Death, Gender, and Ethnicity

Ethnicity and the use of palliative care services

Chris Smaje and David Field

There is a widespread feeling in the British palliative care community that people from minority ethnic populations are underrepresented among the users of services for the dying. Unfortunately, few systematic data are available which allow us to determine whether this belief is well-founded. Nor is there much evidence to inform an understanding of the context within which people from minority ethnic groups may use palliative care services, and their views and experiences of service provision. Nevertheless, there are more general data available which can help clarify patterns of service utilisation among minority ethnic groups, and there are some suggestions in existing research about the way that people from these groups interact with palliative care services.

One of the few British studies concerned with the use of palliative care services by people from minority ethnic groups is Rees’ (1986) report on the use made of St Mary’s hospice in Birmingham by immigrants, including those from Europe. ¹ Rees found use by immigrants to be much lower than that of British-born individuals, with crude utilisation rates among the latter group nearly four times higher than among the immigrants. Yet of those who were referred to the hospice, immigrants were more likely to receive hospice services. From these and other results, Rees inferred that hospices were not discriminating against immigrants, as the crude utilisation figures might at first seem to suggest.

Although in this instance Rees is probably correct, the matter is rather more complicated than his analysis credits. The aim of the present chapter, as well to describe the relevant evidence, is to provide a framework which allows a systematic appraisal of the whole range of factors affecting people’s use of services. This framework is outlined in the following section and its implications for an understanding of ethnic patterns in the use of palliative care services are then illustrated throughout the remainder of the chapter.

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