THE NEW MODEL OF VALUE ATTITUDE TOWARDS LIFE. HOSPICES AND RELAXING MEDICINE

This article discusses some of the philosophical issues of life and health related to hospice movement and palliative, palliative medicine. Bioethics promotes the formation of new values in social and national consciousness, it stimulates significantly the humanization of natural and social sciences, new technologies, medicine and health care, make a transition between the natural, medical, social and humanitarian knowledge, as well as to establish balance between science and morality. Bioethics as a special form of practical philosophy of life teaches that human inter-relation with his own life, the whole biosphere is not only contemplative, theoretical and emotionless, but, being a practical relation, it constantly involves a certain assessment. The philosophical analysis of the problem of euthanasia has shown that the philosophical mind of the 20–21st centuries doesn’t view death as an alien to human existence, but as an existential component of life itself. Not only the problems of life-death bordering situations are implemented philosophically, but also the existential bases of human life i.e. freedom and responsibility. Today the idea of a human’s dignified death is discussed in two directions: as an euthanasia issue and the problem of hospices. In the article an attempt was to give the palliative medicine a philosophical interpretation, the roots of which can be found the Medieval culture. On the base of the formation and development of bioethics in article is substantiated the position according to which the imperative of the contemporary human existence demands a qualitatively new approach to current complicated, global and various issues.

The Universality of Palliative Care Philosophy

The modern hospice movement, which is the origin of what is now known as palliative care, derived strong inspiration from Christianity. Given this original Christian inspiration, the global spread of palliative care even to countries where Christianity is only a minority religion may look surprising. In line with the theory of the “secularization of hospice,” it could be argued that palliative care has spread globally because its underlying philosophy has become secular, allowing it to become universal. However, given the continuing importance of religion in many areas of palliative care, we could wonder how secular contemporary palliative care really is. This article argues that the universality of palliative care philosophy resides in its susceptibility to contextualization. Palliative care has become a global success story because people all over the world committed to palliative care’s principles and ideas have contextualized these and developed models of palliative care delivery and even philosophy that are adapted to the local socio-economic and cultural-religious contexts. This article analyzes palliative care in India to illustrate this point, describing contextualized models of palliative care delivery and showing that palliative care physicians and nurses in India draw inspiration from their local context and religiosity.

Case study analysis of end of life care development in the Chinese cultural context of Macao: a social movement perspective

Background The modern hospice movement is often recognised as a social movement. However, such understanding is primarily based on historic reflection and this approach has lacked theoretical exploration. There is a lack of systematic examination of the modern hospice movement by way of social movement theories. Aim Focusing on the Chinese socio-cultural context of Macao, this study aimed to understand the EoLC movement by applying the social movement theory, the Framing Perspective, as proposed by Snow and Benford in 1988. Methods A case study approach was conducted. Semi-structured interviews were held between 2012 and 2013, with pioneers (n = 11) of the EoLC in Macao. Thematic analysis was adopted to analyse the interviews. Results The Framing Perspective analysis illuminated that there was both growth and stagnation of the EoLC movement. Three themes emerged: 1) the suffering of people at the end of their lives was considered as a social problem needed to be addressed urgently, 2) the incoherent EoLC strategies developed by pioneers indicated the lack of internal ideological cohesion within the movement, 3) external constraints contributed to the stagnation of the movement. Conclusions The EoLC development in Macao can be understood as a social movement. The Framing Perspective provided a theoretical way to understand the emergence of EoLC; offering a novel perspective to conceptualise the modern hospice movement. This sociological and theoretical lens opened up new ways for future research to study the emergence of EoLC in different socio-cultural contexts.

Cicely Saunders, ‘Total Pain’ and emotional evidence at the end of life

In this article I explore how Cicely Saunders championed the hospice movement and initiated what became palliative care by representing her emotional connections with others. She became friends (and, once or twice, fell in love) with dying patients and encouraged others to follow her example in listening to patients’ descriptions of pain. Her approach was radical at a time when she believed doctors routinely ‘deserted’ dying patients because it urged them to understand another’s embodied pain as inextricably bound up with the emotional impact of a terminal diagnosis. Saunders’ attention to how patients expressed their experience is summed up in her term ‘total pain’, which communicates how an individual’s pain is a whole overwhelming experience, not only physical but also emotional, social and spiritual. Previous research frames ‘total pain’ in terms of narrative, emphasising Saunders’ focus on listening to her patients and her use of narratives as evidence in advocating for cultural and institutional change, both of which I understand as engaging with a patient’s emotional reality. However, as Saunders’ ideals become mainstreamed as palliative care and amid calls for ‘narrative palliative care’, I use evidence from Saunders’ extensive written output alongside archival material to suggest that, just as palliative care is by its nature not a single specific intervention, ‘total pain’ should not be understood as simply narrative. Building on existing work in this journal questioning the primacy of conventional understandings of narrative in the medical humanities, I demonstrate how Saunders’ prominent use of fragments and soundbites alongside longer case narratives demonstrates the limits of narrative, particularly when someone is dying. Saunders thus offers a case study for considering the implications that questioning the primacy of narrative as emotional evidence might have for our understandings of how empathy or advocacy can function, or be cultivated, in medical settings.

Case study analysis of end of life care development: A social movement perspective

Background The modern hospice movement is often recognised as a social movement. However, such understanding is primarily based on historic reflection and this approach has lacked theoretical exploration. The modern hospice movement has not been examined by way of any social movement theory. Aim This study addressed the theoretical gap in understanding the end of life care (EoLC) development in Macao China. Focusing on the Chinese socio-cultural context, this study explored the EoLC movement through the social movement theory, the Framing Perspective, as proposed by Snow and Benford in 1988. Methods A case study approach was conducted. Semi-structured interviews were held between 2012 and 2013, with pioneers (n = 11) of the EoLC in Macao. Thematic analysis was adopted to analyse the interviews. Results The EoLC development in Macao can be understood as a social movement. The Framing Perspective analysis illuminated that there was both growth and stagnation of the EoLC movement. Three themes emerged: 1) the suffering of people at the end of their lives was considered as a social problem needed to be addressed urgently, 2) the incoherent EoLC strategies developed by pioneers indicated the lack of internal ideological cohesion within the movement, 3) external constraints contributed to the stagnation of the movement. Conclusions The Framing Perspective provided a theoretical way to understand the emergence of EoLC; offering a novel perspective to conceptualise the modern hospice movement. This sociological and theoretical lens opened up new ways for future research to study the emergence of EoLC in different socio-cultural contexts.

Thanatological competence in the psychological education in Russia and abroad

The article is devoted to the thanatological formation peculiarities of competence in the education of psychologists in Russia and abroad. The article describes the socio-cultural, professional and individual-psychological relevance of thanatological competence in the implementation of the practical and pedagogical activities of a psychologist. The novelty of the research lies in the substantiation of the need to form thanatological competence as mastering thanatological knowledge for making professional decisions. The article describes the history of the development of “death education” abroad and in Russia, originating in the hospice movement. The article provides a brief description of the didactic and experiential approach to the implementation of programs and courses on the formation of thanatological competence for students in the United States. At the same time, in Russia such courses exist in several higher educational institutions, in others they are presented within the framework of single lectures included in the cycles of basic disciplines. The article contains information about studies demonstrating the need for the formation of thanatological competence in students and the success of the implementation of programs aimed at this abroad. In the conclusion of the article, the prospects for the implementation of programs aimed at the thanatological competence formation for practicing students are described.