Choice and compassion at the end of life: a critical analysis of recent English policy discourse
Social Science and Medicine
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Borgstrom, E., & Walter, T. (2015). Choice and compassion at the end of life: a critical analysis of recent English policy discourse. Social Science and Medicine, 136-137 99-105. https://doi.org/10.1016/j.socscimed.2015.05.013.
This is the author accepted manuscript. The final version is available from Elsevier at...
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.
England, end of life care, choice, compassion, discourse, old age, relational ethics, governmentality
Erica Borgstrom would like to thank the funders of her PhD, which inspired much of the thinking in this article. The PhD research was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire and Peterborough NHS Foundation Trust.
External DOI: https://doi.org/10.1016/j.socscimed.2015.05.013.
This record's URL: https://www.repository.cam.ac.uk/handle/1810/248306
Attribution-NonCommercial-NoDerivs 2.0 UK: England & Wales
Licence URL: http://creativecommons.org/licenses/by-nc-nd/2.0/uk/
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