Interventions at the end of life – a taxonomy for ‘overlapping consensus’

Abstract

Context: Around the world there is increasing interest in end of life issues. An unprecedented number of people dying in future decades will put new strains on families, communities, services and governments. It will also have implications for representations of death and dying within society and for the overall orientation of health and social care. What interventions are emerging in the face of these challenges? Methods: We conceptualize a comprehensive taxonomy of interventions, defined as ‘organized responses to end of life issues’. Findings: We classify the range of end of life interventions into 10 substantive categories: policy, advocacy, educational, ethico-legal, service, clinical, research, cultural, intangible, self-determined. We distinguish between two empirical aspects of any end of life intervention: the ‘locus’ refers to the space or spaces in which it is situated; the ‘focus’ captures its distinct character and purpose. We also contend that end of life interventions can be seen conceptually in two ways – as ‘frames’ (organized responses that primarily construct a shared understanding of an end of life issue) or as ‘instruments’ (organized responses that assume a shared understanding and then move to act in that context). Conclusions: Our taxonomy opens up the debate about end of life interventions in new ways to provide protagonists, activists, policy makers, clinicians, researchers and educators with a comprehensive framework in which to place their endeavours and more effectively to assess their efficacy. Following the inspiration of political philosopher John Rawls, we seek to foster an ‘overlapping consensus’ on how interventions at the end of life can be construed, understood and assessed.

Can Exposure to Online Conversations About Death and Dying Influence Death Competence? An Exploratory Study Within an Australian Massive Open Online Course

“…Governments in many countries such as the UK and Australia actively support palliative care and advance care planning as well as death awareness initiatives such as death cafes and compassionate communities to improve community appreciation of dying and death as a normal part of the life continuum (Abel & Kellehear, 2016;Clark et al, 2017;Kellehear, 2016;Pizzo, 2016;URBIS, 2016). By being able to discuss death and dying in our families, communities and with our health care providers, it is presumed we can develop the skills and competence to enable our own decision-making and support for others in our family and community (Noonan, Horsfall, Leonard, & Rosenberg, 2016).…”

The Global Spread of Death Café: A Cultural Intervention Relevant to Policy?

“…Before embarking on our study, we conceptualised Death Café as an end-of-life 'cultural intervention'. This was one of ten categories of interventionsor 'organised responses to end of life issues'we had previously classified, ranging from policy interventions to clinical and educational interventions (Clark et al, 2017). We characterised cultural interventions as the 'structured use of art, culture, and imagination to raise questions, challenge existing viewpoints, provide opportunities for reflection, promote debate, and foster engagement' (Clark et al, 2017: 8).…”

Is Death Taboo for Children? Developing Death Ambivalence as a Theoretical Framework to Understand Children’s Relationship with Death, Dying and Bereavement

“…Death is a universal reality. We live in an ageing population and the number of people dying, and the number of people experiencing bereavement, is expected to rise (Clark and others, ). It is asserted that, by the middle of the 21st century, death and grief will be a significant global concern: for individuals, families and communities as well as for social and health policies (Walter, ).…”