).
As opposed to men, women in the
Iilipino cultuie giieve openly, which
depicts theii love foi the peison who has
passed away, and at the same time
indicates to Cod how heavy theii giief is
foi the one they have lost. When a death
occuis in a family, all fiiends and family
membeis aie expected to attend wakes,
otheiwise it is consideied an offence. The
numbei of people at the wake illustiates
the deceased's life quality. Iilipinos
believe that the body of the dead should
iemain whole, and thus ciemation is
seldom a choice. At the deceased's house,
a Rosaiy session is held eveiy night aftei
his/hei death, in oidei to help his/hei
entiance to heaven (Biaun & Nichols,
1997). The length of these sessions
thiough time, vaiy based on the family's
will (peisonal communication, Maich 11,
2O11).


Kcrcan.
Death in the Koiean cultuie has
seveial dimensions, such as the end of a
painful peiiod, the dispeision of existence
foi the deceased, the tiansmission to an
afteilife woild, and finally the ietuining to
"the oiiginal place, wheie all life began"
(Kyung Rim, Myung Ok, & 1eong Sun,
2OO5). Common beliefs among Koieans
aie ancestial spiiits and afteilife. The
lattei is mostly influenced by Buddhism.
Adult childien aie usually a gieat
influence on theii paients and/oi eldei
membeis of the family iegaiding end-of-
life decisions. The main decisions aie
made by them as long as they aie the
caiegiveis foi theii paients and eldeily
(Eunjeong & Beikman, 2O1O). Lastly, the
social status of the deceased is essential
iegaiding on the peiiod of time that the
beieavement and mouining will last, the
highei the status of the deceased, the
longei the mouining peiiod (Kyung Rim
et al., 2OO5).

RELICION AND THE
POPULATION OI HAWAII

Aftei the death of a loved one,
individuals and families tiy to find
stiengths that will help them adapt to the
new ciicumstances, avoid piolonged giief,
and eventually ie-entei society in teims of
common activities. Adaptation to a death
is a ciitically significant event to all
individuals, and coping skills and
mechanisms, such as ways of giieving,
have to be found eithei within the
beieaved individuals/systems, within
peisonal and societal infoimal systems, oi
within foimal ones (Oibach, 1999,
Callahan, 1999).
The system of Ohana in the Hawaiian
cultuie is a majoi component when it
comes to stiengths aftei a loss. The
membeis of the family aie suppoitive of
each othei in seveial ways, such as
psychologically, socially oi financially.
Additionally, Native Hawaiians and
many otheis have a stiong belief in Cod.
Spiiituality, as well as ieligion, is a
deteiminant factoi in theii lives (Canda &
Iuiman, 2O1O, Kamanaòpono, 1999).
That being said, Chuich/Temple becomes
an asset foi the individuals and families to
oveicome a loss of a loved one. Buddhists
foi example, ciemate the bodies of the
dead, while the fiist seven days aftei death
aie the most impoitant iegaiding funeial
piactices and mouining, piayeis aie said
duiing a 49-houi funeial peiiod, that the
deceased's spiiit can ieceive help to
ieincainate.
The Catholic funeial seivice, on the
othei hand, is called the Mass of the
Resuiiection. Duiing the mass, the life of
1esus Chiist is compaied to the
deceased's, and a final giaveside seivice
accompanies the end of the funeial, as a
faiewell to the deceased. Eulogies aie less
common duiing the mass, howevei, they
aie welcome piioi to that, duiing a wake
foi instance (Canda & Iuiman, 2O1O).
Additionally, mouining is suppoited by
the Chuich and the community as a
whole. As in the Oithodox Chuich
7
,
special piayeis foi the deceased aie held
duiing the funeial, that Cod will foigive
his/hei sins. Also, the Oithodox Chuich
holds a special vigil ovei the deceased,
called the paiastasis of panikhida, duiing
the Mass, the funeial seivice includes
much Bible ieading and chants as well.
Spiiituality and ieligion aie both gieat
stiengths. The people of Hawaii have
stiong bonds with the deities, iegaidless of
theii ieligious oiientation, and theii belief
gets stiongei when death appioaches.
Hence, suppoitive systems aie developed
with ieligion and chuich.

7
Although it is small, there is an Orthodox presence
in Hawaii.


A MULTI-ETHNIC
STRENCTHS PERSPECTIVE

An essential stiength of Asian and
Pacific Islandeis, which include the
Native Hawaiians, is theii iespect foi theii
own diveisity, whethei it is cultuial
diveisity, oi ethnic, oi spiiitual, oi
ieligious (Cieen & Beckwith, 2OO9). They
value theii diveisities as stiengths. Cioup
oiientation and the feeling of Ohana aie
piesent, individual oiientations may
sometimes also help oveicome the giief
ovei a lost loved one (Sue & Sue, 2OO8,
Kublei-Ross & Kesslei, 2OO5, Callahan,
1999).
A gieat diffeience between Native
Hawaiians/Pacific Islandeis, and Asians
living in Hawaiì, is the hieiaichical
ielationships. In all the Asian cultuies,
hieiaichy within the family system and
the household is a ciitical key foi success.
In contiast, many of the Pacific Islandeis
have chiefs, who make many impoitant
decisions (e.g., end-of-life decisions).
Howevei, these hieiaichical ielationships
Asians have in theii families help keep the
bonds well foimed and stiuctuied among
the membeis, with cleai identifications of
each one's iesponsibilities. Iuitheimoie,
in a death expeiience, wheie piepaiations
foi death have to be made, in such
cultuies it seems easiei due to
iesponsibility allocation within the family
system (Sue & Sue, 2OO8).

POTENTIAL PROBLEMS AIIECTINC
THE CRIEI PROCESS

Acculturattcn
Diffeient cultuies in the state of
Hawaiì still hold tight to theii cultuial
beliefs. Native Hawaiians, Samoans, and
Cuamanians believe in legends and
supeistitions to make meaning of the
significant events in theii lives. Howevei,
theie have been a few influences ovei
histoiy on ceitain cultuial dimensions,
such as funeial piactices (Canda &
Iuiman, 2O1O, Cieen & Beckwith, 2OO9,
Biaun et al., 2OOO, Callahan, 1999).
The loss of one's cultuial identity due
to accultuiation and encultuiation is the
stiongest and most challenging issue
among the geneial population. Each
cultuie within the state influences and is
influenced by all the otheis (Sue & Sue,
2OO8). To that extent, within time ceitain
tiaditions, customs, values, and beliefs
may diminish.

Rtsks cf thc Grtcvtng Frcccss
"Ciieving is a noimal life piocessan
adjustment ieaction to a loss. No specific
piecautions aie waiianted" (Kublei
Ross & Kesslei, 2OO5, p.12). Howevei, the
giieving piocess might come acioss with
ceitain ciicumstances which will
complicate the piocess itself. These
ciicumstances may involve the loss of a
child, oi the loss of a loved one due to an
accident oi homicide, foi instance (Teno
et al., 2OO4, Howaid & Scott, 1965).
When a complicated case of giief takes
place, diffeient and extieme iesponses to
the loss can be obseived, depending on the
individual's capacity foi coping, peisonal
iesiliency, and suppoit system. Ioi
example, if the individual feels isolated,
he/ she may be at gieatei iisk foi seveie
depiessive symptoms oi a suicide attempt.
Alteinatively, if the suivivois feel iage oi
angei ovei the loss, theie may be a iisk of
haim to otheis (1ust, 2OO8, Skelton, 2OO3).
Anothei iisk exists conceining the
tieatment of complicated giief. Such
ciicumstances might be chionic,
piolonged giieving oi unexpected loss
(Kublei Ross, 1979, 1975). These
deteiminants complicate the giieving
piocess due to the violent and unexpected
natuie of the loss. Two othei factois that


might impact and complicate moie the
giieving piocess include the type of
ielationship the individual had with the
deceased, and the iesiliency of the
individual.
Those ciicumstances noted above have
a univeisal effectiveness. The geneial
Hawaiian cultuie keeps the family
cohesive, and thus a stiong infoimal
suppoit system is cieated and maintained
thiough time, which allows the beieaved
individuals to have seveial channels of
emotional dis chaige and to that extent
impiovement of theii well being at the
given situation (Kublei-Ross & Kesslei,
2OO5, Tone et al., 2OO4).

Thc Influcnccs cf Scctal Fcltctcs
Death can be expeiienced, not only
fiom an individualized oi a family
system's peispective, but also fiom the
community's point of view. The piocess
of dying has been influenced by policies,
which affect piogiams and seivices foi the
population of Hawaiì. The same happens
with the piocess of beieavement.
HB1453, and HB163 aie essential to
foimally indicate "legal and peisonal
ielationships" in the State of Hawaiì.
Recognizing those ielationships and
putting them in a legal fiamewoik, is
beneficial foi ielatives when the time foi
end-of-life decisions comes. HB1165,
which ielates to "compassionate passing"
and is influencing the end-of-life decisions
of the peison who is expeiiencing the
imminent death, highlights the iight of the
dying peison to fill in an end-of-life foim
and get a piesciiption of medication to
end his life. Additionally, in the lattei bill,
the impoitance of constiucting wills,
contiacts, and othei agieements is
undeiscoied.
"Death with dignity" is a subject
ielated to HB1383, HB1165, and SB8O3,
in the State of Hawaiì. Emphasis is given
to the iight of the peison who is dying, to
end his/hei own life, by filling in a iequest
foim, and having a witness foi it. Lastly,
HB512 ielates to "palliative caie,"and
emphasizes the iights of the beieaved
membeis of a family oi fiiends. Palliative
caie should be coveied in one's health
insuiance as long as it is piesciibed by the
physician.
Aftei the Hcnckahua incident, when
people iallied to assuie that the ielocation
of theii ancestois' twt would come to an
end, the Hawaiì State Legislatuie and the
Coveinoi at that time (1988) enacted Act
3O6. This act amended Chaptei 6E of the
Hawaiì Revised Statutes, and much moie
piotection foi unmaiked buiial sites was
attained. The Act 3O6 cieated the Buiial
Sites Piogiam to oveisee the imple-
mentation of new laws. Additionally, five
island buiial councils weie developed to
indicate piopei tieatment of the buiial
sites that had been found till that day, and
that would be found in the futuie. The Act
set penalties up to $1O,OOO pei buiial foi
unauthoiized action (i.e. excavation).
In 199O, the fedeial Native Ameiican
Ciaves Piotection and Repatiiation Act
(NACPRA) was passed. This Act
iequiied that all the museums and othei
institutions should allow Native
Hawaiians (and othei natives) to
iepatiiate skeletal iemains, buiial goods,
and items of cultuial patiimony to the
lands they oiiginated fiom.

Hcspttal Fcltctcs and Frcccdurcs.
The settings wheie policies influence
death, dying, and beieavement issues and
pioceduies aie mainly hospitals and
hospices. Iiom the social woik
standpoint, a majoi diffeience between the
two is that within a hospital setting, social
woik is a secondaiy seivice, wheieas in a
hospice setting it is usually a piimaiy


seivice (Zeizan, Steains, & Hanson,
2OOO).
Many deaths may occui duiing
hospitalization, and fuitheimoie,
beieaved people may fill in hospital
iooms, suigeiy lobbies, oi the intensive
caie unit (ICU). Accoiding to CDC
(2O1O), twelve out of the fifteen leading
causes of death in the State of Hawaiì,
aie associated with illnesses. Also,
suicides, accidents, and othei causes may
lead an individual to the hospital, dead oi
alive (CDC, 2O1O).
In eveiy oiganization and institution
theie aie specific policies and pioceduies
that need to be followed undei ceitain
ciicumstances. When someone dies at a
hospital while an inpatient, theie aie
ceitain steps that have to be taken. The
fiist thing that may have to be done is to
have the peison named by the deceased as
the next of kin to foimally identify the
body. The same peison, next of kin, may
also allow foi a hospital post-moitem
examination, if the death cause has to be
confiimed.
8

Unless it is iemoved diiectly fiom the
hospital flooi, the body is kept in the
hospital moigue until it is collected.
Collection of the body can be done by
family membeis, fiiends who have been
identified by the deceased, oi most
commonly by a funeial diiectoi who has
been contacted by the family. If the lattei
is the case, unless immediate ciemation
will be done, aftei embalming the funeial
diiectoi will keep the body in a chapel of
iest until the funeial takes place.
The possessions of the deceased aie
secuied by the hospital staff membeis, and
aie given to the family membeis, if
piesent, aftei the death. The doctoi also
gives the funeial diiectoi a medical
ceitificate, which explains the cause of

8
In the State of Hawaii, undei ceitain
ciicumstances an autopsy may be iequiied by law.
death, and is used foi death iegistiation
thiough the DOH. The funeial home
takes caie of the death ceitificate (DC),
and ultimately the official DC is geneiated
by the DOH. In cases of oigan and body
donations to medicine, theie aie vaiious
diffeient policies in eveiy hospital setting.
The only common policy of the hospitals
is that, as long as the death is imminent,
the staff of the hospital needs to be
notified in advance foi the intentions of
the peison who is dying.
All the policies explained above, aie
common in the majoiity of piivate and
public hospitals in Hawaiì. To that
extent, despite the diffeient cultuies, the
pioceduies people will have to go thiough
aie the same. Sensitivity iegaiding cultuial
aspects is geneially shown in cases of
imminent death, hospital peisonnel may
peimit the family membeis to spend
nights at the hospital, in the same ioom as
the patient, oi waive othei geneial policies
(Pobutsky, 2OO1).
Last but not least, some hospitals
piovide suppoit and advice seivices.
Although it is piobably helpful to stait
with the things that need to be done when
someone dies, family membeis and/oi
fiiends who aie taking caie of the
pioceduies may neglect significant
feelings of giief duiing the piocess, which
may lead to ineffective coping
mechanisms. The death has occuiied
alieady and, instead of conceptualizing
the facts, oi maybe at the same time as
that, they aie tiying to go thiough all these
pioceedings. Of couise, not eveiyone can
successfully go thiough them without
suppoit. Advice seivices aie piovided in
some hospitals, in oidei to help family
membeis and/oi fiiends to accommodate
accoidingly aftei death. Howevei, diveise
cultuies peiceive such seivices diffeiently.
Ioi example, the Chamoiio people aie
intense in theii feelings of holding


eveiything in the family setting, and not
being ieceptive to such seivices.

Hcsptcc Fcltctcs and Frcccdurcs
Hospice is a philosophy of caie which
accepts death as the final stage of life.
Iamily membeis and/oi fiiends will have
to go thiough similai piocesses as in a
hospital setting, while death occuis.
Howevei, hospice caie is developed to be
sensitive by natuie and piovide suppoit
and quality of life seivices to both the
dying peison and the family system
(Zeizan et al., 2OOO).

PART II: SOCIAL WORK PRACTICE
AND THE POPULATION OF
HAWAIÌ

MICRO AND MEZZO LEVELS OI SOCIAL
WORK PRACTICE AND THEIR
EIIECTIVENESS

The diveisity and the diffeiences within
the State have led the piofession of social
woik to uige multicultuial counseling
piactices and/oi adjustment of Westein
piactices, methods, and appioaches with
diveise clientele. The NASW Hawaii
Chaptei "is dedicated to piomoting the
quality and effectiveness of social woik
piactice in a state iich with diveisity"
(NASW-HI). The piofession of social
woik is entitled to this dedication, noted
by the NASW Hawaii Chaptei, and its
piactitioneis aie using methods and
appioaches that fiom vaiious peispectives
piomote those standaids (Hepwoith,
Rooney, Rooney, Stiom-Cottfiied, &
Laisen, 2O1O, Toseland & Rivas, 2OO9,
Caivin, Cutieiiez, & Calinsky, 2OO4,
Stiean, 1978).
Ciief suppoit, social case woik,
psychosocial theiapy, family theiapy,
gioup theiapy, the ecosystems peispective,
and palliative caie aie a few of the
appioaches at the micio and mezzo levels
which have been effective with the
population of Hawaiì (Ponteiotto,
Suzuki, Manuel Casas, & Alexandei,
2O1O, Chang & Ng, 2OO2). Howevei, the
diveisity of the state's population iequiies
a diveisity of methods as well, when
coping with death issues, and
beieavement (Ponteiotto et al., 2O1O, Sue
& Sue, 2OO8).
Social woik piactice at a micio and/oi
mezzo level is piovided to individuals and
family systems who expeiience unique
situations and face peisonal difficulties,
such as death expeiiences and
beieavement, with which they aie not able
to fully cope (Collins, 1oidan, &
Coleman, 2O1O, Bieen, 2O1O, Evan, 2OO9,
Woods & Hollis, 2OOO). Piactitioneis of
social woik in the State of Hawaiì have
been and continue to be challenged due to
the evei-changing composition of the
population. A vaiiety of methodologies
has been used thiough the yeais with
Asian Ameiicans and Asians who live in
the State of Hawaii (Chan et al., 2OO5,
Ioiisha, Wiight, & Tucket, 2OO5, Chang
& Ng, 2OO2). Howevei, the effectiveness
of the appioaches is changing depending
on the evolution of the cultuie's
components. "Ethnic and othei gioup
values and tiaditions aie not static, but
evei-evolving" (Woods & Hollis, 2OOO:
p.58) based on a vaiiety of factois, such as
how long an individual oi a family has
been in Hawaii.
"Ycu mattcr bccausc cf whc ycu arc.
Ycu mattcr tc thc last mcmcnt cf
ycur ltfc, and wc wtll dc all wc can,
nct cnly tc hclp ycu dtc pcaccfully,
but alsc tc ltvc unttl ycu dtc."
(Damc Ctccly Saundcrs, fcundcr cf
thc mcdcrn hcsptcc mcvcmcnt)


It becomes impossible foi social
woikeis to adequately infoim themselves
about all the cultuies they aie woiking
with. The clientele social woik
piactitioneis usually woik with is diveise
itself. Besides, moie diveisity aiises within
each cultuie that composes the population
of the State (Ivey, Ivey, & Zalaquett,
2O1O, Ceinstein, Heppnei, AEgisdottii,
Alvin Leung, & Noiswoithy, 2OO9, Sue &
Sue, 2OO8). Theie aie numeious unique
peisonalities and family dynamics within
the cultuies, which may influence the way
individuals, families, oi gioups expeiience
death and dying, and giieve foi the death
of a loved one. Additionally, gieat
diffeiences may be obvious among
individuals, even moie than the ones
among cultuies (Woods & Hollis, 2OOO).
Ioi example, an oldei Native Hawaiian
might believe that people who have lost a
loved one can connect with each othei in
a unique way that no one else can,
wheieas a teenage membei of the same
family believes that this is a supeistition
(Kanuha, 2OO5).
Accoiding to Leung, Cecilia, Siu-
Man, and Mo-yee (2OO9) a body-mind-
spiiit appioach that they have studied in
clinical social woik settings, and which
was emphasized to beieaved Chinese
women who weie following Daoism oi
Buddhism at that time, was inciedibly
effective with the ieseaich paiticipants.
Saleh (1997) has used a case study of a
Micionesian client to addiess baiiieis
while counseling, as well as solutions and
effectiveness of counseling inteiventions.
The main appioaches, and theii
effectiveness, that have been used in the
past, and aie being used at the piesent,
with the population of Hawaiì aie
discussed below.

Falltattvc and hcsptcc carc.
Palliative caie iefeis to any caie that
alleviates symptoms
9
foi individuals who
have been diagnosed with seiious
illnesses, and is chaiacteiized by a team-
oiiented appioach which iefeis to
collective piactice on the behalf of the
patient's needs and wishes. This foim of
quality caie, which is used in a vaiiety of
Hospice units in the state of Hawaiì,
segues into Hospice caie. The lattei is a
type of palliative caie which is offeied in
the (anticipated) last six months of the
patient's life, and is mostly focused on
caiing, and not cuiing (Saundeis & Claik,
2OO2). As indicated in the Kckua Mau
10

oiganization's oiiginal site, hospice caie is
piovided on all the islands of Hawaiì.
Hospice caie helps to alleviate the
stiess that is encounteied duiing the dying
piocess by taking a holistic appioach to
tieatment. It often seives as an
educational tool to the peison and theii
family. Hospice also piovides awaieness
of the options that aie available to the
dying peison. Hospice oiganizations also
seek to educate the community and health
caie woikeis (including social woikeis).
The woid hospice comes fiom the ioot
woid foi hospitality in Latin. In basic
teims, hospice means to piovide
hospitality to the dying peison and theii
family. This means giving palliative oi
comfoit caie to the dying and helping
theii loved ones in many ways.
Cultuial diveisity among the
population one woiks with may inciease
the challenges of piactice in hospice
(Ponteiotto et al., 2O1O, Ceinstein et al.,
2OO9, Sue & Sue, 2OO8). Some cultuies

9
As opposed to caie with piimaiy goals of
addiessing cause and cuie.

10
Kokua Mau is Hawaiis hospice and palliative care
organization. Additional information at:
http://www.kokuamau.org/


(and health caie piovideis) may be moie
ieceptive to palliative and hospice caie,
and thus the effectiveness of this type of
assistance to the population may vaiy. Ioi
example, Samoan populations piefei the
family to be the caie givei foi the dying
peison and usually do not accept hospice
caie (Little, 2OO9), wheieas 1apanese
cultuie is moie ieceptive to this type of
piofessional assistance (Bell et al., 2OO9,
Laungani, 2OO4).
Accoiding to the study by Bell et al.
(2OO9) moie Asian Ameiicans have died
as inpatients, as opposed to the numbeis
of Caucasian Ameiicans. Additionally,
both Chinese and Koiean dying patients
have been depicted as moie iesistant to
hospital and hospice caie as opposed to
othei cultuial gioups (Kwon, 2OO6, Chang
& Ng, 2OO2).
Accoiding to Little (2OO9) and hei
obseivations with Ameiican Samoans,
palliative caie has illustiated incieasingly
effectiveness with that population. Last,
handbooks of counseling with diveise
populations and multicultuial counseling
have piovided valid infoimation when
woiking with NHPIs, as well as Asians
and Asian Ameiicans (Ivey et al., 2O1O,
Ponteiotto et al., 2O1O, Ceistein et al.,
2OO9, Sue & Sue, 2OO8, McColdiick,
Cioidano, & Caicia-Pieto, 2OO5,
Laungani, 2OO4).

Hc`cpcncpcnc
Hc`cpcncpcnc ("to make iight") is a
piocess of solving pioblems and an
ancient Hawaiian piactice of foigiveness.
It was tiaditionally piacticed by kahuna
(tiaditional healeis) to maintain haimony
in the community and within oneself
(Ioiisha et al., 2OO5, Huidle, 2OO2). With
the piactice of hc`cpcncpcnc, the
individual can iediscovei his/hei tiue
identity aftei a ciisis such as a death.
Similai piocesses as this one have
histoiically been used within Pacific
cultuies such as Samoan, and Tahitian
(Ioiisha et al., 2OO5).
This special Hawaiian appioach has
been used in the 21
st
centuiy foi youths, as
well as piolonged beieavement instances.
As foi the lattei instance, it is believed
with hc`cpcncpcnc that the beieaved
individual, with the help of the
enviionment, and in a gioup piocess, in
oidei to oveicome the loss of a loved one,
has to go back to level Zcrc, in which
memoiies stop being iedeliveied into the
mind. Iiom that level, the peison can be
functional again, and pass to the
acceptance stage of the loss (Ioiisha et al.
2OO5, Nishihaia, 1978). Howevei simple
the piocess sounds, theie aie complexities
when it is applied with diffeient Pacific
cultuies (Ioiisha et al., 2OO5, Huidle,
2OO2).
NHPIs, especially Native Hawaiians,
Samoans, and Cuamanians, seem to have
been moie accepting of the appioach, as
similai beliefs on the wisdom of eldeily in
the family system aie held (Ioiisha et al.,
2OO5, Huidle, 2OO2). That being said, the
piocess is often piacticed by an oldei
family membei and not a social woikei.
Howevei, theie have been social woik
piactitioneis who have shown inteiest in
this appioach and have committed to
ieceive tiaining fiom kahuna (Ioiisha et
al., 2OO5).
Hc`cpcncpcnc has been an effective
cultuially-based appioach iegaiding the
Native Hawaiians, Samoans,
Cuamanians, and othei Micionesians
(Ioiisha et al., 2OO5, Huidle, 2OO2,
Nishihaia, 1978). The c`hana feeling has
also been desciibed as an effective
inteivention foi family theiapy (Kanuha,
2OO5). In addition, Sue and Sue (2OO8)
have conducted ieseaich that indicates
specific cultuially-based behaviois
conceining counseling with NHPIs.


Huna, Hakcmt Thcrapy, and Sptrttualtty
The only way that someone can iun a
life the exact way he/she wants to, is to
connect with his/hei spiiit. This is the
coie belief of Huna (Haitman, 1985). The
teaching and piactice of Huna is about
empoweiment and inciease of spiiituality.
It has been believed in ancient Hawaiì,
and also to the 21
st
centuiy, fiom Native
Hawaiians and othei gioups, that it can
fiee the spiiit of the beieaved and attach it
to the wholeness of the expeiience, in
oidei to make sense out of its paits
(Kanuha, 2OO5, Huidle, 2OO2, Haitman,
1985).
Kahuna, who have peifoimed Huna,
believe that, foi someone to bettei
undeistand him/heiself (needs, hopes,
feais, etc.), he/she has to undeistand Cod
fiist (Haitman, 1985). In the Huna beliefs,
Cod is a whole entity, which includes all
the individuals, whethei they aie dead oi
alive, and thus Cod is one of the main
piinciples of Hakcmt theiapy
11
. Huna
focuses on two paits of the innei
expeiiences: the aumakua
12
(high self,
supei conscious), and unthtptlt (low self,
subconscious) (Haitman, 1985). Those
two can otheiwise be intioduced as the
mind and the spiiit (Huidle, 2OO2).
While giieving to the loss of a beloved
one, someone cannot expeiience
wholeness (the connection with his/hei
spiiit, the connection and undeistanding
of Cod) due to iejection of a pait of
existence oi non-existence (death in this
case). Acceptance of the death expeiience
and the giieving piocess aie significant in
this way in Hakcmt theiapy. One of the

11
Hakcmt theiapy is explained latei in the section,
but iefeiied to cuiiently due to its attachment to
Huna beliefs.

12
This woid is also used, as mentioned in chaptei
1, foi the family's totemic iepiesentation, theii
"god".
healing aspects of the lattei is that
negative emotions, such as angei and
hate, aie always accepted, and not
iejected as in tiaditional westein
psychology (Haitman, 1985).
In Hakcmt theiapy it is suppoited that
the disease is and has to be one with the
cuie. The undeistanding of both will lead
to development and health. Hakcmt
theiapy does not condone the absence of
spiiitual beliefs. The main concept of it is
to teach, in a non-judgmental way, the
"knowing of Cod" and spiiituality
(Haitman, 1985).
This appioach has, foi yeais, been
peifoimed by a family membei oi
piactitionei who has gained knowledge
and expeitise thiough tiaining with a
kahuna. It has been effective to beieaved
and dying individuals among NHPIs, as
Chamoiio people and Micionesians
(Salef, 1997).
Nowadays, Hakcmt theiapy can be
taught to piactitioneis eithei as full
studies, oi as a ceitificate piogiam. Both
options aie available thiough the Hakcmt
Institute
13
. Tiaining in Hakcmt theiapy
may last appioximately 36O houis ovei
two yeais. By the end of the tiaining
piactitioneis aie identified as Ccrttftcd
Hakcmt Thcraptsts (CHT) oi Ccrttftcd
Hakcmt Fracttttcncrs (CHP).

Indtvtdual and grcup psychcthcrapy.
Psychotheiapies come in diffeient
foims, such as counseling, and cognitive
behavioial theiapy (CBT). Both aie the
type of theiapy commonly used by clinical
piactitioneis in the State of Hawaiì, with

13
"Iounded in 1981 by Ron Kuitz and a coie
gioup of tiaineis, the Hakcmt Institute is the
oiiginal and most extensive oiganization pioviding
infoimation and tiaining in Hakcmt Expcrtcnttal
Fsychcthcrapy." Moie infoimation aie available at:
http://www.hakomiinstitute.com/


effective iesults and outcomes in the
sessions (Doyle, 2O11, Sue & Sue, 2OO8,
Yalom & Leszcz, 2OO5, Coiey, 1995).
Howevei, diffeient techniques, and skills
of any type of psychotheiapy should be
adjusted to the needs and chaiacteiistics
of each cultuie that it is used foi (Ceistein
et al., 2OO9, Saleh, 1997). Ioi example in
the Koiean cultuie, minois aie usually not
allowed to attend theiapy even if it has to
do with piolonged giief (Laungani, 2OO4).
On the contiaiy, pastoial counseling
14
is
piefeiied by this population (Kwon,
2OO6).

GrIef CounseIIng
Hawaiì has been defined so fai as a
"gatheiing place" of diveise cultuies and
ieligious oiientations. This diveisity has
indicated diffeient piactices, customs,
beliefs, and values iegaiding death
expeiiences, and beieavement (Ponteiotto
et al., 2O1O, Sue & Sue, 2OO8).
Ciief counseling and moie specifically
multicultuial counseling foi giief have
been used by clinical piactitioneis (not
necessaiily social woikeis), as a type of
psychotheiapy to help clients go thiough
the dying piocess, and/oi help beieaved
individuals and families to oveicome giief
oi piolonged giief (Cilbeit, 2O1O,
Ceinstein et al., 2OO9, Camino, Sewell,
Hogan, & Mason, 2OO9, Clazei &
Maicum, 2OO3, Coiey, 1995).
Multicultuial giief counseling
includes thiee aieas of focus which can be
effective within the population of Hawaii,
due to its composition. The fiist aiea
iefeis to the cultuie of the
counseloi/social woikei, which
undeiscoies the necessity foi competence

14
Pastoial counseling is a type of counseling in
which piiest, ministeis, oi othei peisons ieceive
education on ieligion, spiiituality, and counseling
techniques in oidei to piovide clinical seivices
fiom a spiiitual and ieligious peispective.
and cultuial awaieness. The same
piinciples aie highlighted foi the second
and thiid aieas of focus, which aie the
cultuie of the client, and the multiplicity
of vaiiables compiising an individual's
identity/peisonality (Pon-teiotto et al.,
2O1O, 1oidan & Neimeyei, 2OO3).
Accoiding to Saleh (1997) counseling
techniques and skills have been
incieasingly effective with Micionesian
clients. As well, Wada & Paik (2OO9), in
oidei to impiove clinical (individual and
gioup) piactice with Buddhists who aie
giieving, exploied the integiation of
Buddhist psychology into giief counseling.
By the iesults of theii study it is shown
that Asian clients weie moie ieceptive to
this combined appioach, iegaidless theii
ieligious oiientation. To that extent, this
finding seems the same foi any clients
fiom a specific faith peispective, as long as
it is done sensitively.
Micionesians in geneial tend to
emphasize theii family systems, and few
would go individually in theiapy. This is
piobably the majoi ieason why
Micionesian clients aie few in numbei,
and mostly iely on the deity. Similai
values aie held by some Samoan families
in the State of Hawaii, wheieas Native
Hawaiians, and Samoans tend to piefei a
family counseling piocess which is led by
a "chief" in theii family system, who is
usually one of the eldei and wisei,
accoiding to Hawaiian and Samoan
beliefs, iespectively. Ioi the same ieason,
hc`cpcncpcnc and hakcmt theiapy have
been successful in the past with these
populations and othei Pacific Islandei
gioups.

Eamtly Thcrapy
Native Hawaiians and Othei Pacific
Islandeis, in geneial aie family and gioup
oiiented cultuies (Ponteiotto et al., 2O1O).
Common beliefs and sets of values can be


found iegaiding the sense, meaning, and
undeistanding of family bonds. Many
people, including Hawaiians and/oi
people who live in Hawaiì, show
piefeience foi piactices peifoimed by a
family membei (piefeiably an eldei, who
is the wisest in the system), iathei than a
social woik piactitionei (Huidle, 2OO2,
Saleh, 1997). Howevei, in such cases, that
social woikei might want to take moie of
a facilitative iole, oi at least make it cleai
that he/she iecognizes the eldei as a
iesouice in the system. These cultuies aie
ieceptive to family inteiventions
(Ponteiotto et al., 2O1O).
Asians and Asian Ameiicans aie also
ieceptive to family and gioup
inteiventions, but fiom a diffeient
peispective. Asians and Asian Ameiicans
piomote hieiaichical ielationships,
diffeient fiom Pacific Islandeis (Sue &
Sue, 2OO8). It is essential foi the family oi
gioup to follow these hieiaichies, as long
as the well-being of the system iesults
fiom it as well (Sue & Sue, 2OO8, Chang &
Ng, 2OO2, Agbayani-Sieweit, 1994). Ioi
example, when social woikeis woik with
Iilipinos oi Iilipino Ameiicans it is
impoitant to avoid diiective and
confiontational styles, as well as to tieat
both gendeis equally in a family theiapy
(Agbayani-Sieweit, 1994). Chinese
families may be moie ieluctant than othei
Asian cultuies to accept family theiapy
when a death occuis (Chang & Ng, 2OO2).

Fctcnttal Challcngcss fcr Scctal crk Fracttcc
wtth thc Fcpulattcn cf Hawatt.
The puipose of the piofession of social
woik is to help the client enhance oi
iestoie his/ hei capacity foi optimal
psychological, emotional, spiiitual, social
and physical health. Social woikeis
piovide piimaiy and secondaiy seivices in
hospitals and hospices, and paiticipate on
palliative caie teams. Theii piofessional
values and skills aie close to a peifect
match with hospice and palliative caie
piogiams, which aie designed to tieat the
whole peison in an inteidisciplinaiy
mannei to enhance quality of life duiing
challenging times (Sue & Sue, 2OO8,
Kublei Ross & Kesslei, 2OO5, Callahan,
1999, Kublei Ross, 1979).
Social woikeis piomote client self-
deteimination and aie cultuially awaie
and thus moie appiopiiate foi caie. They
should be qualified in evaluating the
stiengths of individuals and families, and
undeistand that good medical caie
iequiies that the wishes and needs of the
individuals being seived aie iespected
(Kublei Ross, 1979). When cuie is no
longei possible, a host of psychological,
physical, and spiiitual stiessois aiise
that social woikeis aie specifically tiained
to assist the individual and family to cope
and manage.
Coping with loss and the ensuing giief
piocess is anothei aiea in which social
woikeis aie well veised. Dealing with the
intense emotions associated with giief can
be oveiwhelming without the piopei
suppoit and infoimation. Social woikeis
in this field aie specially tiained to help
facilitate giief and help people avoid
obstacles that can lead to moie
complicated ieactions like depiession
(Kamanaòpono, 1999). It becomes of
gieat impoitance foi the social woikei to
be awaie of the cultuie he/she is woiking
with, in oidei to accomplish goals and
objectives that aie adjusted and well
matched to the beliefs and values of the
population (Ponteiotto et al., 2O1O, Sue &
Sue, 2OO8).
Cultuial competence is a deteiminate
factoi of the social woikei's effectiveness
and of the effectiveness of the counseling
piocess (Ponteiotto et al., 2O1O, Ceistein
et al., 2OO9, Sue & Sue, 2OO8), and of any
level of social woik piactice (micio,


mezzo, and macio) in geneial. Having the
knowledge and the awaieness of the way
Hawaiians peiceive death, dying and
beieavement might help the piactitionei,
by integiating that knowledge into
piactice, to fully undeistand the giieving
peison's mentality and to that extent be
able to contiibute in a moie pioductive
and effective mannei via counseling,
facilitation oi suppoit.
Expeiiencing the loss of a loved one is,
if not the most challenging, one of the
majoi ciises in life. Individuals and/oi
families who go thiough that piocess,
might be completely disoiganized in theii
minds at that moment and thus
dysfunctional foi any puipose (Kublei
Ross & Kesslei, 2OO5). Including
themselves in giief counseling, foi
instance, has specific puiposes, and one of
them is to educate the social woikei, oi in
geneial the counseloi, about cultuial
elements. Those elements aie most likely
to piovide additional infoimation to the
piactitionei, in oidei to undeistand the
meaning the beieaved gives to the loss and
what the iationale of that meaning is.
Native Hawaiians, Samoans, Chamoiio,
and othei Pacific Islandeis, foi example,
pay ciitical attention to spiiituality and
ieligion, and aie also somewhat
supeistitious (Ushiioda, 2OO8). Having
knowledge about these chaiacteiistics of
the cultuie can help the piactitionei to be
moie effective in theiapy when
conducting social woik on a micio level.
Accoiding to Hepwoith et al. (2O1O)
cieating awaieness about the population
one woiks with is also a method of
enhancing the positive outcomes of the
diiect social woik piactice one conducts.
Within the Asian cultuies, foi instance, it
becomes essential that the social woikei is
knowledgeable about the hieiaichical
stiuctuie within the family system. When
in family theiapy, the spouses need to be
tieated equally on iespect of both. Also,
especially in the Koiean cultuie, minois
aie meant to follow theii paients' desiies
and saciifice foi the family's best inteiest.
While exploiation may be appiopiiate,
opposition to such a belief would most
likely end up iuining the inteipeisonal
ielationship with the paients, as well as
violating social woik ethics.

Macrc Lcvcl cf Scctal crk Fracttcc and tts
Effccttvcncss
Death, dying, and beieavement aie
expeiiences that aie addiessed not only
fiom a diiect piactice peispective, but also
fiom a community based one (Wolfei &
Runnion, 2OO8). Macio piactice mainly
iefeis to and focuses on laigei systems and
social change. Systems theoiy is a
deteiminant component of macio
piactice, while the lattei indicates policy
analysis, policy advocacy, social planning,
community oiganizing, community
development, and othei types of
inteiventions on this level (Buighaidt,
2O1O, Netting, Kettnei, & McMuitiy,
2OO8).
Social needs and pioblems that aie
addiessed thiough death, dying, and
beieavement piocesses in Hawaii, as well
as othei communities, aie subjects of and
oppoitunities foi change, foi the well-
being of the paits of the community and
the community as a whole. As iefeiied to
eailiei, a few of the essential social
pioblems that the beieaved population of
Hawaii is dealing with aie accultuiation
and encultuiation, iisks of piolonged giief,
and, to an extent, loss of cultuial identity
(Ceinstein et al., 2OO9, Sue & Sue, 2OO8).
Social pioblems such as these may affect
and be influenced by death expeiiences
and beieavement.
Encultuiation among the population
of Hawaii is conceived as the piocess of
majoiity gioups who willingly acquiie


customs, beliefs, and values fiom the
indigenous cultuie, Native Hawaiian, so
they can bettei fit in the Hawaiian
community. On the othei hand,
accultuiation mostly iefeis to minoiity
gioups in the state, as Native Hawaiians,
Samoans, Cuamanians, Afiican
Ameiicans, etc. With accultuiation,
individuals aie imposed with cultuial
beliefs and values fiom the dominant
gioup of iesidents. Often enough, people
tend to lose theii cultuial identity due to
this piocess (Sue & Sue, 2OO8). Needs that
aiise fiom such pioblems and/oi iisks
may be addiessed fiom thiee diffeient
peispectives: statc, nattcnal, and
tntcrnattcnal.

Statc, Nattcnal, and Intcrnattcnal Lcvcls cf
Macrc Fracttcc
A gieat deal of iallying and advocacy
has taken place, since the 18OOs in
Hawaiì by iesidents fiom diveise
ethnicities and backgiounds. Among the
most impoitant causes foi Native
Hawaiians aie legislation that has
addiessed iespect foi the bones of the
deceased, the death piocess, and a
communal iespectful behavioi towaid the
death of the indigenous people, as well as
towaid beieaved individuals, families, and
gioups within the community.
Local communities offei a handful of
piogiams and seivices both foi people
who aie dying and foi people who aie
giieving. Quality of life is the dominant
focus of the existent piogiams, which aie
deliveied thiough goveinmental, non-
goveinmental, and voluntaiy oigani-
zations and agencies (i.e. child welfaie
and family seivices, health seivices, senioi
centeis, substance abuse piogiams).
Hospitals and nuising homes make a
woithwhile effoit with end-of-life seivices,
to piomote quality seivices to needed
families and individuals. The planning of
those seivices is mainly peifoimed within
the social seivices and social woik
depaitments of the health settings.
Hospices compiise a tiemendous ielief
and suppoit foi dying people and theii
families and fiiends. Macio piactice is
demonstiated within these settings foi
social planning, implementation, and
evaluation of the seivices and the specific
piogiams that aie offeied (Buighaidt,
2OO9, Evan, 2OO9).
Lantein Iloating Hawaii is a
ceiemony held each yeai on Oàhu on
Memoiial Day. Lantein Iloating biings
togethei, eveiy yeai, moie than 4O,OOO
iesidents and guests of the islands who
cast afloat lanteins in iemembiance of
loved ones, oi as a symbolic piayei foi a
haimonious futuie. The ceiemony is led
by the spiiitual head of Shtnnyc-cn
15
. As
stated by one of the iesidents duiing the
2O1O ceiemony "Nobody dies, because, if
theie is a connection of love between the
people who aie heie and the people who
passed on, the life continues" (peisonal
communication, May 31, 2O1O). With this
ceiemony, the people of Hawaiì
ieminisce and honoi those who have
passed, fiiends and family, as a united
community. Even though this iitual
comes fiom Buddhism, this has nevei
been an obstacle foi people fiom diffeient
spiiitual oiientations to join, and this
becomes one of the stiengths the
population of Hawaiì demonstiate.
NASW standaids foi palliative and
end-of-life caie (2OO4) state:
The social woikei shall advocate foi the
needs, decisions, and iights of clients in

15
"Shtnnyc-cn was founded by the accomplished
Buddhist mastei Shtnfc and continues to thiive
undei the spiiitual guidance of his daughtei and
spiiitual heii, Hei Holiness Keishu Shinso." See
additional infoimation at:
http://www.lanteinfloatinghawaii.com/shinnyoe
n.html


palliative and end of life caie. The social
woikei shall engage in social and
political action that seeks to ensuie that
people have equal access to iesouices to
meet theii bio-psychosocial needs in
palliative and end of life caie. (p. 4)
Policy advocacy and policy piactice in
geneial have both been peifoimed at
length on the behalf of the population, in
oidei to impiove and empowei the quality
of seivices and piogiams that aie
deliveied to those who expeiience death,
and those who giieve foi the loss.
NASW (2OO1), as well as the
Inteinational Iedeiation of Social
Woikeis (IISW) (2OO9) have essentially
achieved cultuially based philosophies of
the social woik piofession. Each cultuial
gioup is unique and holds independent
customs, beliefs, and values that have to
be iespected and sensitively addiessed by
social woik piactitioneis (Ceinstein et al.,
2O1O). Cultuial awaieness has become of
ciitical impoitance in the past few
decades, especially since the 199Os (Sue &
Sue, 2OO8). Accoiding to the Inteinational
Association of Schools of Social Woik
(IASSW) (2OO9) social woik education,
iegaidless of concentiation, has to be
filled with cultuially sensitive infoimation.
These standaids fiom national and
inteinational associations aie landmaiks
foi social woik piactice in Hawaiì as
well. The needs to conseive one's cultuial
identity and avoid unintended
accultuiation aie the focus of such
standaids. Doing so, a community
consisting of numeious diffeient cultuies
will then become a multicultuial
community, and not a community with
diffeient cultuial minoiity gioups
(Ponteiotto et al., 2O1O). In these teims,
within a multicultuial community, equity
and social justice aie essential
deteiminants foi its existence,
development, and maintenance.
Thc Effccttvcncss cf Fcltctcs, Organtzattcns,
and Frcgrams
Accoiding to Mokuau et al. (2OO8)
NHPIs have been identified by the 2OOO
Census as a distinct and unique minoiity
gioup oi iace, which holds its own histoiy
and backgiound. This identification had a
majoi effect on the population of Hawaii.
Social woik piactice with the population
of the State has not been highly effective,
in teims of cultuial expeitise, due to lack
of infoimation among diffeient cultuial
and ieligious gioups. To that extent, death
and dying attitudes, and coping and
beieavement mechanisms and behaviois,
aie as yet unidentified foi each cultuie.
In theii liteiatuie ieview, Mokuau et
al. (2OO8) focused on publications that
iefeiied to social woik piactice and
NHPIs. The ieview was conducted
between 1994 and 2OO4, when only 32
aiticles weie found in 23 diffeient
jouinals. The iesults have shown that
limited infoimation has been published
iegaiding the NHPIs, and that much
infoimation published is combined with
the population of Asians and Asian
Ameiicans, iegaidless theii iesidence,
which hindeis evidence-based piactice.
The identification of the populations
which inhabit Hawaii has been a
coineistone to the development of policy
piactice and innovative ieseaich iegaiding
diffeient cultuies, death, dying, and
beieavement. As long as social woik
ieseaich has been ietiieving infoimation
on diffeient cultuies, and evidence-based
piactice can be applied, new piogiams
and seivices can be cultuially-based and
moie effective to the diveise population
they addiess. Accoiding to data fiom the
KP (2OO9) only 2,735 people aie using
hospice seivices in Hawaiì. An
assumption to this numbei may, as
mentioned by Ioiisha et al. (2OO5), be the
limited expeitise of the staff iegaiding the


diveisity and multi-ethnicity of the
clientele. Othei assumptions may include
diffeient peiceptions of diffeient ethnic
families iegaiding hospice caie, oi the
possibility of sufficient iesouices within
one's own family system.

Scctal crk Rcscarch
The IISW (2O11) states that:
Social woik bases its methodology on a
systematic body of evidence-based
knowledge deiived fiom ieseaich and
piactice evaluation, including local and
indigenous knowledge specific to its
context. It iecognizes the complexity of
inteiactions between human beings and
theii enviionment, and the capacity of
people both to be affected by and to altei
the multiple influences upon them
including bio-psychosocial factois. (p.1)
Social Woik piactice itself would not be
effective if the theoiies, skills,
competencies and knowledge weie not
tuned-in to the constant changes of the
woild and the cultuies that inhabit this
woild (D'Ciuz & 1ones, 2OO4). The
piofession's main mission, as stated by the
NASW, is the well-being of the systems
(individuals, families, gioups, oigani-
zations, communities) that social woikeis
seive. In oidei to attain the state of well-
being, one needs to be awaie of the needs
of the population he/she seives,
depending on the geogiaphic, age,
histoiical, cultuial, educational, etc.
diffeiences and changes thiough time.
Social woik ieseaich is the most
effective appioach foi social woikeis to
become awaie in theii field, gain
evidenced-based knowledge, and follow
up with the changes and new needs of
theii clients. This type of ieseaich aims to
piomote knowledge and inciease skills
and competence level of the piactitioneis
(Ciinnel & Uniau, 2O1O, D'Ciuz & 1ones,
2OO4).
Currcnt Etndtngs
Limited ieseaich has been conducted
to today, iegaiding death expeiience, and
death, dying, and beieavement attitudes
and behaviois of the population of Hawaii
(Cilbeit, 2O1O, Mokuau et al., 2OO5,
Huidle, 2OO2). Mokuau et al. (2OO5) have
based theii liteiatuie ieview on 32 aiticles
published within a ten yeai time fiame.
That numbei equals to O.64% of the
aiticles published in the specific jouinals
duiing that peiiod (Mokuau et al., 2O5).
A gieat numbei of the aiticles iefeiiing
to the State of Hawaiì aie focused on
Asians alone and Asian Ameiicans
(Bieen, 2O1O, Bell et al., 2OO9, Wada &
Paik, 2OO9, Chan et al., 2OO5, Kanuha,
2OO5, Chang & Ng, 2OO2, Huidle, 2OO2,
Agbayani-Sieweit, 1994, Haitman, 1985,
Nishihaia, 1978). Accoiding to Bell et al.
(2OO9) and the showings of the Honolulu-
Asian Aging Study they have conducted,
Asian Ameiicans tend to follow theii
Asian cultuial backgiound to deteimine
theii death attitudes and behaviois.

Dcarth cf Data
The population of Hawaiì has faced
accultuiation to an extended level, and
thus lots of woik and ieseaich is still
iequiied, in oidei to piomote and impiove
cultuially-based and giounded intei-
ventions at all levels. The cuiient data
fiom social woik ieseaich iegaiding
death, dying, and beieavement among this
population lacks significant iefeiences,
wheieas the social needs of the population
inciease and become moie complex as the
enviionment and the inteiactions between
the systems and the enviionment become
multifold (Ceinstein et al., 2OO9).
Theie is a deaith of infoimation when
woiking with dying and giieving Native
Hawaiians, Samoans, Chamoiio people,
and othei Pacific Islandeis. This gap
incieases the limited effectiveness of social


woik piactice on all levels, as well as the
expeitise of the social woik piactitioneis.
This should be an aiea of high piioiity foi
social woik piactitioneis.

LECAL AND ETHICAL ISSUES ASSOCIATED
WITH THE POPULATION OI HAWAIÌ

State and fedeial laws have to be
followed by eveiy individual. Sometimes
individuals and/oi families fiom vaiious
ethnic and cultuial backgiounds may hold
opposite ideas on what should be done. In
situations like that, the family's
piefeiences aie illegal in the State of
Hawaiì. Ioi example, Samoans believe
that the buiial of the deceased family
membei in theii own piopeity will keep
the family togethei based on constant
communication. Accoiding to state laws,
this is an illegal action and people fiom
that iace have to follow diffeient piactices.
Of couise these aie instances that cannot
iadically be changed by social woikeis,
although ceitain seivices and/oi piogiams
foi Samoans could be planned and
developed. Ioi example a cemeteiy foi
Samoan family membeis could be cieated
and memoiial piogiams could be offeied
by the community.
As discussed eailiei in the papei,
ceitain lawsuits aie influencing the
population of Hawaiì, and specifically
Native Hawaiians. House Bills and Acts
(e.g. Act OO1) which ielate to the bones of
the ancestois and theii maintenance of
theii own land, as opposed to tiansfeiiing
the iemains to diffeient locations, show
effectiveness till today and aie addiessing
legal issues that may aiise. On the othei
hand, ethical issues which aie not guided
by laws but by cultuial iamifications and
subjectivity aie haidei to iesolve and to
that extent make judgments ciitical.
Respect foi diffeient customs, beliefs,
and values is an essential issue that ielates
to the ethical piactice of Social Woik. It is
impoitant foi piactitioneis to be sensitive
to those diffeiences and make decisions
which aie cultuially sensitive. As
mentioned by Sue and Sue (2OO8), social
woikeis should fiist identify the aieas of
ethical dilemmas with clients fiom
diffeient cultuies, and then pioceed to
inteiventions.
Significant attention has been given
lately to ethical conflicts that aiise in
multicultuial settings (Mullei &
Desmond, 1992). Especially in hospital
settings when someone dies, diffeiing
cultuial and value-based backgiounds of
the individual/family and the
piactitioneis may inciease the complexity
of the situation and will affect the given
pioceduies. Accoiding to Mullei and
Desmond (1992), a vaiiety of ethical
dilemmas and issues aiose aftei the death
of a Chinese woman in a hospital. Those
dilemmas included the withdiawing of the
fact of death fiom some family membeis,
the iole of the family in making medical
decisions, and the impact of such
dilemmas on the family system. The
authois examined all the effects those
issues had on the family system, and
highlighted the need foi moie ieseaich
and expeitise in such multicultuial
contexts.
Social Woik piactice has made a
significant contiibution to expeiiences
such as death, dying, and beieavement
(Evan, 2OO9). Howevei, cultuial
competence of the piactitioneis is still a
subject foi development. Lo (2OO9)
undeiscoies how ethical dilemmas can be
iesolved when the piactitionei becomes
awaie of the diffeient cultuial gioups of
the community he/she is woiking foi/in.
It is also highlighted that ethical dilemmas
do not necessaiily aiise just fiom cultuial
diffeiences, which may lead to moie
intense complexity of the ethical issues.


IFSY & NZSY Codes of EthIcs
Both IISW and NASW state specific
piinciples and ethical codes, which have
to be followed by social woik
piactitioneis. Those codes of ethics iefei
to a sensitive piactice and, foi the
puiposes of this papei, cultuially-based
inteiventions, which will piomote and
maintain the well-being of the people who
aie ieceiving seivices.
IISW (2OO9) states, at the pieface of
the statement of piinciples, that: "Ethical
awaieness is a fundamental pait of the
piofessional piactice of social woikeis.
Theii ability and commitment to act
ethically is an essential aspect of the
quality of the seivice offeied to those who
use social woik seivices." Cultuial
sensitivity and awaieness aie majoi paits
of the piinciples. Accoiding to the IISW,
social woikeis should tieat eveiy client
system based on the piinciples of human
iights and dignity, social justice, and
piofessional conduct. In all these thiee
piinciples, social woikeis ought to piovide
seivices based on the inteiest of the
clientele, theii cultuial and ethical
backgiound, and theii cuiient beliefs, and
values. "Social woikeis should iecognize
and iespect the ethnic and cultuial
diveisity of the societies in which they
piactice, taking account of individual,
family, gioup and community
diffeiences." ( IISW, 2OO9).
"Social Woikeis aie sensitive to
cultuial and ethnic diveisity and stiive to
end disciimination, oppiession, poveity,
and othei foims of social injustice."
(NASW, 2OO1). NASW sets up standaids
and expected competences foi social woik
piactitioneis, which will piomote and
inciease social justice within the
communities. Accoiding to the 2OO8
ievised Code of Ethics, paiagiaph 1.O5 (c)
states: "Social Woikeis should obtain
education and seek to undeistand the
natuie of social diveisity.with iespect to
iace, ethnicity, national oiigin, coloi, .,
ieligion, immigiation status."
Both IISW and NASW Codes of
Ethics iefei to aieas that aie sensitive foi
the population of Hawaiì, and moie
specifically the beieaved iesidents. Even
though the accepted values and codes of
ethics do seive the population, bettei
undeistanding of the diveisity in the
specific community, Hawaii, is needed.
Knowledge, not only of the diffeient
individual cultuies but of theii existence
as a whole and theii inteiactions is still
needed and most likely in need of
impiovement by social woik piactitioneis.

PART III: CONCLUSIONS

IMPLEMENTATIONS IN SOCIAL WORK
PRACTICE AND
IMPLICATIONS IOR SOCIAL ACENCIES

Social woik piactice on issues
associated with death, dying, and
beieavement may be found in numeious
settings, as these aie univeisal concepts of
life. Hospitals, hospices, nuising homes,
geiiatiic settlement houses, and otheis aie
settings which may fiequently include
giief-ielated social woik piactice. In
addition, policy piactice in agencies and
oiganizations (e.g. Non Coveinmental
Oiganizations
16
|NCOs]), Child
Piotective Seivices (CPS), Adult
Piotective Seivices (APS), oi community
piogiams may as well include social woik
with dying people oi giieving individuals
and systems. Social woikeis, as othei
piactitioneis, will most likely encountei
such issues in theii woik with clients, at
any level of piactice (micio, mezzo,
and/oi macio) (Calahan, 1999).

16
Moie commonly known as nonpiofits in the
United States.


"Gravcyard," Chrtstt Sava, stcck.xchng

Paiagiaph 1.O5, section (a), in the
NASW Code of Ethics iefeis to the
necessity foi undeistanding cultuies and
the impoitance of stiengths peispectives
when woiking with diveise individuals
and/oi systems. (NASW, 2OO1, p.7).
Knowledge of infoimation such as is
piovided thiough this theoietical
appioach of coiielations and ciosstabs
about death, dying, beieavement, cultuie,
and ieligion may be ciitically useful foi
social woikeis. Such data do not only
ieveal the stiengths of each cultuie one is
woiking with, in addition they piovide full
undeistanding of a diffeient woildview
which may be deteiminant in the helping
piocess and helping ielationship.
Cultuial awaieness iegaiding the
conceins, piactices, and behaviois of one's
clientele may lead to effective
implementation of theoiies and
appioaches (Hepwoith et al., 2O1O,
Dinitto & McNeece, 1997, Hancock,
1997). Awaieness of cultuie has thiee
diffeient components.
Iiist, social woikeis
17
should be awaie
of theii own cultuie, including piejudices,
typical behaviois, and ceitain spiiitual and
ieligious iituals attached to the cultuie
(Deiezotes, 2OO6). Self-awaieness is a
ciitical element of pioductive and effective

17
This infoimation and these conclusions may
apply to moie disciplines. Howevei, foi bievity I
will be iefeiiing to social woikeis only.
piactice, foi it will eliminate micio-insults,
micio-aggiession and in geneial
unintended behaviois and piactices fiom
the piactitionei's peispective.
Second, piactitioneis should be awaie
of the cultuies of theii clients. Even if
awaieness has not come thiough
education oi peisonal enactment, having
clients teaching the social woikei may be
pioductive and in the long iun effective.
All the cultuies examined in this papei aie
centeied on eithei a collectivistic oi an
individualistic peispective. Native Hawaii-
ans, Samoans, Chukeese, Maishallese,
Iijians, and Cuamanians aie all cultuies
of a collectivistic piefeience. Hence, theie
is an initial piefeience foi someone who is
dying to be taken caie of a family
membei, iathei than a nuise, while at the
same time, giief is moie welcome indoois,
among ielatives, iathei than in theiapy.
Hieiaichical ielationships have been
ciitical in many cultuies that have been
examined in this papei. Iilipinos, as well
as Chinese young adults, usually make
end-of-life decisions foi the paients,
wheieas Koieans follow diffeient patteins
when it comes to such decisions.
Tiaditionally, in the lattei cultuie, even if
the patient is the fathei, despite the
stiuggles, he will make the decisions.
Iinally, social woikeis should be
pione to undeistanding the inteiactions
and diffeiences of the diveise cultuies,
especially between them and the clients
(Hull & Kiist-Ashman, 2OO4). Being
awaie of the cultuies that meige into the
helping ielationship is not enough. The
pioducts of such a cultuial ielationship,
though, may add significantly to the
piocess and to the effectiveness of the
piactice.
"Iiguiing out how an individual client
thinks and functions is fascinating." (Hull
& Kiist-Ashman, 2OO4, p.19). Social woik
piactice with beieaved individuals does


not only consist of comfoit piactices, oi
adjustment tendencies. Change is a iadical
component of this piactice and ciitical in
social woik with beieaved systems and/oi
dying people. "What is left ungiieved
iemains stoied in oui body, heait, and
soul. It can come out each time we
expeiience loss anew." (Kublei-Ross &
Kesslei, 2OO5, p. 73). Piolonged giief
situations/issues may inciease the need
foi the piactitionei to focus on cultuial
stiengths, which will allow him/hei to
fully conceptualize the ieasons why the
giief is piolonged, as it may oiiginate fiom
diffeient causes iathei than clinical ones.
Ioi example, Iilipino families aie
expected to piolong theii giief and extend
theii emotions foi moie time than is usual
in the Westein cultuies. If this is not the
case, then disiespect is shown to the
peison who passed away.
Hull and Kiist-Ashman (2OO4) have
stated: "The individual is iight in fiont of
you. The othei systems with which the
individual client is involved aie much
moie abstiact. Theii inteiactions and
effects may seem vague and distant.
Because of the complexity of the outside
systems, pinpointing taigets of change
often seems moie difficult" (p.19).
Diffeient cultuial peispectives
iegaiding death, dying, and beieavement
attitudes and behaviois, as well as
tiaditions and customs, can lead to
pioductive piogiam evaluations and
assessments. What aie the existing
piogiams and seivices that aie piovided to
the population of Hawaii! What aie the
theoiies and appioaches on a macio level
that aie applied in this State! These
elements may be examined thiough a
new, cultuially-based scope, and thus
piovide feedback which will piomote
needed changes based on the new needs of
the population, and additionally impiove
the outcomes of community-based
piactice (1ansson, 2O1O). Accoiding to
Hull and Kiist-Ashman (2OO4) the ability
to apply knowledge which conceins
diffeient cultuies is an essential pait of
cultuial competence. Such applications on
the macio level of social woik piactice
may inciease the sustainability of human
seivices in the State of Hawaii. Also, as
implied by Bell et al. (2OO9), the same
applications may piomote new tiends and
tendencies to the populations in need, as
opposed to lack of knowledge and/oi tiust
of the seivices piovided in one's com-
munity.
Sue and Sue (2OO8) have suggested
that ignoiance is a deteiminant factoi foi
micio insults and micio aggiession in the
society. Social seivices aie piovided by
ceitain individuals/woikeis who woik at
those seivices. These piactitioneis will
piomote the wiong idea to the seivice
seekeis, and discouiage them on seeking
the seivices again, unless they
(piactitioneis) aie awaie of the
population, its needs, challenges,
stiengths, and weaknesses. All these may
be included in one's cultuie.

ETHICAL CHALLENCES AND
RESOLUTIONS

As discussed eailiei in the papei,
numeious ethical challenges, which aie
iooted in cultuial chaiacteiistics, may
aiise thiough social woik piactice.
NHPIs, oi at least a majoiity of these
cultuies, and specifically Native
Hawaiians, Samoans, Chamoiio, and
Chukeese tend to have a chief membei in
the family. That membei is the peison
who will make the end-of-life decisions
when the time is iight, and nobody else.
"When my giandfathei died, we weie still
in Cuam, and we had to wait 11 houis foi
the doctoi to tell us, because he was
waiting foi the 'chief' of my extended


family to be told fiist" (peisonal
communication, Apiil 2, 2O11).
Ethical challenges and dilemmas can
be expeiienced in many diffeient ways,
depending on the cultuial awaieness of
the social woikei. Value conflicts can aiise
especially when a social woikei is
pioviding seivices to clients whose
ieligious oi cultuial beliefs suppoit
diffeient behaviois than the social
woikei's. In this case, it is the social
woikei's iesponsibility to figuie a safe
channel of communication and piactice
which will piomote the client's well-being
(NASW,2OO7, Hugman, 2OO5, Dinitto &
McNeece, 1997, Cambiill & Piugei, 1997,
Wells & Masch, 1986).
Woiking at a hospital oi a hospice
with clients fiom many diffeient cultuial
and ieligious values, and beliefs incieases
the obligations foi awaieness on these
issues, and also the need to be mindful of
any possible ethical dilemmas, and/oi
conflicts. Ioi example, when a Samoan
child needed an opeiation in a hospital
setting, the mothei was not willing to sign
the papeiwoik foi the pioceduie to take
place, iegaidless the seveiity of the
situation. Although undei Hawaii law
she had to give hei consent, she insisted
on waiting foi the chief of the family to
come in and do the signatuies. Cultuially
she was not allowed to do what the
physician was asking hei to do (peisonal
communication, Maich 29, 2O11). In this
ethical challenge, it was ciitical foi all the
paities to be cultuially sensitive.
Undeistanding of the situation, and the
client's willingness, as opposed to
aggiessive and non fiiendly behaviois and
communications, can lead to moie
successful piactice. This example may be
exploied thiough the ecosystems
peispective. Social woikeis do not only
woik with the client/client system. They
also do not only woik with the system in
its enviionment (Peison-in-Enviionment
'PIE'). Social woikeis woik with the
peison, the enviionment, and the
inteiactions between the peison and the
enviionment. The social woikei in the last
case can be seen as a mediatoi, foi
example, between the physician and the
client. Both need to undeistand why the
othei paity is making the decisions that
aie made. Additionally, the client system
needs to undeistand what the best choice
is at that moment.
This papei has piovided in-depth
infoimation and syntheses of ieligious and
cultuial infoimation. With this piovision,
social woik piactitioneis may equip
themselves somewhat bettei foi futuie
piactices. Ethical challenges and/oi
ethical dilemmas have no specific
iesolutions. Some choices, though, aie
bettei than otheis, and some choices may
be unethical. Howevei, though being
cultuially awaie and/oi applying
cultuially-based piactices, such decisions
may become easiei to make, and thus
moie acceptable to both the social woikei
and the client.

IUTURE TRENDS IOR SOCIAL WORK
RESEARCH

Reseaich in effective inteiventions to
meet the needs of diffeient populations is
necessaiy. Iuitheimoie, not all beieaved
people, even fiom the same cultuie,
expiess themselves in the same ways oi
shaie the same expeiiences in managing
giief. Reseaich needs to include beieaved
peisons fiom a bioadei spectium of the
population of Hawaii. Due to the diveisity
of the population, "beieavement studies
should systematically test foi cioss-
cultuial and ethnic compaiisons" (Lund &
Caseita, 1998, p.295). Moie heteio-
geneous samples need to be included in
the studies, with sufficient numbeis of


Hispanic, Native Ameiicans, Afiican
Ameiicans, and othei Pacific Islandeis,
such as Iijians oi people fiom the
Maiiana Islands. It is impoitant to
compaie cultuial similaiities and
diffeiences to moie fully undeistand the
piocess of giieving in the community, and
in oiganizational settings. To that extent,
sophisticated knowledge and awaieness of
such similaiities and diffeiences can lead
to an emphasis on which inteiventions oi
social woik stiategies aie moie effective
foi which cultuie.
Anothei challenge foi futuie social
woik ieseaich is to impiove the
undeistanding of the impact of ieligious
oiientation in one's cultuie, and,
fuitheimoie, inciease the knowledge of
how ieligious beliefs and piactices can be
distinguished fiom cultuial ones, oi how
those piactices can be consideied as
subcultuies. Moieovei, the piofession of
social woik may be challenged to name
specific social woik inteiventions foi
death and beieavement, not only to
specific cultuies, but specific to
cultuie/ieligion ciosstabs (i.e. Asian
Agnostic vs. Asian Buddhist).

IINAL COMMENTS

As stated by NASW (2OO4) in the
NASW Standaids foi Social Woik
Piactice in Palliative and End-of-Life
Caie:
Social woikeis have unique, in-depth
knowledge of and expeitise in woiking
with ethnic, cultuial, and economic
diveisity, family and suppoit netwoiks,
multidimensional symptom manage-
ment, beieavement, tiauma and
disastei ielief, inteidisciplinaiy
piactice, inteiventions acioss the life
cycle, and systems inteiventions that
addiess the fiagmentation, gaps, and
insufficiency in health caie. These aie
ciitical aieas foi implementing change
in palliative and end-of-life caie (p.14).
In oidei to gain knowledge of and
expeitise in the aieas mentioned above,
social woikeis need to follow NASW's
continuing education philosophy. NASW
views continuing education as "an
essential activity foi ensuiing quality
social woik seivices foi clients" (NASW,
2OO3, p.7). Iuitheimoie, NASW
encouiages and essentially suppoits
cultuial competence in social woik
piactice (NASW, 2OO7, 2OO1).
Hawaii is a State that is constantly
undeigoing demogiaphic changes, and
thus community changes. Such tiansitions
(e.g. new languages, new customs,
incieased accultuiation piocesses, and
elimination of community paiticipation
unless in same-cultuial gioups) necessitate
cultuially-based and giounded intei-
ventions when woiking with dying
individuals, beieaved family systems,
beieaved communities and neighboi-
hoods. The decision to become a social
woikei is a decision to commit to those
changes and challenges, and a
commitment to advocate foi the well-
being of the evei-changing systems, no
mattei how long the "living" state of the
client/client system will last. Social
woikeis should be iesponsible foi quality
seivices and quality inteiventions which
embiace the diveisity of the populations
with which they aie woiking.

REIERENCES

Agbayani-Sieweit, P. (1994). Iilipino
Ameiican cultuie and family: guidelines foi
piactitioneis. Eamtltcs tn Scctcty, 75(7), 429-
438.

Beckei, E. (1973). Thc Dcntal cf Dcath. New
Yoik: Simon & Schustei.


Bell, C.L., Davis, 1., Haiiigan, R.C.,
Somogyi-Zalud, E., Tanabe, M.K.C., &
Masaki, K.H. (2OO9). Iactois associated with
place of death foi eldeily 1apanese-Ameiican
men: the Honolulu Heait Piogiam and
Honolulu-Asian Aging Study. 1curnal cf thc
Amcrtcan Gcrtatrtcs Scctcty, 57(4), 714-718.

Biaun, K., Pietsch, 1.H., & Blanchette, P.L.
(2OOO). Cultural Issucs tn End-Of-Ltfc Dcctstcn
Maktng. CA: Sage, Thousand Oaks.

Biaun, K.L., & Nichols, R. (1997). Death and
dying in foui Asian Ameiican cultuies: a
desciiptive study. Dcath Studtcs, 21(4), 327-
359.

Bieen, L.1. (2O1O). Piofessionals' expeiiences
of giief counseling: implications foi biidging
the gap between ieseaich and piactice. 1curnal
cf Dcath & Dytng, 62(3), 285-3O3.

Buighaidt, S. (2O1O). Macrc practtcc tn scctal
wcrk fcr thc 21
st
ccntury. USA: Thousand Oaks,
SACE.
Callahan, B.N. (1999). Grtcf Ccunscltng. A
Manual fcr Scctal crkcrs. Denvei: Love
Publications.

Canda, E.R., & Iuiman, L.D. (2O1O).
Sptrttual Dtvcrstty tn Scctal crk Fracttcc. Thc
Hcart cf Hclptng. NY: Oxfoid.

Caiioll, R. (1996). Chtckcn sktn. truc spccky
stcrtcs cf Hawat`t. HI: The Bess Piess.

Centeis foi Disease Contiol and Pievention,
National Centei foi Health Statistics, Division
of Vital Statistics, National Vital Statistics
Repoit Volume 58, Numbei 19, May 2O1O,
Table 29. Available at:
http://www.cdc.gov/nchs/data/nvsi/nvsi58
/nvsi58_19.pdf

Chan, C.L.W., Chow, A.Y.M., Ho, S.M.Y.,
Tsui, Y.K.Y., Tin, A.I., Koo, B.W.K., &
Koo, E.W.K. (2OO5). The expeiience of
Chinese beieaved peisons: a pieliminaiy
study of meaning making and continuing
bonds. Dcath Studtcs, 29(1O), 923-947.

Chang, H.H., & Ng, K.S. (2OO2). The
peiception of iesiliency mechanisms in
Chinese Ameiican families: implications foi
family theiapy. Eamtly Thcrapy, 29(2), 89-1OO.

Collins, D., 1oidan, C., & Coleman, H.
(2O1O). An tntrcducttcn tc famtly scctal wcrk (3
rd

cd.). Canada: Cengage Leaining.

Coiey C. (1995). Thccry and Fracttcc cf Grcup
Ccunscltng (4
th
cd.). Califoinia, US: Cengage
Leaining.

D'Ciuz, H., & 1ones, M. (2OO4). Scctal wcrk
rcscarch. cthtcal and pcltttcal ccntcxts. Cieat
Biitain: The Ciomwell Piess.

Deiezotes, D.S. (2OO6). Sptrttually crtcntcd
scctal wcrk practtcc. USA: Peaison Education.

Dinitto, D.M., & McNeece, A.C. (1997).
Scctal wcrk tssucs and cppcrtuntttcs tn a
challcngtng prcfcsstcn. (2
nd
ed.). USA: Allyn and
Bacon.
Doyle, A. (2O11). Histoiy of ieseaich on
piocess ielevant to clinical social woik.
Cltntcal Scctal crk 1curnal, 39(1), 68-78.

Eunjeong, K., & Beikman, C.S. (2O1O). Role
of childien in end-of-life tieatment planning
among Koiean Ameiican oldei adults. 1curnal
cf Scctal crk tn End-cf-Ltfc & Falltattvc Carc,
6(3/4), 164-184.
Evan, C. (2OO9). Review of woiking with loss,
death, and beieavement: a guide foi social
woikeis. Australtan Scctal crk, 62(2), 3O6-
3O8.

Ioiisha, B., Wiight, C., & Tucket, M. (2OO5).
"Towaid a cultuially and spiiitually
consonant tieatment of Native Hawaiians: an
integiation of family theiapy and
Hoòponopono." In Heitlein, K.M., & Vieis,
D. Thc ccuplc and famtly thcraptsts nctcbcck.
hcmcwcrk, handcuts, and acttvtttcs fcr usc tn
marttal and famtly thcrapy. Btnghamtcn, NY,
US: Hawoith Clinical Piactice Piess.


Cambiill, E., & Piugei, R. (1997).
Ccntrcvcrstal tssucs tn scctal wcrk cthtcs, valucs,
and cbltgattcns. USA: Allyn and Bacon.

Camino, L.A., Sewell, K.W., Hogan, N.S., &
Mason, S.L. (2OO9). Who needs giief
counseling! A iepoit fiom the Scott & White
giief study. 1curnal cf Dcath & Dytng, 6O(3),
199-223.

Caivin D.C., Cutieiiez M.L., & Calinsky
1.M. (2OO4). Handbcck cf Scctal crk wtth
Grcups. New Yoik: The Cuilfoid Piess.

Ceistein, L.H., Heppnei, P.P., AEgisdottii,
S., Alvin Leung, S-M., & Noiswoithy, K.L.
(2OO9). Intcrnattcnal handbcck cf crcss-cultural
ccunscltng. cultural assumpttcns and practtccs
wcrldwtdc. USA: Sage.

Cilbeit, R.B. (2O1O). Ethical piactice in giief
counseling. Illncss, Crtsts & Lcss, 18(2), 173-
176.

Clazei, H.R., & Maicum, D. (2OO3).
Expiessing giief thiough stoiytelling. 1curnal
cf Humantsttc Ccunscltng, Educattcn &
Dcvclcpmcnt, 42(2), 131-138.
Cieen, L.C., & Beckwith, M.W. (2OO9).
Hawaiian Customs and Beliefs ielating to
Sickness and Death. Amcrtcan Anthrcpclcgtst,
28 (1), 1762O8, (published online at:
http://onlinelibiaiy.wiley.com/doi/1O.1525/
aa.1926.28.1.O2aOOO3O/pdf).

Ciinnel, R.M. 1i., & Uniau, Y.A. (2O1O).
Scctal wcrk rcscarch and cvaluattcn. fcundattcns cf
cvtdcncc-bascd practtcc. New Yoik: Oxfoid
Univeisity Piess.

Han T.L., Collins, S.L., Claiks, S.D., &
Cailand, A. (1986). Hawaiian moituaiy
Piactices. In Moe kau a hoòilo, Hawattan
mcrtuary practtccs at Kccpu, Kcna, Hawat`t (pp.
33-59). Honolulu, HI: Bishop Museum.

Hancock, M.R. (1997). Frtnctplcs cf scctal wcrk
practtcc. a gcncrtc practtcc apprcach. New Yoik
and London: The Hawoith Piess.

Haitman, S. (1985). Huna, Hakomi, and
spiiituality. Hakcmt Ecrum, 3, 29-33.

Hattoii, K., McCubbin, M.A., & Ishida, D.N.
(2OO6). Concept analysis of good death in the
1apanese community. 1curnal cf Nurstng
Schclarshtp, 38(2), 165-17O.
Hcaltng. (2
nd
cd.). USA: Oxfoid Univeisity
Piess.

Hepwoith, D.H., Rooney, R.H., Rooney,
C.D., Stiom-Cottfiied, K., & Laisen, 1.A.
(2O1O). Dtrcct scctal wcrk practtcc. thccry and
sktlls (8
th
cd.). Canada: Cengage.

Hope B.E. & Hope 1.H. (2OO3). Native
Hawaiian Health in Hawaii: Histoiical
Highlights. Caltfcrnta 1curnal cf Hcalth
Frcmcttcn, 1 (special issue: Hawaiì 1 9).

Howaid, A. & Scott, R.A. (1965). Cultuial
values and attitudes towaid death. 1curnal cf
Extstcnttaltsm, 6(22), 161-171.

Hugman, R. (2OO5). Ncw apprcachcs tn cthtcs fcr
thc cartng prcfcsstcns. China: palgiave
macmillan.

Hull, C.H., & Kiist-Ashman, K.K. (2OO4).
Thc gcncraltst mcdcl cf human scrvtccs practtcc.
USA: Biooks/Cole, Thomson Leaining.

Huidle, D.E. (2OO2). Native Hawaiian
tiaditionally healing: cultuially based
inteiventions foi social woik piactice. Scctal
crk, 47(2), 183-192.

Inteinational Iedeiation of Social Woikeis
|IISW]. (Retiieved: O2/2O11). Dcftntttcn cf
Scctal crk. Last updated: O4/1O/2OO5.
Available at:
http://www.ifsw.oig/p38OOO2O8.html

Inteinational Iedeiation of Social Woikeis
|IISW]. (2OO9). Ethtcs tn scctal wcrk. statcmcnt
cf prtnctplcs. Available at:
http://www.ifsw.oig/p38OOO324.html

Ivey, A.E., Ivey, M.B., & Zalaquett, C.P.
(2O1O). Intcnttcnal tntcrvtcwtng & ccunscltng.


factlttattng cltcnt dcvclcpmcnt tn a multtcultural
scctcty. US: Cengage Leaining.

1ansson, B.S. (2O1O). Bcccmtng an cffccttvc
pcltcy advccatc. frcm pcltcy practtcc tc scctal
fusttcc. US: Biooks/Cole.

1oidan, 1.R., & Neimeyei, R.A. (2OO3). Does
giief counseling woik! Dcath Studtcs, 27(9),
765-786.

1ust, C. (2OO8). Dcr gcscllschaftltchc Umgang mtt
Stcrbcn und Tcd und daraus rcsulttcrcndc
Kcnscqucnzcn fur dtc Fflcgc (p.49). Beilin
Univeisity, (unpublished woik).

Kamana'opono M.C. (1999). Conceptions of
Depiession: a Hawaiian Peispective. Factftc
Hcalth Dtalcguc (FHD), 6 (2).

Kanuha, V.K. (2OO5). "Na òhana: Native
Hawaiian families." In McColdiick, M.,
Cioidano, 1., & Caicia-Pieto, N. Ethntctty &
famtly thcrapy. New Yoik, US: Cuilfoid Piess.

Kawahaiada, D. (2OO3, Maich 7). The
settlement of Polynesia, pait 1 |Online Ioium
Comment]. Retiieved fiom
ht t p: //www. paul wat ei s . com/mi gi a
t e. ht m

Kiich, P.V. & Rallu, 1.V. (2OO7). Thc Grcwth
and Ccllapsc cf Factftc Island Scctcttcs. HI:
Univeisity of Hawaiì Piess

Kublei-Ross E. (1975). Dcath. Thc ftnal stagc cf
grcwth. NY: Touchstone.
Kublei-Ross E. (1979). On dcath and Dytng.
Athens - Cieece: Tamasos.

Kublei Ross, E. & Kesslei, D. (2OO5). On
grtcf and grtcvtng. Etndtng thc mcantng cf grtcf
thrcugh thc ftvc stagcs cf lcss. NY: Elisabeth
Kublei Ross Iamily Limited Paitneiship
and David Kesslei.

Kwon, S-Y. (2OO6). Ciief ministiy as
homecoming: fiaming death fiom a Koiean-
Ameiican peispective. Fastcral Fsychclcgy,
54(4), 313-324.

Kyung Rim, S., Myung Ok, C., & 1eong Sun,
K. (2OO5). The meaning of death as
expeiienced by eldeily women of a Koiean
clan. Qualttattvc Hcalth Rcscarch, 15(1), 5-18.

Laungani, P. (2OO4). Astan pcrspccttvcs tn
ccunscltng and psychcthcraptcs. New Yoik:
Biunnei-Routledge.

Leung, P., Cecilia, C., Siu-Man, N., & Mo-
yee, L. (2OO9). Towaids body-mind-spiiit
integiation: east meets west in clinical social
woik piactice. Cltntcal Scctal crk 1curnal,
37(4), 3O3-311.

Lim, R.C. Depaitment of Business, Economic
Development & Touiism. (2OO9). 2009 Statc cf
Hawatt data bcck. Hawaii: Coveinment
Piinting Office. Retiieved fiom:
ht t p: //hawai i . gov/dbedt /i nf o/ec o
nomi c/dat abook/db2OO9/

Little, V. (2OO9). Palliative caie needs in
Ameiican Samoa. 1curnal cf Falltattvc Mcdtctnc,
12(5), 411-413.

Lo, B. (2OO9). Rcsclvtng cthtcal dtlcmmas. a
gutdc fcr cltntctans (4
th
cd.). Republic of China:
Lippincott Williams & Wilkins.

Long, 1. B. (1975). The Death that ends
Death in Hinduism and Buddhism. In Kublei-
Ross, E. Dcath. Thc ftnal stagc cf grcwth. NY:
Touchstone.

Lund, D.A., & Caseita, M.S. (1997-98).
Iutuie diiections in adult beieavement
ieseaich. 1curnal cf Dcath & Dytng, 36(4), 287-
3O3.
McColdiick, M., Cioidano, 1., & Caicia-
Pieto, N. (2OO5). Ethntctty & famtly thcrapy.
New Yoik, US: Cuilfoid Piess.

Meimann, A.C. (1991). Spiiitual Aspects of
Death and Dying. Thc Yalc 1curnal cf Btclcgy
and Mcdtctnc, 65(1), 137-142.

Mokuau, N., Cailock-Tuialiì, 1., & Lee, P.
(2OO8). Has social woik met its commitment


to Native Hawaiians and Othei Pacific
Islandeis! A ieview of the peiiodical
liteiatuie. Scctal crk, 53(2), 115-121.

Mui Hi ng, 1. M. (2OO2). Accepting the
timing of one's death: an expeiience of
Chinese hospice patients. Omega: 1curnal cf
Dcath and Dytng, 45(3), 245.

Mullei, 1.H., & Desmond, B. (1992). Ethical
dilemmas in a cioss-cultuial context. A
Chinese example. cstcrn 1curnal cf Mcdtctnc,
157(3), 323-327.

National Association of Social Woikeis
|NASW]. (2OO7). Indtcatcrs fcr thc achtcvcmcnt
cf thc NAS Standards fcr cultural ccmpctcncc tn
scctal wcrk practtcc. NASW Piess, available at:
http://www.naswdc.oig/piactice/beieaveme
nt/standaids/standaidsO5O4New.pdf

|NASW]. (2OO3). NAS Standards fcr
ccnttnutng prcfcsstcnal cducattcn. NASW Piess,
available at:
http://www.socialwoikeis.oig/piactice/stan
daids/NASWContinuingEdStandaids.pdf

|NASW]. (2OO1). NAS Standards fcr cultural
ccmpctcncc tn scctal wcrk practtcc. NASW Piess,
available at:
http://www.naswdc.oig/piactice/standaids/
NASWCultuialStandaids.pdf

|NASW]. (2OO4). NAS Standards fcr palltattvc
& cnd cf ltfc carc. NASW Piess, available at:
http://www.naswdc.oig/piactice/beieaveme
nt/standaids/standaidsO5O4New.pdf

Netting, E.I., Kettnei, P.M., & McMuitiy,
S.L. (2OO8). Scctal wcrk macrc practtcc. USA:
Allyn and Bacon.

Nishihaia, D.P. (1978). Cultuie, counseling,
and Hoòponopono: an ancient model in a
modein context. Fcrscnncl & Gutdancc 1curnal,
56(g), 562-566.

Nishimuia, S.T., Coebeit, D.A., Ramisetty-
Miklei, S., & Caetano, R. (2OO5). Adolescent
Alcohol Use and Suicide Indicatois among
Adolescents in Hawaii. Cultural Dtvcrstty &
Ethntc Mtncrtty Fsychclcgy, 11(4), 3O9-32O.

Ofahengaue, V., Halaevalu, I.C., & Meiipa,
T. (2OO8). Iamily and cultuie, and the
Samoan youth. 1curnal cf Eamtly Scctal crk,
11(3), 229-253.

Oi bach, A. (1999). Ltfc, Fsychcthcrapy and
Dcath. Thc cnd cf cur cxplcrtng. Cieat Biitain:
Athenaeum Piess.

Pang, T. H.C. & Lam, C.W. (2OO2). The
widoweis' beieavement piocess and death
iituals: Hong Kong expeiiences. Illncss, Crtsts
& Lcss, 1O(4), 294-3O6.

Peiez, M.P. (2OO5). Colonialism,
Ameiicanization, and Indigenous Identity: A
ieseaich note on Chamoiio identity in Cuam.
Scctclcgtcal Spcctrum, 25(5), 571-591.
Pobutsky, A.M. (2OO1). Economics and
Ieitility: changing family stiuctuie among
Chamoiios on the island of Cuam. Htstcry cf
thc Eamtly, 6(1), 95.

Ponteiotto, 1.C., Suzuki, L.A., Manuel
Casas, 1., & Alexandei, C.M. (2O1O).
Handbcck cf multtcultural ccunscltng. US: Sage.

Ritz, M.K. (2OO6, August 2). Rites of passage.
Hcnclulu Advcrttscr, p.14.

Saleh, M.A. (1997). Counseling the
Micionesian client. Intcrnattcnal 1curnal fcr thc
Advanccmcnt cf Ccunscltng, 19(2), 131-141.

Saundeis (Dame), C.M., & Claik, D. (2OO2).
Ctccly Saundcrs. fcundcr cf thc hcsptcc mcvcmcnt.
sclcctcd lcttcrs 1959-1999. UK: Oxfoid
Univeisity Piess.

Shimabukuio, K.P., Daniels, 1., & DÀndiea,
M. (1999). Addiessing spiiitual issues fiom a
cultuial peispective: the case of the giieving
Iilipino boy. 1curnal cf Multtcultural Ccunscltng
& Dcvclcpmcnt, 27(4), 221-239.


Skelton, 1. (2OO3). Death and dying in
liteiatuie. Advanccs tn Fsychtatrtc Trcatmcnt,
9(1), 211-217.

State Histoiic Pieseivation Division |SHPD].
(2O11). Hawaii Depaitment of Land and
Natuial Resouices |DLNR]. Infoimation
available at: http://hawaii.gov/dlni/

Stiean, H.S. (1978). Cltntcal scctal wcrk. thccry
and practtcc. US: The Iiee Piess.

Sue W.D. & Sue D. (2OO8). Ccunscltng thc
Culturally Dtvcrsc. Thccry and Fracttcc (5
th
cd.).
USA: Wiley.
Swaitz, P.Y. (2O1O). Cood death in the
Chinese cultuie: a ielational peispective.
Dcath Studtcs. 34(3), 278-284.

Tauiliili, D.S., Delva, 1., & Biowne, C.
(2OO1). A study of attitudes towaid aging and
caiegiving patteins among Samoan families in
Hawaii. 1curnal cf Eamtly Scctal crk, 6(1), 1-
14.

Tomei, A., Eliason, T.C., & Wong, T.P.P.
(2OO7). Extstcnttal and sptrttual tssucs tn dcath
attttudcs. N1: Lawience Eilbaum Associates.

Tone, 1.M., Claiiidge, B.R., Casey, V.,
Welch, L.C., Welte, T., Shield, R., & Moi, V.
(2OO4). Iamily peispectives on end-of-life
caie. 1curnal cf Amcrtcan Mcdtcal Asscctattcn
(1AMA), 291(1), 88-93.

Toseland, R.W., & Rivas, R.I. (2OO9). An
tntrcducttcn tc grcup wcrk practtcc (6
th
cd.). US:
Peaison.

U.S. Census Buieau. (2OOO). Available at:
http://www.census.gov/main/www/cen2OO
O.html

U.S. Census Buieau. (2OO9). Available at:
http://www.census.gov/compendia/statab/

U.S. Census Buieau. (2O1O). Available at:
http://2O1O.census.gov/2O1Ocensus/

Ushiioda M. (2OO8). Cultuial Implications of
Native Hawaiian Influences on Ciief and
Beieavement in Hawaiì as Expeiienced by
"Locals". Hawatt Factftc 1curnal cf Scctal crk
Fracttcc (HF1SF), 1(1), 36-54.

Van Zile, 1. (1983). 1apanese Bon dance and
Hawaii: mutual influences. Scctal Frcccss tn
Hawatt, 3O, 49-58.

Wada, K., & Paik, 1. (2OO9). Integiating
Buddhist psychology into giief counseling.
Dcath Studtcs, 33(7), 657-683.

Wells, C.C., & Masch, K.M. (1986). Scctal
wcrk cthtcs day tc day. gutdcltncs fcr prcfcsstcnal
practtcc. USA: Waveland Piess.

Wolfei, T.A., & Runnion, V.M. (2OO8).
Dcath, dytng, and bcrcavcmcnt tn scctal wcrk
practtcc. dcctstcn cascs fcr advanccd practtcc. New
Yoik: Columbia Univeisity Piess.

Woods, M.E., & Hollis, I. (2OOO). Cascwcrk. a
psychcscctal thcrapy. US: Mc Ciaw-Hill.

Xu, 1., Kochanek, K.D., Muiphy, S.L., &
Tejada-Veia, B. (2O1O). Deaths: final data foi
2OO7. Nattcnal Vttal Stattsttcs Rcpcrts, 58(19).
Retiieved fiom:
ht t p: //www. c dc. gov/nchs /dat a/nv
s i /nvs i 58/nvs i 58_19. pdf

Yalom, I.D., & Leszcz, M. (2OO5). Thc thccry
and practtcc cf grcup psychcthcrapy (5
th
cd.). New
Yoik: Basic Books.

Yang, S. C. & Chen, S.I. (2OO2). A
phenomenogiaphic appioach to the meaning
of death: a Chinese peispective. Dcath Studtcs,
26(2), 143-175.

Yick, C.A., & Cupta, R. (2OO2). Chinese
cultuial dimensions of death, dying and
beieavement: focus gioup findings. 1curnal cf
Cultural Dtvcrstty, 9(2), 32-42.


Yokomizo, A.I. (2OO1). Pahala's last (Bon)
dance: the dead aie not dead. Qualttattvc
Inqutry, 7(1), 21-34.

Zeizan, 1., Steains, S., Hanson, L. (2OOO).
Access to palliative caie and hospice in
nuising homes. Thc 1curnal cf thc Amcrtcan
Mcdtcal Asscctattcn (1AMA), 284(19), 2489-
2494.

ACKNOWLEDCEMENTS

Many components contiibuted foi the
completion of this piofessional papei, and those
should be acknowledged. To stait with, I would
like to expiess my deepest wishes and a waim
thank you to my academic advisoi foi this papei,
Di. Maiy Sheiidan. Even though she was not
physically with me, she made hei piesence
peiceivable thiough hei suppoit and essential input
to the completion of this pioduct. I want to thank
hei foi hei unique guidance to this pioduct.
A waim thank you and deep appieciations to
the faculty of the School of Social Woik, at the
Hawaiì Pacific Univeisity (HPU), foi they have
taught me well and efficiently to be able to fulfill
this iequiiement. Special thanks to Di. Loiaine
Maiais, Di. Pattie Nishimoto, and Mis. Maigo
Baie foi theii suppoit and constant consultation
thiough my "jouiney" at the school.
Special thanks to the State Scholaiship
Ioundation of Cieece (IKY), foi I have ieceived
suppoit and financial awaids foi the completion of
the MSW. Additionally, I want to thank my
paients, Nikos and Eleni. Without them, without
theii suppoit in any kind, and without theii love,
this pioduct would not have come to papei, and
this piogiam would not have been completed.
Last but not least, I want to show my giatitude
to my supeivisoi and close fiiend, Di. Vassilios
Mpountalis, who has been a suppoitive souice in
my academic and piofessional life, since 2OO4, and
to all of my fiiends and infoimal suppoitive
systems, foi they stood by me duiing all this time.

A 2O1O MSW giaduate of Hawaii Pacific
Univeisity and a Cieek national, Notis Pentaiis
divides his time between Athens and London,
woiking with migiants and studying in a doctoial
piogiam.

"Euncral ltghts," rcctcr, stcck.xchng

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