Cultural considerations in planning palliative and end of life care

Ending life with dignity, with freedom from pain and with appropriate social, psychological, spiritual and medical support are widely accepted as attributes of good palliative care -but the manner in which this can be achieved certainly varies enormously across cultures, jurisdictions and settings.There are many features to the related debates.Efforts to extend quality end of life care are underway in many countries, but are often under-resourced and lack coverage.Moreover, we still have limited agreement on just how these efforts might be more successful.There are examples from many societies of the apparent failure to care for older people effectively and adequately as they face death -at home, in hospitals, in care homes, prisons and other institutional settings.As the effects of population ageing are felt and as the incidence and prevalence of dementia increase, these challenges will grow.There are also special requirements arising from the pandemic of AIDs-related deaths and from increasing mortality associated with cancer in the developing world.Recently there has been debate about whether palliative care can or should be the answer to good end of life care in all contexts.Some arguments, particularly from the rich world, propose wider access to assisted dying and the legalisation of euthanasia, to extend 'choice' at the end of life and promote autonomy.Others seek not elite dying for the few, but palliative care principles embedded across the health and social care system, thereby maximising benefits for the greatest number.Some positions revolve around the need to build community resilience in the face of ageing, dying and death, drawing on perspectives from health promotion and public health to develop strategies for intervention.