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Rethinking palliative care

Rethinking palliative care: A social role valorisation approach

Paul Sinclair
Copyright Date: 2007
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  • Book Info
    Rethinking palliative care
    Book Description:

    This book's striking message is that palliative care does not deliver on its aims to value people who are dying and make death and dying a natural part of life. This book draws from wider social science perspectives and critically and specifically applies these perspectives to palliative care and its dominant medical model. Applying Social Role Valorisation, the author argues for the de-institutionalisation of palliative care and the development of an alternative framework to the approaches found in hospices, palliative care units and community-based palliative care services. He offers a new conceptualisation of death and loss that refines and expands modern understandings in a way that also resonates with traditional religious views concerning death. Wide-ranging recommendations advise fundamental change in the concept of palliative care, the way support and services are organised and the day to day practice of palliative care. Rethinking palliative care will be of interest to academics, students and practitioners in palliative care as well as those in disability, social policy, sociology, social work, religion, thanatology, nursing and other health related fields.

    eISBN: 978-1-84742-234-7
    Subjects: Health Sciences, Sociology

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-v)
  3. Acknowledgements
    (pp. vi-vi)
  4. List of abbreviations
    (pp. vii-viii)
  5. ONE Origin of the argument
    (pp. 1-8)

    This book is an argument. And the argument is that palliative care does not deliver on its aims of valuing people who are dying and making death and dying a natural part of life. This book argues for the deinstitutionalisation of palliative care and the development of an alternative framework to institutional approaches, whether these occur in hospices, palliative care units or in community-based palliative care services. This alternative framework consists of a dispersed support network established within the normal communities in which people who are dying live.

    This book is original for four reasons. First, no one has previously...

  6. Part One: Palliative care paradigm

    • TWO Paradigm of care
      (pp. 11-42)

      In this book, the terms ‘death’ and ‘dying’ generally denote circumstances other than sudden, accidental, violent or suicidal death. Chapter Seven is the exception since it explores the concept of death itself. The terms ‘hospice’, ‘hospice care’ and ‘palliative care’ are generally used interchangeably. The main exception is when ‘hospice’ is used to refer to a hospice, an institution, which usage is made clear by the context. ‘Palliative care’ is used more than ‘hospice care’ in order to reduce emphasis on the end-stage of dying that is associated with the term ‘hospice care’.

      In modern times palliative care is one...

    • THREE Palliative care
      (pp. 43-78)

      Being part of the care system, palliative care expresses and interprets its mission within the paradigm of care. The historical development of palliative care is bounded by this constriction. A paradigmatic analysis of palliative care shows how palliative care gives expression to the constraints of the broader paradigm of care. The practice of contemporary palliative care also exhibits, in general terms, the detrimental effects of the broader paradigm. Problems, therefore, arise from palliative care’s conformity to the paradigm of care.

      This chapter aims to develop a brief paradigmatic analysis of palliative care using the same framework that was derived for...

  7. Part Two: Palliative care and social devaluation

    • FOUR Social Role Valorisation
      (pp. 81-118)

      Originally religious approaches and the organisation of religious institutions dominate the landscape of care. When modern medicine and science supplant religion in political and social influence, the paradigm of care becomes dominated by medical approaches and the medical institution. In this way, the social devaluation of people who receive care is established and perpetuated by this paradigm, of which palliative care is a part. Palliative care, therefore, must express the social devaluation of people who are dying. An examination of the ways social devaluation operates in palliative care requires a theoretical tool that can analyse the process of social devaluation....

    • FIVE Implications for palliative care
      (pp. 119-160)

      Rather than analysing the palliative care system by exploring the specific implications of each core theme, the implications of four key principles that bring together essential SRV ideas and core themes are discussed. These four principles or objectives define the kinds of approaches that SRV requires of service systems. The significance of these principles for palliative care approaches is examined under each principle. All four principles have implications concerning institutionalisation because the institution of care is the clearest and most extreme example of how a service system establishes and perpetuates social devaluation. The inherent effects of institutions are discussed separately...

  8. Part Three: Reconceptualising palliative care

    • SIX An ideal palliative care model
      (pp. 163-192)

      SRV’s most significant impact occurs in the field of intellectual disability. The fundamental changes in this field since the 1960s reveal those key elements that need to shift in service systems in order to begin to remediate social devaluation. Central to restructuring these service systems is the conviction that institutional models are intrinsically flawed and unnecessary for classes at risk of social devaluation. The aim of this chapter is to envisage an ideal palliative care system by applying the key elements of SRV-based systems to the palliative care context.

      This chapter argues that service systems can evolve beyond the institutional...

    • SEVEN Reconceptualising death
      (pp. 193-214)

      The contradiction that palliative care devalues people who are dying while aiming to value them asks many questions of palliative care. Since palliative care seeks to change society’s attitudes to death and dying, this contradiction must have some reflection in palliative care’s understanding of death. This book argues that this contradiction shows a deep confusion about devaluation and its processes. Something in palliative care’s understanding of death as it relates to devaluation must, therefore, intersect with this contradiction and help sustain it.

      This chapter seeks to explore this connection with palliative care’s conceptualisation of death that, naturally, reflects rather than...

    • EIGHT The choice
      (pp. 215-218)

      This book aims to provide the theoretical groundwork to enable the palliative care field to begin to analyse the current conceptualisation of palliative care from an entirely new perspective.

      SRV’s crossover into palliative care enables the palliative care system to become aware of its perpetuation of the devaluation of people who are dying and how to address this devaluation. To this point, explorations in end-of-life care by SRV proponents have focused on protecting vulnerable people’s lives rather than on palliative care specifically. Some projects of the interdisciplinary research work of the New Emerging Teams Research Project (Canadian Institutes of Health...

  9. References
    (pp. 219-240)
  10. Index
    (pp. 241-246)