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Elliott, Carly

University of British Columbia

British Columbia’s Palliative Care Benefits (BCPCB) is a provincial program implemented by the Ministry of Health that offers coverage of medications for symptom management through the PharmaCare BC Palliative Care Drug Plan (Plan P), as well as medical supplies and equipment through local health authorities for eligible patients. BCPCB is available to B.C. residents who have reached the end stage of a life-threatening illness and wish to receive palliative care services at home. Utilizing Fairclough’s Dialectical–Relational Critical Discourse Analysis, this thesis analyzed how BCPCB registration and a companion policy, the Home and Community Care Policy Manual: Home Health Services, governs practices that determine service users’ eligibility for BCPCB, as well as determining resource allocation based on perceived level of the service user’s need, function, illness burden and urgency. This analysis aimed to show how the BCPCB and Policy Manual are constructed within socio-historic discourses of biomedicalism, medical paternalism, empiricism, ableism, postcolonialism, and neoliberal orientations of the provincial government. The BCPCB and Policy Manual define eligible service-users as patients with “life-limiting illness” who are determined by a physician to be in the last 6 months of life. To be considered eligible, service users must also agree to receive palliative care services in the home and consent to comfort care as the focus of treatment. Vague and discriminatory prognostication practices outlined by the BCPCB are implemented by physicians to determine service user eligibility to BCPCB, while unclear and ableist-oriented approaches to determine resource allocation is outlined in the Policy Manual and implemented by nurses once service users are deemed eligible for BCPCB. The discourses of the BCPCB and Policy Manual can be seen as produced within neoliberal governing practices that prioritize efficiency in the production and consumption of health services over the redistribution of healthcare costs equitably among society. Current health care practices and structures that rely on narratives and discourses based on deficit, physical function, prognostication, and illness burden perpetuate health inequities for service users at the end of life. Nurses are ideally positioned to challenge discourses and practices that compromise the human rights of people living with life-limiting illness.

Text

2025-04-30

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/86123

Nursing

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/