Assoc. Prof. Klaus Wegleitner and Dr John Rosenberg
PHPC theory and practice involve ambiguities and risks. Against the background of the personal experiences of the workshop participants, our aim is to discuss the ambivalence that lies in the evolution of PHPC through the critical lens of a care ethics perspective.
PHPC has emerged as a field of study and practice following two decades of exploration and evolution. Under its umbrella, many approaches and initiatives have developed, primarily based on:
1) integration of health promotion into palliative care addressing issues of dying, death and bereavement through the lens of the ‘new’ public health;
2) implementation of WHO´s palliative care strategy into national health care policies; and,
3) population-based public health research in EOLC (Dempers & Gott 2017).
The complementarity between civic EOLC, compassionate communities, generalist and specialist palliative care is described by Abel, Kellehear and Karapliagou (2018) as ‘the new essentials’ of palliative care, which considers the social and relational dimensions of care and aspects of social justice.
Palliative care, conceptualised in this way, is an expression of care ethics that focusses attention on the supportive resources of social systems and care relationships, raising fundamental questions about ethical implications of the social organisation of care. Above all, care ethics could help us to sharpen our critical awareness about underlying ambivalence, tacit care knowledge, and the existential and social-political implications of developments in PHPC.
However, we also observe attempts to transform a heterogeneous, often bottom-up PHPC movement into structured, tool-oriented, evaluation-focused programs. These programs run the risk of transferring public health and community development methods to the field of EOLC in a simplified way, possibly reproducing the main problems of mainstream public health strategies:
· being paternalistic and morally charged;
· insufficiently addressing aspects of inequalities in care and care work;
· lack of appreciating existential experiences, local care-wisdom and care cultures
· emphasis predominantly on the level of rhetoric and appeals, than on the question of an everyday life embedded ethic of caring (Charles Taylor).
To appreciate and make the known ethical issues of PHPC, we will explore the potential of care ethics to remind us of the sources of hospice and palliative care philosophy and the dimensions of its caring culture.