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27 An adequate ethical basis for palliative care provision
  1. Madeleine Fisher,
  2. Anshuni Kaneria and
  3. Wing May Kong
  1. Faculty of Medicine Imperial College London, UK


Currently, in England, palliative care provision could be argued to be unjust as it treats equals in need unequally. For example, those from black and ethnic minority groups (Public Health England, 2018), or those from a lower socioeconomic class (Macmillan, 2017), are much less likely to receive access to palliative care services. This paper sought an ethical framework that would adequately resolve this current injustice. An adequate ethical basis of palliative care would ensure a minimum baseline of care to all equals in need, without compromising palliative care’s aims. This paper argues that this can be provided by using a care ethics framework in conjunction with justice.

Care ethics argues that caring and being cared for is universal and intrinsic to humanity (Tronto, 1993). A framework of care ethics could encourage all individual caregivers to provide the deeply holistic, individualised care currently provided in hospices. However, providing palliative care only from a care ethics perspective may mean that some go without care, as caring under this framework is voluntary, with no obligation to meet everybody’s needs. Additionally, this may allow for the charitable basis of hospice funding to mask an unjust system, thus preventing social reform of palliative care services.

This paper argues that all should have equal access to highly individualised and holistic palliative care, as is currently provided in many hospices. An adequate ethical basis of palliative care provision would support this and would require both justice at the societal level and care ethics at the individual level.

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