Balancing empathy and rationality ( raso jo pareso ): A cultural lens on gender and palliative care

Dear Editor,

I read with great appreciation the article by ¹ “Sex and gender in palliative and end-of-life care: A service evaluation and qualitative analysis.” This study provides a valuable reminder that, while quantitative data revealed minimal sex-based differences in referral reasons, timing, or place of death, the qualitative findings highlighted significant gendered dynamics in caregiving and support. Women were disproportionately expected to assume caregiving roles, while men often hesitated to accept help due to norms of masculinity and stoicism.

When contextualized within Minangkabau culture, a society in West Sumatra, Indonesia, with a matrilineal kinship system, these findings invite deeper reflection. In the Minangkabau tradition, lineage and inheritance are passed through the female line. ² Women hold central roles as custodians of the rumah gadang (clan house) and as inheritors of property. Men, however, play essential roles as mamak (maternal uncles) responsible for their sisters’ children, and as fathers providing for their nuclear families. ²

In practice, caregiving responsibilities often fall to women, mothers, daughters, or nieces—mirroring Hudson et al.’s findings. Yet, the Minangkabau matrilineal system also positions men, particularly mamak, as morally and socially responsible for the well-being of the extended family. ² This creates opportunities for collective caregiving, where responsibility can be distributed across kinship lines rather than concentrated solely on women.

Key cultural values such as “raso jo pareso” (balancing empathy and rational consideration) and “duduak samo randah, tagak samo tinggi” (egalitarian consensus) provide a foundation for culturally responsive counseling in palliative care. Counselors working with Minangkabau families can facilitate deliberation within the extended family to ensure more equitable caregiving arrangements. ³ In this way, palliative care becomes not only an individual or nuclear family duty but a shared responsibility embedded in cultural norms of solidarity.^4,5

Also emphasize the lack of gender identity and sexuality data in palliative care records. ¹ Within Minangkabau society, religiously devout and highly attuned to values of malu (shame) and sopan santun (politeness), these conversations require particular cultural sensitivity. Counselors must create safe spaces for disclosure while respecting dignity and cultural boundaries, ensuring that inclusivity is not sacrificed in the name of cultural propriety.

In conclusion, study ¹ demonstrates that sex and gender differences in palliative care cannot be divorced from cultural contexts. In Minangkabau society, the matrilineal kinship system provides both challenges and opportunities for equitable caregiving. Integrating cultural values, religious principles, and indigenous philosophies into counseling frameworks could enrich palliative care practices and make end-of-life care more just, dignified, and inclusive.

Triyono Triyono Department of Guidance and Counseling, Universitas PGRI Sumatera Barat, Padang, Indonesia Rahmi Dwi Febriani Department of Guidance and Counseling, Universitas Negeri Padang, Indonesia Randi Saputra Department of Guidance and Counseling, IAIN Pontianak, Indonesia Rizky Andana Pohan Islamic Guidance and Counselling, Institut Agama Islam Negeri Langsa, Indonesia