Intercultural Concepts of End-of-life care - ambitions and reality from an organizational ethics perspective
Federal Ministry of Health
Against the background of a growing and increasingly ageing population in Germany issues of social justice concerning the distribution of available resources in health care system, the respect for different values as well as the dealing with intercultural aspects from an ethical perspective become more important. In view of the unequal opportunities for disadvantaged groups such as immigrants in nursing and hospice care and the lack of institutional structures in coping with these challenges, questions about possible causes and solutions of these problems arise.
Therefore, the aim of the current study is to reconstruct the significance of cultural diversity of the ageing society in scientific and health policy discourses from a critical perspective on power relations. We intend to examine how these discourses shape the views of responsible actors in end-of-life care and whether and how the expectations of dying individuals and their relatives are represented in these discourses. From the perspective of organizational ethics the study discusses, whether and how interculturality as a normative concept is able to contribute to a good and equitable care at the end of life considering the available resources.
To provide a comprehensive understanding of ethical aspects in intercultural care design different qualitative methods will be triangulated. Interview data from an earlier study with dying individuals and their relatives will undergo a secondary analysis in order to explore the participants’ normative concepts and expectations of caregiving. A critical discourse analysis of scientific papers and health policy documents then aims at reconstructing the impact of normative concepts and discursive practices in previous discussions on health policy, especially on the legal and structural frameworks of the nursing and hospice care at the end of life. Expert interviews will be conducted with various actors in the health care system. They address experts’ social representations of ethical responsibility and their role within the organization of care. Additionally, scholars from the humanities will be asked to discuss the meaning of shared and possibly contradictory value orientations in this field.
The research process will be complemented by round tables with external experts from ethics and philosophies.
The interpretation of all results comprises different ethical approaches. This allows to develop a discussion paper in order to provide new impulses for future debates in the field of health policy and to contribute further conceptions of practice-oriented approaches for successful care at the end of life in a diverse and ageing society.
The research project is funded by the Federal Ministry of Health from March 2017 to December 2019.
Migala, S., Sokolova, O., & Flick, U. (2017). "Ich bin aber Gott sei Dank kein ausgeprägter Atheist." Verständnisweisen postsowjetischer Juden in Deutschland von Religiosität und ihre Bedeutung für die Versorgung am Lebensende. In S. M. Probst (Hrsg.), Die Begleitung Kranker und Sterbender im Judentum. Bikkur Cholim, jüdische Seelsorge und das jüdische Verständnis von Medizin und Pflege (S. 227-241). Berlin: Hentrich & Hentrich Verlag.
Migala, S., & Flick, U. (2018). Individual Needs, Cultural Barriers, Public Discourses. Taking Qualitative Inquiry into the Public Sphere. In N. K. Denzin, & M. D. Giardina (Eds.), Qualitative Inquiry in the Public Sphere (pp. 90–107). London: Routledge.
Migala, S., & Flick, U. (2017): Altern und Sterben in Diversität – Implikationen einer intersektionalen Perspektive für die Analyse gesundheitspolitischer Diskurse. Vortrag bei der gemeinsamen Jahrestagung der Sektionen III und IV der DGGG, 29. September 2017, Fulda.