Accepted Paper:

Standardising end of life care: the movement of 'best practice' of idealised hospice care  


Erica Borgstrom (Open University)
Natashe Lemos Dekker (Leiden University)

Paper short abstract:

'Best practice' within end of life care is typified in English hospice care. There have been attempts to replicate these practices in different care settings, both within England and other countries. This paper critically examines this movement towards standardisation

Paper long abstract:

End of life care involves the managed care of dying persons, usually within the last few days of life. It is primarily based on palliative care principles and practices . These have been developed since the modern hospice movement was founded in England in the 1960s, which seeks to provide holistic care, not just biomedically-focused treatment.

Acknowledging that end of life care can improve the quality of life, different countries have sough to apply these care practices in other settings. An example of this is the development and proliferation of the Liverpool Care Pathway for the Dying Patient (LCP). This is a document developed to adapt the 'best practices' of hospice care to other clinical settings. In England, it was promoted by national policies and funding strategies to be implemented in all hospitals. It has also been adopted in other countries, for example the Netherlands.

In this paper, we examine how the adoption of the LCP sought to standardise care and the ways in which the movement of knowledge (from hospice to other settings, from England to other countries) shifted the kinds of care that could be possible. Thereby it dictated what should be considered quality of care at the end of life and its use seeks to standardise how death can occur through the management of the dying process. By examining the mobilisation of the LCP, and where this has been challenged and not challenged, we will comment on the extent to which dying continues to problematise medical management.

Panel MB-MT07
Movement of medical knowledge & practice: crossing borders and constructing boundaries in a global world