Abstract
Background: Increasing evidence has suggested that a person-centred approach is beneficial not only for improving care outcomes but also for mitigating the pressure on public health systems. However, policy implementation gaps have prevented the translation of this complex framework into useful practical, ethical and moral stances for end-of-life care. This article aims to explore the meaning and implications of person-centredness in end-of-life care policy discourses.Methods: By perceiving policy documents as a medium embodied with socio-political and cultural norms, we analysed how person-centred approach in end-of-life care is constructed within specific socio-cultural contexts and the implications of these contexts on resultant care. Focusing on England and Japan, we conducted a critical policy analysis to examine and compare key policy and legal documents collected between 2007 and 2019 in these two post-industrial and socio-culturally distinctive countries. Results: Our analysis found that the person-centred approach is mobilised in policy discourses primarily through three interconnected dimensions: individual, relational and existential. While acknowledging that both countries have developed varied policy and legal mechanisms to emphasise holistic and integrated care with respect to these three dimensions, we also identified significant gaps in the policies both within and between England and Japan. They include ambiguity in defining patients’ best interests, fragmented support for social and family care and the neglect of existential needs. Conclusions: This cross-cultural analysis has revealed the complex nature of discourses around person-centred approach in English and Japanese end-of-life care policies, which often concentrate on the multifaceted aspects of experiences as one approaches the end of life. Despite this, we argue that a more holistic construction of person-centred approach is needed in end-of-life care policies not only in England and Japan but also more broadly, to encapsulate the richness of end-of-life experiences.
An Exploration of Person-Centred Approach in End-of-Life Care Policies in England and Japan
