Culture-specific beliefs, values and behaviours about end of life both constitute and complicate the organization of palliative care. Palliative care practices, including the development and regulation of scope and best evidence, as well as clinical teaching and research, are therefore subject to the same challenges as other cultural practices. For practitioners, understanding one’s place in that culture requires reflexivity and an ability to see how and why one acts upon a particular situation and at the same time how and why one is acted upon in the process.

From a practical perspective, efforts to extend quality end of life care are underway in many countries, but these initiatives are often under-resourced and lack coverage. Furthermore, the philosophical goals of practice may be held in tension with the realities of care provision. As a result, while the expansion of palliative care is championed as a global public health priority, we still have limited agreement on what constitutes appropriate end of life care within different types of countries, cultures, and care settings.  Without better insights into practices that contain both local relevance and global efficacy, it is unclear how these efforts might be more successful, even as many societies increasingly highlight their inability to care for older people effectively and adequately as they face death – at home, in hospitals, in care homes, prisons and other institutional settings. Our project provides a crucial context in which to explore these matters.

Advance Care Planning

Advance Care Planning has proved to be a compelling field of end of life practice around which to build comparisons between the two cultures.  We have conducted a detailed analysis of approaches and methods in Scotland and Japan, focussing on public documents and guidelines and with a special emphasis on the language and imagery that is used. We see common themes in the concern to reduce medical costs and hospital admissions, as well as the tension between autonomy and control versus relational perspectives. But these over-arching themes give way at the national level to differences in the amount of information resources that are available, the varied links between ACP and medical records,  and the direct and indirect connections to larger health policy goals.

Dr Marian Krawczyk and Dr Haruka Hikasa lead this aspect of the project.