Around the world there is a growing interest in the ways in which dying people are cared for, but there is little or no agreement on what ‘good death’ really means. With such fundamentals left unresolved, should we address the global challenge of end of life care around the world in a unified way, or with plural approaches?
These are questions raised in our article Common or multiple futures for end of life care around the world? Ideas from the ‘waiting room of history’, published in Social Science & Medicine in January 2017.
In this paper, what my colleagues David, Hamilton, Sandy and I argue is that everyone is entitled to a ‘good death’ and palliative care is a human right which everyone should receive. But also that countries should have the opportunity to define and to decide on a culturally relevant and sustainable means to a good death.
I’ve been working in global health for quite some time now and through my experience in doing research and teaching global health I have observed tendencies to universalise ideas and models.
There are many models and frameworks which have been developed in the West and transferred to different parts of the world. I have long felt an uneasiness about ideas formulated in a certain place, particularly in Europe, being uncritically transferred to other parts of the world.
Post-colonial theory applied to end of life issues
I am intrigued by the ideas of post-colonial thinker Dipesh Chakrabarty and his work ‘Provincializing Europe (2007)’.
In his book Chakrabarty argues how, according to the history of modernity, Europe is seen to be fully modern, while the rest of the world retains many pre-modern elements. In this understanding of history, the mission of the rest of the world is to try to catch up with Europe or the West.
For Chakrabarty, Europe is not just a geographical area rather a particular mind-set associated with values which originate in the European Enlightenment. He argues that this value system judges non-European societies in terms of their incompleteness and lacking of the modernity mission. Such societies therefore remain in the waiting room of history, aspiring to the future, that of Europe.
Chakrabarty raises major concerns about the uncritical transfer of ideas, practices and narrative from one context to another. He argues in the context of political modernity that we should stop looking at history as a developmental process that pays attention solely to the transfer of the modernity of Europe to other places. Instead, we need to look at a history of the translation of modernity from Europe to other parts of the world through the multiple relationships that exist between them.
While my colleagues and I consider that there is a good knowledge base in palliative care, we believe that more energy is being spent on the transfer of knowledge and ideas than on the translation.
What we are advocating is that we must first question some of the ideas which we take for granted in relation to end of life interventions. Let us think about the essence of these ideas and whether we should transfer these ideas uncritically, or whether we should find ways to translate them to fit in a new context.
Usually this post-colonial critique is applied in political science and in history. It’s not been used much in health, particularly in global health, and far as I am aware this post-colonial perspective has not previously been used in the palliative care field.
Zaman, S., Inbadas, H., Whitelaw, A., and Clark, D. (2016) Common or multiple futures for end of life care around the world? Ideas from the ‘waiting room of history’. Social Science and Medicine, (doi:10.1016/j.socscimed.2016.11.012)