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Choice and compassion at the end of life: A critical analysis of recent English policy discourse

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  • Borgstrom, Erica
  • Walter, Tony

Abstract

End of life care in England has recently been framed by two very different discourses. One (connected to advance care planning) promotes personal choice, the other promotes compassionate care; both are prominent in professional, policy and media settings. The article outlines the history of who promoted each discourse from 2008 to early 2015, when, why and how and this was done. Each discourse is then critically analysed from a standpoint that takes account of bodily decline, structural constraints, and human relationality. We focus on the biggest group of those nearing the end of their life, namely frail very old people suffering multiple conditions. In their care within contemporary healthcare organisations, choice becomes a tick box and compassion a commodity. Informed choice, whether at the end of life or in advance of it, does not guarantee the death the person wants, especially for those dying of conditions other than cancer and in the absence of universally available skilled and compassionate care. Enabling healthcare staff to provide compassionate, relational care, however, implies reversing the philosophical, political and financial direction of healthcare in the UK and most other Anglophone countries.

Suggested Citation

  • Borgstrom, Erica & Walter, Tony, 2015. "Choice and compassion at the end of life: A critical analysis of recent English policy discourse," Social Science & Medicine, Elsevier, vol. 136, pages 99-105.
    • Handle: RePEc:eee:socmed:v:136-137:y:2015:i::p:99-105
    DOI: 10.1016/j.socscimed.2015.05.013
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    References listed on IDEAS

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    Cited by:

    1. Zivkovic, Tanya, 2018. "Forecasting and foreclosing futures: The temporal dissonance of advance care directives," Social Science & Medicine, Elsevier, vol. 215(C), pages 16-22.
    2. Teggi, Diana, 2018. "Unexpected death in ill old age: An analysis of disadvantaged dying in the English old population," Social Science & Medicine, Elsevier, vol. 217(C), pages 112-120.
    3. Driessen, Annelieke & Borgstrom, Erica & Cohn, Simon, 2021. "Placing death and dying: Making place at the end of life," Social Science & Medicine, Elsevier, vol. 291(C).
    4. Collier, Aileen & Broom, Alex, 2021. "Unsettling Place(s) at the end of life," Social Science & Medicine, Elsevier, vol. 288(C).
    5. Zivkovic, Tanya, 2021. "About face: Relationalities of ageing and dying in Chinese migrant families," Social Science & Medicine, Elsevier, vol. 291(C).

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