Book Review
Health Promoting Palliative Care
Alan Kellehear
ISBN: 0-195507-85-1 1999 Oxford University Press
Glenda Parmenter
Faculty of Nursing, University of New England, Armidale NSW
Alan Kellehear presents a new perspective on the delivery of palliative care services based on the principles of health promotion. He argues that there are aspects of palliative care that are underdeveloped and that health promotion is an ideal model by which to bring about the necessary changes.
Kellehear suggests the adoption of social science and public health perspectives in the delivery of palliative care. He argues that the social side of care, as well as early stage care, and the active treatment phase of a person's illness are aspects of palliative care that need to be more fully addressed. He also contends that palliative care services should increase their involvement with those with life threatening illness and not only be concerned with terminal illness.
The provision of a comprehensive education program which encompasses health, dying and death along with a broader community involvement is recommended. Active support groups with family, friends and neighbours being informed about, and involved in, the delivery of their palliative care services are advocated. A more participatory approach for the dying person is proposed with interpersonal reorientation being a way of achieving this, which allows the person to address the meaning of living with a life threatening illness.
My only reservations about this book are that Kellehear does not make it clear on what he bases his assertions. How does he know that people in the early or treatment phase of a life threatening illness want the involvement of a palliative care service? Also, I am a little concerned at his advocacy of turning to the corporate sector for funding support as it appears to abandon all hope of strengthening public sector support. This might leave palliative care services in a position of being unduly influenced by corporate economic imperatives.
Despite these minor reservations I found this book to be both stimulating and thought provoking. It is beautifully written with clearly presented arguments, a great deal of background information and a number of suggestions as to how a health promoting palliative care may be provided in a range of settings. I would recommend this book to anyone who is seeking to improve their palliative care service and to anyone who is feeling frustrated with attempting to provide a service based on holistic ideals, in times when health care budgets are reducing and the focus is increasingly on physical care.
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