scholarly journals Palliative care & the injustice of mass incarceration

2019 ◽  
Vol 1 (2) ◽  
pp. 4-16
Author(s):  
Helen Hudson ◽  
Amélie Perron ◽  
David Kenneth Wright

Due to the criminalization of marginalized people, many markers of social disadvantage are overrepresented among prisoners. With an aging population, end of life in prison thus becomes a social justice issue that nurses must contend with, engaging with the dual suffering of dying and of incarceration. However, prison palliative care is constrained by the punitive mandate of the institution and has been critiqued for normalizing death behind bars and appealing to discourses of individual redemption. This paper argues that prison palliative has much to learn from harm reduction. Critical reflections from harm reduction scholars and practitioners hold important insights for prison palliative care: decoupled from its historical efforts to reshape the social terrain inhabited by people who use drugs, harm reduction can become institutionalized and depoliticized. Efforts to address the harms of substandard palliative care must therefore be interwoven with the necessarily political work of addressing the injustice of incarceration.

Author(s):  
Yngvild Olsen ◽  
Joshua M. Sharfstein

What is harm reduction? Harm reduction is “a set of practical strategies aimed at reducing negative consequences associated with drug use.” It is also “a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”...


2013 ◽  
Vol 62 (1) ◽  
Author(s):  
Adriana Turriziani ◽  
Carlo Barone ◽  
Alessandra Cassano

Le Cure Palliative sono una risposta alla crescente necessità di assistenza per i malati affetti da patologie inguaribili, la cui presa in carico è spesso gravata dall’inadeguatezza della rete sociale e familiare, dalla scarsità delle risorse a loro destinate e dalla carenza formativa degli operatori sanitari. Sebbene il percorso istituzionale di questa nuova disciplina sia a buon punto, la conoscenza dei suoi principi fondanti è ancora molto limitata sia da parte dei cittadini sia, ancora più sorprendentemente, da parte degli stessi operatori, che ancora vedono nelle Cure Palliative una medicina della consolazione e della frustrazione. Al contrario, questa disciplina trova il proprio centro nella dignità dell’uomo fino alla fine della vita, proponendosi di rispondere in maniera globale a tutti i suoi bisogni e a quelli del nucleo familiare. Se il centro di tale risposta assistenziale è l’uomo, allora è necessario rendere lo stesso paziente in grado di identificare le proprie necessità ed entrare così nel processo decisionale sulla propria cura. Per giungere a questo tipo di relazione di cura, sinergica e consapevole, e ad una reale condivisione delle responsabilità si deve necessariamente passare attraverso una progressiva presa di coscienza della condizione di malato. Tale percorso deve essere guidato in primis da un medico formato in tal senso. Chi si avvicina al fine vita ha infatti bisogno di cure di alta qualità, che rispondano a tutte le sfere della persona coinvolte nella malattia, di continuità nell’assistenza e di relazioni terapeutiche stabili e mature. Parimenti, anche l’operatore che vive l’assistenza al fine vita deve avere gli strumenti adeguati per non danneggiarsi e lasciarsi sopraffare dall’intensità di queste relazioni. Da questo contesto nasce la necessità di un Master di studi che sviluppi competenze specialistiche e colmi il vuoto formativo in modo uniforme come primo passo verso un profondo e necessario cambiamento culturale. ---------- Palliative Care is an answer to the growing need of care for patients suffering from incurable diseases, whose management is often burdened by the inadequacy of the social and family networks, by limited resources and poor training of health workers. Although the institutional pathway of this new discipline is on its way, the knowledge of its founding principles is still very limited both among citizens and, even more surprisingly, among the same operators, who still see Palliative Care as a “consolation and frustration medicine”. On the other hand, this discipline focuses on the dignity of men till the end of life, trying to give a global answer to all their needs and those of their families. If the center of the health care response is the human being, then it should be the same patient to be able to identify his needs and thus to enter into the decision-making process. In order to achieve this level of care relationship, synergistic and aware, and a real sharing of responsibilities, patients must go through a gradual understading of their own disease condition. A trained physician should guide patients through this foundamental journey. In fact, people approaching the end of life do indeed need high quality care, which should meet all their inner spheres, but also continuity of care and stable and mature therapeutic relationships. Similarly, every health worker who lives patients’ end of life should have proper tools not to be damaged and not to be overwhelmed by the intensity of these relationships. In this context, a Master in Palliative Care is meant to develop specialized skills and fill the educational gap and it should be the first step towards a deep and claimed cultural change in our country.


2021 ◽  
pp. 009145092199382
Author(s):  
Ryan J. Lofaro ◽  
Hugh T. Miller

Safe injection sites are spaces where people who inject drugs can do so under the supervision of staff at the sites who attempt to revive them if they overdose. Public officials in Philadelphia, Pennsylvania, have proposed the sites as a means to reduce opioid overdose deaths in the city, a policy proposal that has been politically and legally contested. This article uses the Narrative Politics model to elucidate the concerns, values, and aspirations of the competing narratives in the public discourse over safe injection sites in Philadelphia. Despite the aspirations expressed within the Harm Reduction narrative to open such a site, opposition from the Nimby (not in my backyard) narrative has, at the time of this research, successfully precluded such a step. Other narratives in the discourse include the Abstinence narrative opposing safe injection sites and the Social Justice narrative opposed to incarceration but also hesitant to wholeheartedly endorse the Harm Reduction narrative for its delayed advocacy of compassionate treatment of people who use drugs now that the face of the person who uses opioids is a white one. In addition to juxtaposing competing narratives against one another and considering their alignments, disagreements, and interactions, the authors consider absences and shared presuppositions. The social construction of the purported drug addict varies in some ways between and among the prevailing narratives; in other ways, all the narratives problematize “addiction” as an affliction that justifies techniques of discipline aimed at caring for and controlling the population.


Aporia ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 26-35
Author(s):  
Trevor Goodyear

Poststructuralism, with its critical interpretations of knowledge, discourse, truth, and power, offers a set of compelling analytic tools for disentangling and deconstructing the ways in which health-related phenomena exist and are understood. This paper adopts a poststructuralist stance to outline the impacts of medical hegemony on the lives of people who use drugs, as well as responses to the harms experienced by this population. This analysis reveals how structuralist projects have narrowed the scope and impact of harm reduction through processes of medicalization, neoliberal responsibilitization, and medical co-opting and depoliticization. Nomadic thinking is then introduced as a means for health policy makers and practitioners to transform the boundaries of dominant approaches to harm reduction – particularly, in ways that (re)politicize harm reduction through forms of equity-promoting and social justice-oriented action. Implications for (re)politicized, community-engaged, and structurally responsive approaches to harm reduction in health policy and practice are then discussed.


2019 ◽  
Vol 28 (3) ◽  
pp. 1356-1362
Author(s):  
Laurence Tan Lean Chin ◽  
Yu Jun Lim ◽  
Wan Ling Choo

Purpose Palliative care is a philosophy of care that encompasses holistic, patient-centric care involving patients and their family members and loved ones. Palliative care patients often have complex needs. A common challenge in managing patients near their end of life is the complexity of navigating clinical decisions and finding achievable and realistic goals of care that are in line with the values and wishes of patients. This often results in differing opinions and conflicts within the multidisciplinary team. Conclusion This article describes a tool derived from the biopsychosocial model and the 4-quadrant ethical model. The authors describe the use of this tool in managing a patient who wishes to have fried chicken despite aspiration risk and how this tool was used to encourage discussions and reduce conflict and distress within the multidisciplinary team.


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