Inequity in palliative care: class and active ageing when dying

Abstract

The purpose of this article is to explore social inequity in palliative care in Denmark, a country that is seen as a stronghold of universal health care. Using data stemming from 2 years of research, we have selected two cases for analysis. They consist of palliative conversations with two quite different patients. Drawing on sociocultural class theory, we find that the conversations involve social exclusion processes due to discourses of active ageing. We find that one privileged patient performs in line with an entrepreneurial self and is supported by the nurse. The other, disadvantaged patient performs in a passive way, and the conversation mainly alleviates the disrespect he has experienced in healthcare encounters. We conclude that palliative care reinforces classifying practices and distinctions between “good” and “bad” patients, when active ageing becomes a dominant factor. We suggest improving the quality and sensitivity of medical training and call for increased reflexivity among professionals on the unequal situation of patients in order to reduce inequity in access to health care when close to death.