Rethinking Palliative Care: A Social Role Valorisation Approach (Book Review)

Rethinking palliative care is a challenging book for a number of reasons. Taking aim at some of the sacred cows of palliative care, Paul Sinclair challenges the notion that palliative care facilitates the normalization of death and dying, for its institutional nature inherently devalues dying people. This confronting assertion presents an opportunity for apologists of palliative care to reflect upon their endeavours. I have often wondered why palliative care falls short of its goal of ‘‘total care.’’ Is it because, as suggested by Sinclair, total care is impossible in an institutional model? His critique of contemporary palliative care asserts that its mainstreaming has promoted conformity with an inherently devaluing model of institutional care. Ironically, this ‘‘inclusion’’ of dying people into mainstream health care excludes them from their ‘‘normal’’ social contexts. This is an example of how, as Sinclair suggests, ‘‘modern society handles death through making normative those ideals that mask the face and the fact of death’’ (p. 14). Using social role valorisation (SRV) to reframe approaches to death and dying, Sinclair proposes the social inclusion of people who are dying through dispersal of services from institutions to home. This is not simply a geographical relocation of settings of care, but a philosophically driven attempt to recapture the value of vulnerable people—in this case, those who are dying