Palliative Care, Culture and the Clinic: Setting the Stage

In January 2021, a global (virtual) symposium was held on Palliative Care, Culture and the Clinic. Hosted by five institutes, located in North America, Europe and Africa, this symposium was dedicated to dialogue and to constructive solutions to enhance global access to palliative care across the resource setting spectrum to ensure humanistic and culturally sensitive care for individuals with advanced disease and at the end of life.  Although the pandemic did not allow this symposium to take place in person, its virtual nature meant more than 600 participants from over 60 countries in all parts of the world were able to participate in what became a most unique dialogue.

The symposium highlighted a range of issues that are typically overlooked or marginalized in health policy, resource allocation, medical education and in the delivery of clinical care. These included the influence of industry and of attitudes within mainstream medicine on the balance between biomedical and technological approaches to medical care and humanistic ones. The importance of trust and cultural safety in the acceptability of palliative care within many communities, and the value of clinical practice that takes into account cultural differences in the acceptability or desirability of open communication about death and dying and in end-of-life care were also highlighted. Death anxiety and stigma about palliative care within the medical community in both high and low income countries were identified as barriers to the integration of palliative care within mainstream medicine and, in some circumstances,  as contributors to the delivery of aggressive interventions of limited or no value for individuals near the end of life.   

Further,  it was evident that the exchange of knowledge has too often flowed unidirectionally from high to low income countries, with insufficient attention to approaches developed within those countries that may have value in both high and low income countries.  These include the more comprehensive family and community support and the delivery of psychological and spiritual support by trained nonprofessional health care providers and volunteers, which have been shown to be both feasible and cost-effective.

We hope that you will find these papers as stimulating as so many found them when they were first delivered as oral presentations and that they will encourage you to consider joining a global initiative to optimise the balance between biomedicine and what has been called the “soul of medicine”.

Two editorials related to the symposium can be found here:

Culture, communication and community in palliative cancer care: a view from India

Decolonizing end-of-life care: lessons and opportunities