Charles Waddell

The institutionalization of the good death

There has been some recent concern in Britain and North America that the increasing institutionalization of hospice care may compromise the movements founding ideals. The threats posed by the encroachment of mainstream medicine and the medical technological imperative to treat, are also a source of concern to hospice administrators and staff. This study uses Australian data based on interviews with nurses and participant observation in an in-patient hospice unit and a community based hospice service to investigate whether the Good Death ideal, as central to the hospice philosophy, is compatible with the institutionalization of hospice care. The issues that arise, although interrelated are conceptualized as the following five challenges to hospice care: (1) encroachment of mainstream medicine and the medical technical imperative; (2) competing motivations; (3) delimitation of intellectual structures; (4) organizational maintenance; and (5) routinization of the Good Death. This conceptual framework is based on the way in which nurses and other health care professionals have used shared logic and strategies to negotiate the daily demands of their work and illustrates the tension that arises between the maintenance of the ideal and the maintenance of the organization.

Palliative care in a multicultural society: perceptions of health care professionals

This study assesses the perceived competence of 191 Australian palliative care professionals in delivering crosscultural care. The relationship between the perceived competence levels of professionals and their experience and training is examined. Strategies to improve crosscultural palliative care, as suggested by palliative care providers, are also presented. Information about perceived competence and the kinds of difficulties encountered in crosscultural palliative care interactions form the basis of suggested guidelines for proposed education programmes. The results of this study suggest that specific education, rather than individual experience of crosscultural interactions, which may not always be positive, is needed to improve the competence of palliative care professionals. Education, therefore, is the key to the provision of culturally appropriate care to patients and their families from all cultural backgrounds.

Social Correlates of Unsafe Sexual Intercourse

Building upon the work of Connell and colleagues, this paper examines four social correlates of unsafe sexual intercourse for gay, bisexual and heterosexual people. These are: (1) alcohol consumption; (2) uncertainty about ones HIV-infection status; (3) learned and shared logic about condoms; and (4) logic about the seriousness of the AIDS epidemic. The data come from two samples of sexually active people in Perth: (1) the gay community and (2) clients at an STD clinic. Data collection consisted of self- administered questionnaires (N=906), follow-up interviews (N=361) and ethnographic field work at heterosexual and gay venues. The conclusion reached is that unsafe sexual intercourse may be considered to be a collective, cultural institution and not merely due to individual ignorance, weakness or foolishness. HIV education and prevention programs need to focus more on collective action to achieve safer sex practices and on grassroot social processes that will sustain changes toward safer sex.

The medicalization of Aboriginal children: A comparison of the lengths of hospital-stay of Aboriginal and non-Aboriginal children in Western Australia and the Northern Territory

This paper compares the lengths of hospital‐stay of Aboriginal and non‐Aboriginal children in Western Australia and the Northern Territory over the past few years. The comparison yields two trends: (1) Aboriginal children stay longer in hospital than do non‐Aboriginal children; (2) within each racial group, children stay longer in hospital in the Northern Terrritory than in Western Australia. By‐and‐large, these trends continue irrespective of age, sex, diagnostic category. hospital and usual piece of residence. It appears that factors In addition to high rates of infectious disease, severity of illness and remoteness of home address affect length of hospital stay. Two organizational factors are suggested: (1) the latent, working logic of service institutions such as public hospitals and (2) the tendency of government to institutionalize impoverished people. It is concluded however, that as health care becomes holistic and more the responsibility of Aboriginal people, there is every reason to predict a decrease in the lengths of hospital stay of Aboriginal children.

Book reviews : A HEALING PLACE: INDIGENOUS VISIONS FOR PERSONAL EMPOWERMENT AND COMMUNITY RECOVERY Kayleen M. Hazlehurst Rockhampton, Central Queensland University Press, 1994, xiii, 274 pp.,

mainstream media. The results of this study therefore have important ramifications for wider social inter-relations between the broader Australian community and Indochinese in Australia. The authors of this book have examined the continuing transformations underway within the Indochinese communities as well as the effects of changing labour markets and housing markets upon unemployment rates and concentration patterns. While the book is sensitive, scholarly, and thorough, it highlights the need for further research on Indochinese communities in Australia. Only then can we obtain a fuller picture of the unique experiences of Indochinese peoples and their relations with wider Australian society.