What would a death literate care service look like?

Health care is, for the most part, an effective way to treat injury and disease. However, mainstream services still struggle to support people whose illnesses are progressive and incurable. Palliative care is an approach to the care of those nearing the end of their lives; it is based upon altruistic motives to relieve suffering and support the dying person through an holistic approach. Palliative care brings expertise in the clinical care of the dying person and a familiarity with death and dying that many do not possess.  But palliative care has two problems – it is poorly understood by the wider community, and is sometimes greatly paternalistic in its interaction with patients, their families and carers, and the communities to which they belong. A paradigm shift is represented in Health Promoting Palliative Care, which attempts to integrate the components of health promotion into palliative care services; this has the potential to enable services to change public policies, create supportive environments, strengthen community action, and develop the personal skills of professionals, carers and communities. To achieve this, a reorientation of palliative care services – and indeed health services too – is required. A death literate palliative care service is one that provides a social model of care based upon acknowledgement of community capacity to support its dying members, enters into equal partnerships with communities, and stimulates policy change towards promoting death literacy. To achieve this, a number of strategies at systems, organisational and individual levels are required, all of which entail partnership with communities.