Table 2 Four categories, and text and code examples, which informed Theme 2, Religious followers’ diverse approaches towards end-of-life care reflect varied religious and cultural backgrounds, and faith interpretations and attitudes

I think the generations are different. Younger people talking about 30 years and younger especially if they’re brought up in Australia have a different approach to handling that situation. The older generation tends to be different. The older generation is a lot more conservative, more faithful I guess. I don’t want to generalise. And more not so proactive, more reactive. Whereas the younger generation I think wants to be a bit more proactive. They want to know the facts and they want to know the truth. Sometimes gender does play a part. Some families are very strong in terms of the gender, the male being the head of the family and the male needs to make decisions. But again, that’s more to do with the older generations. Younger generation are more about equality and being partners in the decision. (Coptic Orthodox 31)

Coptic country of origin differences

Generational differences: older male tends to make decisions; elder more conservative & faithful; younger want the truth (Coptic)

2a. Family and geographical origin and backgrounds

Anglican Church is quite strong in parts of Africa and I wouldn’t know how to speak about how Black Africans might or however we approach the culture, but Africans how Africans and different regional groups might want to talk about end of life issues. They would take a cultural position that would have nothing to do with being Anglican or not. There’s quite a lot of Chinese Anglicans and I think the same would be true for them. I think really I can only talk about White Anglo Celtic Anglicans, which are English, Australian, New Zealand, American, probably White South African. Cultural is probably more important than religion in lots of ways. (Anglican 18)

Culture is more important than religion in approaching ACP conversations (Anglican)

Culturally a lot of the Muslim people, the non-practising ones believe once you close your eyes that’s it. The people that do practice the religion do believe there is after life and they’re going to heaven, to eternity. It all depends on the individual. Some people say I’m a Muslim. If somebody asks me my religion I’m Muslim, I practice the religion but I personally don’t believe in all the preaching’s of the Koran but I believe the principles – you should be a good citizen, love thy neighbour approach. (Islamic 14)

Range of cultural ways of living as a Muslim - non-practicing to practicing religion & belief in heaven/eternity;

Practices the religion - doesn’t believe all Koran preachings but in good citizen principles

2b. Cultural traditions; types/sects within religions

Usually as you find with every culture and religion, a lot of religious expressions are cultural. So if I’m working with Buddhist people I’m not talking about Buddhists, I’m talking about the six different expressions of Buddhism so that makes it very complex. (Christian 02)

Buddhism encompasses different expressions of faith

If you’re in tune with orthodox spirituality you’re happy to die, the dying process is a peaceful one. There is not that fear and angst around it. That’s a cultural phenomenon rather than – you see some very faithful people and their death is so smooth and easy. Then you see other people who aren’t, not that they aren’t faithful but they don’t follow the faith as much as others, they’re screaming, pulling their hair out, crying. That’s not the orthodox faith because we believe the person continues to live. (Greek Orthodox 20)

If in tune with Greek Orthodox spirituality, happy to die/ peaceful; less faithful scream, pull hair out, cry

2c. Personal attitudes and religiosity

I think these days the Lutheran church is kind of like a lot of churches in some ways, the rigid doctrine isn’t what’s expected by most and it’s not practiced by most. For some of them this sort of thing in some ways can be a bit hard to make connections. Okay a funeral yes, everybody has to have a funeral but to think of their life and their choices can be a little bit of a different. Again there is nothing prescribed within the Lutheran faith no matter where you might be on the spectrum – rigid, conservative, fairly liberal, haven’t really been involved very much at all. To me I think it will be much more of a personal thing. (Lutheran 16)

Lutheran - ‘like a lot of little churches’

Relationship with Lutheranism is personal, seldom strong

Each case is different and you can’t say in this case the Rabbi said it’s okay and this case the Rabbi said it’s not okay they must be arguing. Not necessarily, maybe they have different scenarios. Say one scenario the health of the person has deteriorated – you have questions about whether to put a peg in to feed a person. You don’t want to starve a person but to what level do you feed them? These are all questions that come into the criteria. When you just have the RCA (Rabbinical Council of America) document it’s hard to get the information you need out of it that’s yes, no, black and white. That’s why I think it’s important the patient or some Rabbi should be involved in this process also. (Jewish 37)

Rabbi should be involved in deciding if tube fed, etc., as no black and white decisions

2d. Interpretations of faith and doctrine, and misunderstandings

There are people that come from kind of a Catholic heritage that mistakenly think they can’t put a not for resuscitation directive in their care plan because it’s goes against their faith teaching which is in fact not the case. So not for resuscitation is a perfectly acceptable – not to have this kind of extraordinary situation of people intervening when it’s clearly impossible for this person to be brought back, to be resuscitated. (Catholic 19)

Some Catholics think can’t put not for resuscitation as against faith (wrong)