Space, place and wellbeing at the end of life

July 9 2019

In this blog post Aileen discusses the special session she convened titled: Space, Place and Wellbeing at the End of life at the International Medical Geography Society (IMGS) conference in Queenstown.

First off, I’d like to thank Janine Wiles for all her work on the IMGS conference. She was on the organising committee, and they did a fabulous job in putting together a very interesting and thought-provoking conference.

The special session
Because of my interest in geographical inquiry, which I had previously embarked on regarding how people who are dying feel about different spaces and places,  I was thrilled when I found out that IMGS was coming to NZ.  I was keen for the opportunity to promote discussion on what health geography and the spatial turn might offer us as palliative care scholars.

To preface the special session, I drew from the works of French post modernists Giles Deleuze and Félix Guattari and human geographer Doreen Massey. This enabled a conceptualisation of space as what Massey calls a ‘simultaneity of stories so far’. This view of space as a product of inter-relations, never fixed and always ‘becoming’ allows all sorts of possibilities to open up for the way we study palliative and end of life care.

I critiqued current ways of thinking about space and place in palliative care – for example, the way in which hospital is considered a ‘bad’ place to die in contrast to home, which is often conflated with a ‘good’ or ‘natural’ death. This is despite places of care and death having much more layered and complex meanings as Alex Broom presented so profoundly in his presentation. Alex argued that locales (however differentiated across families, societies and cultures) “offers different and evolving challenges, and are deeply rooted in social, bioethical and moral normative expectations around death, dying and care” This affirmed my earlier findings about the meaning of home at the end of life. In response to a question from the audience: “Is a good death possible in hospital” Alex’s words perhaps sum it up- “A ‘good death’ depends on who you ask”!

This view of space also allows us to consider wellbeing as both context-specific and relational (Corsín-Jiménez, 2008) as we discussed in our paper exploring patient safety in palliative care and GP practices.

With this in mind Tess Moeke Maxwell gave a wonderful presentation on Māori Deathscapes. Sharing stories from her Health Research Council NZ Pae Herenga study, Tess conveyed how Māori meanings about places of death and cultural customs are equally important for those who have passed on and whānau left behind. Tess talked about wairua transitions encompassing movement of energy through physical space and time. As I listened to Tess, I was struck by how much I have learned from this work in my role as a nurse!

Finally, Kelsey Hanrahan shared with us her amazing work with the rural Konkomba community in northern Ghana, and her thesis titled “Living Care-fully: Labor, Love and Suffering and the Geographies of Intergenerational Care in Northern Ghana”  The concept of ‘Livingdying’ from the experiences and stories of Gahanians resonated deeply with the other presentations.

The synergies between presentations were tangible, perhaps unsurprising if we consider them through the lens of space and place!