Public Health and Community

The Compassionate Workplace

The compassionate leadership, workplace support (life-threatening illness and carers) project is based on a health-promoting model of care and support, is embedded in deep ecology, compassion, and justice, and is based on a former Australian community palliative care service model—the Melbourne Eastern Palliative Care Association (MEPCA) model of co-leading in community. What sets this project apart from a conventional understanding of palliative care? How does it fit into a medical model of care and support?

Firstly, this model doesn't fit into a medical model; it sits alongside the medical model as a model that co-leads in community. The model is embedded in an understanding of shared leadership rights and responsibilities (accountabilities), and quality of care measured through the lens of deep ecology, compassion, and justice within a community of care and support. The model is community led, in concert with all health care professionals involved in end-of-life care and support. The model insists on relationships based on being human first and experts second, with an inherent respect, understanding, and equality of rights and responsibilities in all shared tasks and activities to offer quality of care to dying people, their carers, families, and friends.

Secondly, both the American Roundtable discussion and Australian National End-of-Life Framework Forum distill their meanings and understandings from within a medical-led paradigm. The compassionate workplace model distills its meanings and understandings from within a community-led paradigm. Each model offers compassion and justice from within its own understandings; each model is not in competition with the other.

For example in health promoting palliative care, the central tenets in compassion and justice are the overarching ethics and emphases on deep ecology (rather than pharmacy), social inclusion (rather than consumerism), and possibility (rather than expectation; e.g., advance care planning/goals). The policies and practices inherent in each understanding differ; both are fundamental to moving the palliative care and health-care reform agendas forward in ways meaningful to the patients, carers, and families we serve.

There's Always Room for One More at a Round Table!

(IWG, Death, Dying Bereavement member, Hong Kong meeting, 2004)

A social model of health and well-being (health-promoting palliative care) through end-of-life transitions

All the advance care planning in the world does not fully prepare a person or their loved ones for an unexpected death. In 1987, I was invited to facilitate a workshop at the Cancer Council, Melbourne for the CALD (Culturally And Linguistically Diverse) community. The CALD community already knew about the fragility of life and what it was to experience being the “sandwich generation” of carers for the young and elderly. There was insight into the fact that, in spite of any planning, a person could leave that room and be killed by a bus on the way home—suddenly and unexpectedly—whilst living with a life-threatening/terminal illness or being a carer! These people understood the need for and importance of a social model of health in palliative care; one embedded in community, wherever they live out their daily lives. It is through being in-community (in a covenantal way) that any uncertainty, suffering, loss, and grief can be faced, wrestled with, and worked through in life-affirming ways, such as the model health promoting palliative care offers through the La Trobe University Public Health Unit, Australia. How does this public health and community model work?

A New Public Health: Embracing Expectation and Possibility

The Australian National End-of-Life Framework Forum suggested that “uncertainty has led to a disproportionate focus on options such as euthanasia and physician-assisted suicide because people do not have an awareness of, or access to, care at the end of life” (Palliative Care Australia). The Australian forum did not outline the way in which this insight could be addressed; the American Roundtable discussion offered operationalized integrative medicine as their response. This response is too limited—a more public health and community-centered view needs to be considered.

Uncertainty and ignorance, will always play a part in death, dying, and bereavement. A public health/health-promoting palliative care understanding to end-of-life care both understands and, most importantly, embraces this reality. Do life and death challenges need to always be reduced to becoming “problems to be fixed” or “commodifiable products”? Some life and death questions do not have answers, instead they have responses to issues and needs as they arise. The place of possibility is foundational here, to attending to the four issues of power, vulnerability, trust, and security as part of an ethical, accountable approach to quality end-of-life care in which the ethic of beneficence means not only to do good but to also do no harm.

Health-promoting palliative care approaches these four issues through offering a spiritual, social, and emotional container of support and care, alongside medical and nursing care, as committed members of a community … just as the former MEPCA model offered its community. Doctors, nurses, social and pastoral care workers, volunteers, community groups, and businesses all worked together in a spirit of mutuality and reciprocity, to support and care for the community they'd been commissioned to serve … and some of the lessons from that model have been transformed into a compassionate workplace model of care and support from within a health-promoting palliative care perspective … of co-leading within community. Shared leadership roles, tasks and intent are offered in end-of-life care through interdisciplinary, palliative care teams in partnership with the medical model, their communities and businesses (an integrated side-by-side model). In business, this approach is upheld through benign competition that strives for excellence in one's own area of expertise whilst recognizing and respecting the interdependence of other expertise, as needs arise, to address the four issues of power, vulnerability, trust, and security for people encountering end-of-life transitions.

Co-leading in community is not an easy task to undertake, uphold, or embed, and yet, at the beginning of the 21st century, it is offering renewed possibilities embedded in the origins of hospice and palliative care philosophy and practice. If we don't each model what end-of-life quality of care and accountability look like to a broader audience, regardless of setting, then what can this quality of care and accountability be benchmarked against? How will the public know what quality and accountability in end-of-life care and support looks and feels like, or indeed can be experienced, in life-affirming ways? The compassionate workplace project can offer this benchmark, in health-promoting ways, in equal partnership with the medical model and business community. Perhaps the ultimate challenge for us all is to celebrate and uphold each other's model of care and support as equal partners … a public health (includes health-care system), business and community side by side!

In February 2010, an inaugural workshop was held at VicHealth, Melbourne, Australia with health promotion mentors and mentees, who were exposed to the science, art, and practice of how to co-lead in community from a public health/health-promoting palliative care perspective. The Centre for Mother and Child Health Research, La Trobe University planned the workshop, and as a mentor, I co-led the workshop with a nominated mentee from a Victorian rural community health center. The workshop was framed as an approach to compassion and justice hallmarked by the practice of deep ecology, interdependence, nondominance, and being nonjudgmental … it is filled with promise and possibility.