A social role valorizing model of palliative care towards an alternative paradigm

This theoretical thesis examines the social devaluation by the palliative care system of people who are dying and proposes a new paradigm for palliative care based on the principles of Social Role Valorization (SRV) (Wolfensberger 1983, 1998). The current practices and organisation of palliative care work against its aims to value people who are dying and to make death and dying a normal or natural part of life.

The thesis is an original work because palliative care has never been examined from an SRV based perspective nor has SRV theory been applied in a systematic way to any service system other than the intellectual disability service system. In addition, the new palliative care paradigm developed in this thesis is only the second social model of palliative care, after health promoting palliative care (Kellehear 1999c).

Using an historical overview, palliative care is shown to conform closely to the paradigm of care in general. The social devaluation of care recipients attends this broader paradigm to which palliative care conforms. Palliative care therefore must also express this devaluation.

To address the social devaluation of people who are dying, I argue for the closure of inpatient palliative care facilities/hospices and a reconfiguration of the entire social organisation of palliative care. Following the methods used to de-institutionalise the intellectual disability system, in-patient palliative care facilities/hospices should be replaced by dispersed community-based support networks.

Social devaluation is shown to pervade palliative care, I therefore also argue for a complete re-appraisal of palliative care practice particularly concerning the social imagery conveyed, the influence of the models underpinning palliative care, and the way practitioners conceptualise their practice and understand the effects of their actions.

The material in this thesis has been published since as:
Rethinking Palliative Care: A Social Role Valorisation Approach, 2007, Policy Press, Bristol