"This is Dr Michael Wilks. With a second opinion. This is a tale of two dying men. Marcus who is a black man. Dying of what is probably prostate cancer and Armand a white man dying of lung cancer. It is hard to say how long each has to live but both will probably live less than a month. Neither is getting any active treatment to cure their cancer after numerous treatments. They have both failed to respond both need and deserve to be on hospice. Care while cure is not possible care is still our goal treating pain rain and nausea and grief and perhaps loneliness hospice care is comprehensive care. It's geared toward those who want to focus on the quality of life and no no longer want treatments. That won't work or are considered overly aggressive or painful. Marcus will have no part in hospice nor will his his wife. They are not giving up on my Marcus explained his wife. Marcus still hopes for a cure. He told me so. You never know what they may invent tomorrow. Armand was eager to enroll in hospice. He accepted that medicine. Had nothing left to cure him but he he was scared of being in pain and being a burden to his family. It is probably not a coincidence. That Marcus is black and Armand is white. Federal title. Insurance data suggest that blacks near the end of life are thirty percent less likely to enroll in hospice compared to whites and compared to whites. Blacks are also far less likely to ask the doctor for a D. N.. Are Do not resuscitate order in other words requesting that no CPR CPR or intimation be performed if they have a cardiac arrest in both examples. Blacks seem to be opting for more aggressive care ear. When I asked Marcus about this? He explained that there are several explanations. He told me that blacks don't trust the healthcare system. He told me that he he has never forgiven the US government for studies into ski or doctors purposely chose not to treat black men with antibiotics. He is always always afraid that he won't get the same high quality care as whites. I trust you doctor. He told me but I don't trust the system. No Oh hospice for me. Promise I want everything done possible. Another common belief is that we push people into hospice to save the system. Money as I told Marcus I get paid a salary. My goal is to help you make decisions that are best for you. Neither my employer or I get any financial benefit or incentive to push a person toward or away from hospice care so from my perspective. Black people at the end of life are often missing. Good care out of fear of not getting aggressive care. Culture plays a huge. which part in how we deal with issues at the end of our life perhaps black doctors and other doctors from different cultural groups need to take a lead making sure that patients and their families understand the concept of a good death however they define that so that we can make choices to value and respect those"