Antea Worldwide Palliative Care Conference
Rome, 12-14 November 2008
Presenting author
Alessandra Sannella
Email:
alessandra.sannella@uniroma1.it
.it
Phone
Mobile phone
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abstract
• Pain and other symptoms
• Palliative care for cancer patients
• Palliative care for non cancer
patients
• Paediatric palliative care
• Palliative care for the elderly
• The actors of palliative care
• Latest on drugs
• Pain
• Illness and suffering through
media
• Marginalization and social stigma
at the end of life
• Palliative care advocacy projects
• Prognosis and diagnosis
communication in
different cultures
• Communication between doctor-
patient and patient-
equipe
• Religions and cultures versus
suffering, death and
bereavement
• Public institution in the world:
palliative care policies
and law
• Palliative care: from villages to
metropolies
• Space, light and gardens for the
terminally ill patient
• End-of-life ethics
• Complementary therapies
• Education, training and research
• Fund-raising and no-profit
• Bereavement support
• Volunteering in palliative care
ABSTRACT FORM
Migration-discrimination-stigma-inequality – ethical issue
Authors (max 6, presenting author included): Prof. Aldo Morrone, Alessandra Sannella
In preceding ages sufferance was a daily experience and ill persons were cared for within their family or the
community the belonged to. With the present development of the technique the patient, and above all the
person who is near to dying, is taken away from the family and entrusted to the ‘expert’, a doctor, a nurse, a
social worker, a family caregiver. Death, managed by technique, is hidden from usual life. Post-modernity
has socialized death, or rather, de-socialized dying.
In regard to terminal patients, an amount of marginalization is observed which tends to become
more and more extended with time, both from the social and from the human point of view. This kind of
marginalization, to which the experience of a terminal illness is added, dwells in the beds of our hospices: it
is the immigrant patient, the non-EU national, the product of press sensationalism, the object of social
stigma and discrimination. Redefinition of medicine, and in particular medicine of migration, consists in
meeting and coping with the need of assisting persons whose socio-sanitary conditions are socially and
culturally changing. Foreign patients have a very different attitude towards the experience of disease,
sorrow, sufferance and death. A different perception of symptoms depending on different cultures of origin is
valid for all populations. Immigrants use somatic metaphors as a shortest and easiest way of expressing
emotions and feelings not otherwise communicable. They often complain of a number of vague symptoms
(headache, digestive disorders, indefinite and diffuse pains, itching, smarting urination) without somatic
evidence.
The change process the migrant person is confronted with calls for a continuous crisis of his/her
own historical and cultural identity and s/he will be asked in advance for an endless adjustment to
completely different situations at a high price. But anticipation of a sufferance is not sufficient for
eliminating it. In contact with patients from different cultures doctors risk to linger on the mere
consideration of somatic metaphors, unable to get from the whole picture the deep meaning of their
attempts to recover a new identity.
Unable to share the history of the persons with whom we share daily life, even less will we be
able to share living and dying. Death and dying are two different things and the challenge we face is to be
there in living otherness in daily life and to increase our potential for sharing a different vision of dying and
the presence of the other.
When the soothing power of medicine and technology fade away for a person who has lost the
value of sufferance and dying, nothing but the abyss of void and inequality is left. It’s up to us the great
challenge not to let this happen.
On this very issue should the terms of care and assistance be redefined. Death and illness point
out to an ever more precise and severe discrimination, within a same community, between the rich and the
poor, the natives and the immigrants. Quite often, beside immigrant patients, there are no families who
could assist them to their last breath. Nor are there cultural codes to allow interpretation of the event, no
traditional supportive practices in the last moment of life. Dismantled in their bodies and souls the
immigrants die with the burden of social invisibility.
Who can help assist a terminal patient, unable to communicate in any official language, not cared
for by his family of origin, alone, abandoned, stigmatized, and who is going to die? Who can safeguard and
provide recognition of one’s own traditions, understand and codify them in order to give dignity to one’s life
course? Who can help give voice to the last wishes of a person in a foreign country? Definitely essential in
the socio-sanitary context today is the training of ‘intercultural mediators specialized in dealing with
terminal patients’, caregivers of transcultural assistance, expert in ‘reception’, in ‘taking care’, in assisting
them through the knowledge of ethnical, cultural, linguistic and personal differences. The caregiver can
acquire specific ethical competence for the delicate ‘last moment of life’, in order to offer to the immigrants
in Italy the dignity that too often they have been stripped of in our country.
Session: Marginalization and social stigma at the end of life
Chair of the session: Prof. Aldo Morrone
• Rehabilitation in palliative care