Ian Maddocks

The Caring Community

The pioneers of palliative care made an impressive early impact on health care in focusing primarily on comprehensive symptom management for dying individuals, a focus which, sadly, was quite unusual at that time. As palliative care matured into a recognized discipline, its field of activity extended to include matters of family support, staff counselling, bereavement care and community education. Much of the energy which fostered the growth of palliative care came from the non-government sector of society with impressive efforts at the community level to raise funds and establish hospices. Only later did palliative care achieve a measure of respectability within the established canon of medical specialties, and come to be seen as a proper recipient of a moiety of government funding for everyday health care. The acceptance of palliative care within medicine and by government bureaucratic responsibility has not been viewed universally as a positive development. It is seen to have detracted from the volunteer spirit which motivated so much of the first efforts to improve the care of dying persons; it has been accused of ‘medicalizing’ what was a remarkable grass-roots social movement. But the desirability of continuing or re-establishing a committed community support for palliative care services is still recognized, and has become a concern for palliative care advocates within professional bodies and governments alike. That concern is illustrated in the national palliative care strategy adopted by the peak body for Australia, Palliative Care Australia, which lists as one of its primary objectives: