Total pain and limited time: clinical ethics and the relationality of hospice care

Description

The work of Cicely Saunders, particularly her wish to avoid the medicalisation of death, influenced the development of the 'hospice movement’. Hospice care offers holistic, patient-focused care in the context of an acceptance of mortality. Key to this holistic approach is the concept of ‘total pain’, developed by Saunders into an understanding that hospices offering palliative care for people facing life-limiting illness must acknowledge and address their physical, emotional and social pain, as well as the spiritual need for security, meaning and self-worth.

This paper builds on my doctoral research, which concluded that, in attending to patients’ ‘total pain’, hospices take a relational approach to patient care and decision-making. Relational ontologies understand humans as emerging through, and as part of, their tangled intra-relating. Rather than considering someone as a separately existing, bounded individual, a relational approach understands her as constituted in the relational processes which go on in language-based interactions. I suggest here that the temporal implications of a life-limiting diagnosis, taken together with the notion of ‘total pain’, inform and underpin a dynamic, relational approach to clinical ethics in the hospice context, from which other healthcare settings might learn.

At the core of clinical ethics is an emphasis on the one-to-one relationship underpinning a healthcare professional’s obligation to make the care of their patient their first concern. Hospices, however, explicitly bring the ‘patient-in-relationships’ into the ambit of their concern. This relational understanding of a patient attends to the ‘total pain’ of the temporal processes of dying and bereavement, for the patient and their family. I argue that, especially with the relational harms of the pandemic fresh in our minds, a specific intention to value a richer mix of human experiences in the conception of the patient could usefully inform a ‘review’ of clinical ethics and medical law more broadly.

Period	19 Jun 2024
Event title	Shifting Dynamics in Medical Law: New Spaces, Temporalities and Actors
Event type	Workshop
Location	Manchester, United KingdomShow on map
Degree of Recognition	National