Dying in country: Implications of culture in the delivery of palliative care in indigenous Australian communities

In recent years, palliative care and hospice service providers have been criticised for their contribution to the increasing medical rationalisation of death and dying. At the same time, efforts to make palliative care more culturally appropriate for different ethnic minorities are also being criticised for their reification of cultural practices. In this paper, I examine three aspects of the process of dying for Pitjantjatjara Aboriginal people of Central Australia—their preference for dying in their home ‘country’, their preference for provision of palliative care through matrilineal kin structures, and the difficulties of providing complex treatments in the remote settings in which they live. I show that the cultural and historical specificity of the Pitjantjatjara way of dying exemplifies the way in which dying is a culturally mediated part of a specific way of living, the elements of which relate structurally to other aspects of the way of living. Because the underlying assumptions of palliative care models relate structurally to the cultures of dying in which they arose, we should not expect to be able to respond to cultural difference simply by changing details of service delivery. If we want to provide culturally appropriate palliative care, we must ensure that the underlying assumptions of the care we are providing relate to the culture of dying of the patients to which the services are being provided.