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93 In your opinion what are the most important ethical issues for the specialty in the next five years and how could we address them
  1. Jack Maddicks
  1. University College London (UCL)


Introduction Just access to palliative care for people from Black, Asian and Minority Ethnic (BAME) populations has long been recognised as a prominent ethical issue in the specialty. However, changing social, political and demographic factors mean that this issue is especially significant now.

Methods This essay reviews literature and population data to explore the barriers faced by people from these groups in the UK. They are grouped into patient-level, society-level and structural barriers, with provider-level mediators.

Findings There are numerous patient-level, personal barriers in palliative care. Frequently denoted examples include cultural, religious and linguistic differences between patient and caregiver. Although the exact nature of these barriers varies between ethnic groups, their existence remains relatively unchanged over time. However, recent society-level factors – the demographic changes of an ageing, diversifying, mobile population – is magnifying their impact currently. Structural changes also lend the issue contemporary significance. Namely, the so-called ‘hostile environment’ policies of recent governments have produced new barriers to palliative care. Although palliative care is exempt from patient charging, and the policies do not specifically target BAME populations, both are still affected. Poor implementation has led to inappropriate identity challenges, hospital fees and denial of care, which has in turn worsened health-seeking behaviour and healthcare experience amongst people from BAME groups.

Suggested solutions The solutions suggested are rooted in medical education: the provider-level factors that mediate barriers to care. These include ‘structural competencies’ to encourage engagement of clinicians in political discourse, and ‘cultural competencies’ to facilitate greater understanding between clinicians and patients. Inclusion of these extra-clinical competencies into training would create a healthcare workforce that is able to commission equitably, engage with policy and care effectively.

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