The Philosophy of Palliative Care

Abstract

The idea of a philosophy of palliative care emerged with Cicely Saunders' vision for ‘a good death’, and was developed further with the World Health Organization (WHO) definition of palliative care. It is now being applied not only to cancer patients, but to all patients in end-of-life situations. As this palliative care approach advances, it is important to pause and comment on its effectiveness. It is a philosophy of patient care, and is therefore open to critique and evaluation. Using the Oxford Textbook of Palliative Medicine, 3rd edition as their basic reference, the authors present their argument that the palliative care approach has become too busy and over-professionalised, and that it therefore has significant weaknesses. They examine the framework of the specialty – quality of life, autonomy, dignity, patient-centredness, and the priority assigned to relatives in the remit of care – and the moral problems associated with implementing such a philosophy. The resource implications of various healthcare policies are also discussed in relation to the WHO definition. Whilst the authors defend the achievements of palliative care and those who work in the profession, they present suggestions for an alternative philosophy that prompts many ethical and philosophical questions about the future of palliative care.

Why Good Quality Care Needs Philosophy More Than Compassion Comment on "Why and How Is Compassion Necessary to Provide Good Quality Healthcare?"

“…Being denied and marginalised in a society traumatised by the second world war and hypnotized by the promises of modern technology, care for dying people was often limited to physical support, if at all. 8 By introducing the concept of 'total pain, ' and founding an institution -St Christopher's hospice in London -that played a leading role in developing a new approach to terminal care, she helped developing a new way of understanding what care for the dying should be like. Worldwide palliative care is now seen as care for the whole person and his or her family, intrinsically multidimensional, including physical, psycho-social and spiritual support, and thus essentially non reductionist.…”

The Place of Volunteering in Palliative Care

“…This whole provision is seen as a 'high person, low technology and hardware system of health care ' (De Spelder & Strickland, 2005) providing intimate care at scale. Its ultimate goal is the attainment of a 'good death' from the perspective of both the dying person and their family (Sandman, 2005), with the period before death characterised by the best possible quality of life (Randall & Downie, 2006). Whilst space does not permit an extended discussion of this concept, it is important to note that the 'good death' is contested; it is socially produced with, in the developed world, death often taking place over time as people live with life-threatening illness or slow degenerative conditions (Holloway, 2007).…”

“…Although mainly charity-based, hospices now operate on a business model raising funds from corporate sponsors as well as from sales in their high street shops and individual donations. Despite the continuing drive to maintain some autonomy, the independent feature of their operation is gradually being eroded within a culture of audit and evidence-based practice, as hospices increasingly are expected to demonstrate the effectiveness of services as part of the NHS referral system (Randall & Downie, 2006).…”

Journeying with Morrie: Challenging Notions of Professional Delivery of Spiritual Care at the End of Life

“…The model of patient-centred care has in particular been incorporated within the professional discourse of specialist palliative care practice that has its roots within the hospice movement (Wright, 2004;Randall and Downie, 2006). The philosophy of palliative care involves care of the 'whole' person that includes responsibility for practical, psychosocial and spiritual problems as well as the treatment of physical symptoms.…”

“…Against this backdrop, from the patients' perspective, the themes of achievement, joy, disappointment, guilt, loss and fear may be deeply held, interwoven and even unsayable, especially as part of the hurried professional encounter. The ideal that this mix of feelings which contribute to psychosocial distress that itself can be effectively 'treated' by professionals as they attend the spiritual care needs of the dying, Randall and Downie (2006) suggest, is unrealistic and can lead to a form of 'harassment by questioning in the name of compassion' (Randall and Downie, 2006: 153). The pressure on patients to 'disclose' rather than share concerns as part of the patient/professional relationship can result in patients making deeply personal revelations, feeling unable to dissent from this exchange often because it is part of a wider package of care that is wanted and appreciated.…”