Palliative Care and Social Inequity
December 1 2023
In August 2023, Tess Moeke-Maxwell co-authored a paper that delves into the profound impacts of social inequity on palliative care, along with Maddy French and Lorraine Hansford. The paper titled, “Reflecting on choices and responsibility in palliative care in the context of social disadvantage”, provides a crucial analysis of the challenges faced by frontline professionals in ensuring equitable end-of-life care, especially in the context of structural injustices and socio-economic disadvantages.
The research highlights the urgent need to enhance our understanding of palliative care provision for people affected by a range of social inequities, including poverty, ethnic and racial disparities, LGBTQ+ identities, and indigenous identities. It explores the professional and ethical complexities that healthcare providers must navigate when working in socially disadvantaged contexts. This includes the intensive resources and emotional work required to support patients with psychological, social, and material needs arising from lifelong structural disadvantage.
A significant aspect of the study is its emphasis on the distinction between 'equity' and 'equality' in healthcare. Equity in healthcare involves treating individuals according to their unique needs and circumstances, rather than providing the same care for all, regardless of their different life situations. The paper discusses how healthcare professionals often face tensions between the structures and processes associated with palliative care models and the preferences or needs of patients, particularly those whose lives are markedly different from 'traditional' recipients of palliative care.
One of the key themes of the research is the need to understand patient choice within the context of social disadvantage. It suggests focusing on the social forces and structures that patient choices come into conflict with, such as societal attitudes and political apathy towards issues like substance use and social housing. The study argues for adopting frameworks like the capabilities approach and cultural safety in healthcare, which focus on understanding and addressing the constraints on individuals' choices and decisions.
The paper stresses the importance of developing a deeper understanding of the frameworks, attitudes, and philosophies that influence how palliative care professionals respond to social inequities. It calls for further research and practice-based initiatives to unravel the links between how inequity is conceptualized in palliative care practice, professional attitudes towards patients, and the actions taken by healthcare providers.
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