Book Review
Palliative care: Explorations and challenges
Judith Parker & Sanchia Aranda (Eds.)
ISBN: 0-864331-20-7; 1998; 307 pages; MacLennan & Petty;
Allan Kellehear
Professor of Sociology, Centre for Death and Society, Department of Social and Policy Sciences, University of Bath, Bath, UK
This book is essential reading for anyone with an interest in contemporary palliative care, but especially the practice and policy issues of that field in Australia. There are few edited books one would describe as compelling reading but this one would definitely qualify. The reasons are simple to see.
First, the book is an excellent introduction to the current unease and tensions in the field today-the retrograde developments in current policy directions for palliative care; the competing discourses by different professional stakeholders; and the relationship between the practice of palliative care and other issues in death and dying such as the euthanasia debate.
Secondly, the book provides a useful and timely reminder to those in the field (or introduction for newcomers) of the cultural diversity within palliative care and how the different interests position themselves within policy and practice. For example, the authors of the various contributions include those who are obvious apologists for the current policy directions; those who believe it is valuable to approach death and dying issues with the humour of a syrupy, US sitcom; those who approach the current issues with a critical social science gaze; those concerned with practice issues alone; and those who are solely concerned with the original hospice mission and ideals.
Finally, the three parts of the book are well chose, moving from system-based issues to practice ones. Part one examines broad policy issues. Part two examines issues directly relevant to our understanding of death and dying such as euthanasia, the good death, or the inevitability of death. Chapter three examines palliative care in diverse settings such as acute care, transplant units or critical care, and with diverse people, such as children or those with Alzheimer's Disease.
However, a good book such as this one is not without its problems. For me, a 'non-nurse', the book inevitably reads like a book for nurses. This raises several important issues for other 'non-nurse' readers. Is palliative care an interdisciplinary field or not? At least half of the 25 chapters are written about topics specific to nursing practice. One could equally have written that many chapters for doctors, pastoral care practitioners, or for social workers, for example. The book's title and sub-title do not indicate this concentration and the first the reader knows about this is by browsing the book's contents. Nevertheless, for readers of this journal, this particular emphasis will be an added attraction of direct relevance.
Finally, the one problem that I have with palliative care literature-written by any discipline-is the sheer enormity of the emphasis on health service issues. Surely, if palliative care is about the study and care of the dying person, some research about dying from their point of view will be relevant. To be sure, there are attempts to do this in Part Two. But there is little current research on the experience of dying included, or even a chapter or two written by people who are living with life-threatening or terminal illness. And yet, these people are particularly relevant to a book such as this. It is a continual concern that palliative care literature consistently pays so little attention to the voices of those for whom it aspires to service.
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