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Good enough death: autonomy and choice in Australian palliative care

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  • McNamara, Beverley

Abstract

This paper draws upon Australian fieldwork to trace the changing notions of a good death held by hospice and palliative care practitioners. Palliative care practitioners search for an ideology to inform their practice within the context of a complex society for which there is no one good death. Social demographics, the multicultural nature of society and institutional constraints frame the experience of dying in complex ways, while contemporary social responses to dying reflect the uncertainties held by many Australians. Despite the fragmentation evident within contemporary Australian society, the hospice movement in Australia and in other Western contexts has sought to reintroduce a ritual for dying. The good death ideology of the original hospice movement proposed a manner of dying in which open communication and acceptance of death were actively encouraged. The hospice model of a good death, however, has become increasingly inappropriate in the current climate of patient autonomy and consumer choice. The practice of palliative care, a holistic form of care for dying people, which follows the individualistic ethic of choice, has emerged from and replaced the original hospice movement. Consequently, the good death of the original hospice movement has been abandoned in favour of a philosophy of a 'good enough' death. However, what may appear a compromise informed by ethical practice masks a return to routine medical practices and a hierarchy of care which prioritises the physical management of symptoms. It appears that while palliative care practitioners may often fail in their facilitation of a good death for their patients, they can be proactive in alleviating their patients' pain and physical discomfort.

Suggested Citation

  • McNamara, Beverley, 2004. "Good enough death: autonomy and choice in Australian palliative care," Social Science & Medicine, Elsevier, vol. 58(5), pages 929-938, March.
  • Handle: RePEc:eee:socmed:v:58:y:2004:i:5:p:929-938
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    Citations

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    Cited by:

    1. Paolo Rossi & Matteo Crippa & Gianlorenzo Scaccabarozzi, 2021. "The Relationship between Practitioners and Caregivers during a Treatment of Palliative Care: A Grounded Theory of a Challenging Collaborative Process," IJERPH, MDPI, vol. 18(15), pages 1-15, July.
    2. Lang, Alexander & Frankus, Elisabeth & Heimerl, Katharina, 2022. "The perspective of professional caregivers working in generalist palliative care on ‘good dying’: An integrative review," Social Science & Medicine, Elsevier, vol. 293(C).
    3. Kirby, Emma & Broom, Alex & MacArtney, John & Lewis, Sophie & Good, Phillip, 2021. "Hopeful dying? The meanings and practice of hope in palliative care family meetings," Social Science & Medicine, Elsevier, vol. 291(C).
    4. Chabot, Boudewijn E. & Goedhart, Arnold, 2009. "A survey of self-directed dying attended by proxies in the Dutch population," Social Science & Medicine, Elsevier, vol. 68(10), pages 1745-1751, May.
    5. Olson, Rebecca E. & Smith, Alexandra & Good, Phillip & Neate, Emily & Hughes, Cody & Hardy, Janet, 2021. "Emotionally reflexive labour in end-of-life communication," Social Science & Medicine, Elsevier, vol. 291(C).
    6. Ana Patrícia Hilário & Fábio Rafael Augusto, 2022. "Pathways for a ‘Good Death’: Understanding End-of-Life Practices Through An Ethnographic Study in Two Portuguese Palliative Care Units," Sociological Research Online, , vol. 27(2), pages 219-235, June.
    7. Collier, Aileen & Broom, Alex, 2021. "Unsettling Place(s) at the end of life," Social Science & Medicine, Elsevier, vol. 288(C).
    8. Zivkovic, Tanya, 2021. "About face: Relationalities of ageing and dying in Chinese migrant families," Social Science & Medicine, Elsevier, vol. 291(C).
    9. Alexandre Cotovio Martins & Michel Binet & David Monteiro & Oriana Brás, 2022. "Preparing End-of-Life Talks in Palliative Care: Exploratory Remarks on a Social Process," Sociological Research Online, , vol. 27(2), pages 236-250, June.
    10. Broom, Alex & Cavenagh, John, 2010. "Masculinity, moralities and being cared for: An exploration of experiences of living and dying in a hospice," Social Science & Medicine, Elsevier, vol. 71(5), pages 869-876, September.

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