Routinization and medicalization of palliative care: Losses, gains and challenges

Abstract

This article investigates some of the criticisms that have been directed at the hospice movement in the process of interaction with the traditional Western healthcare system, such as those relative to its routinization and medicalization. It also aims to review some of the consequences of this process of institutionalisation for the field of end-of-life care: surveillance and control over the process of dying, at the expense of decisions preferably based on the patient and that patient's ability to decide how to die, with the loss of wider objectives originally established by the movement, such as unconditional reception for the patient. Based on these criticisms, some considerations are made regarding the moral implications and risks related to this specific mode of action, the hospice way of care.

Bureaucratization and medical professionals’ values: A cross-national analysis

“…Prior studies have demonstrated how the employment of medical professionals in bureaucratized work roles, organizations and healthcare fields weakens their occupational values (e.g. Harrison & Ahmad, 2000;Marjoribanks & Lewis, 2003;Potter & McKinlay 2005;Kitchener et al, 2005;Gross et al, 2007;Tousijn & Giorgino, 2009;Floriani & Schramm, 2012;Waring & Bishop, 2013;Lin, 2014;Toth, 2015). However, there is a lacuna of cross-national research on the normative impact of bureaucratized national governance that is likely to influence the priorities of medical work across distinct roles, work settings and fields of specialization.…”

Specialist palliative care nursing and the philosophy of palliative care: a critical discussion

“…Some have suggested that this core value within nursing fits easily with the philosophy of palliative care (Floriani and Rolland, 2012) and is the reason why nursing has made such a significant contribution to the development of a strong practice philosophy in palliative care.…”

“…However, the routinization and medicalization of hospice care has arguably resulted n a (Floriani and Rolland, 2012) which compromises the principles of holistic palliative care. A number of factors have influenced this paradigmatic shift.…”

“…Secondly, with an expansion of palliative care to include all those with a life limiting illness (not just those with cancer) there is an increasing complexity of the illness trajectory (Murray et al, 2005). Finally, integrating palliative care early in the illness trajectory and extending it has required more integration with mainstream health services, many of whom remain embedded in the biomedical model of service delivery (Floriani and Rolland, 2012). This integration into mainstream services may create some challenges.…”

Palliative Medicine and Psychiatry

“…2 The routinization, bureaucratization, medicalization, and institutionalization of palliative and hospice care may not be accommodating to the ''good death,'' a major goal of hospice care. 3 Incorporating, or indeed retaining, holistic practice is challenging. The emergence of palliative medicine as a medical specialty has, as to be expected, been accompanied by growth pains.…”