Applying the capability approach to end of life care: a programme for research

Coast, Joanna (2011). "Applying the capability approach to end of life care: a programme for research" Paper presented at the 8th annual conference of the HDCA, 6-8 September 2011, the Hague, the Netherlands.

The evaluation of care strategies at the end of life is becoming increasingly important as, globally, the population of older people rises. Increases in healthy life expectancy have not kept pace with improvements in total life expectancy and so the number of people in need of greater care at the end of life continues to rise. Although policies to improve the quality of end of life care are being put in place, these inevitably have economic implications, and it is possible that more successful and/or less costly care strategies could be pursued at the end of life, enhancing the ability of a society to provide care for all. The evidence base for informing such resource allocation decisions, however, is almost non-existent. This lack of evidence is partly due to the methodological and ethical difficulties associated with conducting evaluations at this difficult time within people?s lives, but there are also philosophical difficulties associated with applying the usual cost-effectiveness approach to end of life care. This paper considers an alternative focus for evaluation: evaluating different care strategies in terms of the capabilities that result from providing such care. The paper outlines the philosophical strengths of such approach but the bulk of the paper discusses the challenges, from the philosophical to the practical, of applying a capability approach to the allocation of resources at the end of life. Four particular challenges are discussed in-depth: What capabilities are important to the individual at the end of life? What capabilities are important to the individual?s loved ones at the individual?s end of life? How should capability measures for end of life be measured and valued? And, How should capability measures be used to assist in resource allocation? The paper ends with a set of recommendations for future research.
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