Approaching death in multicultural Australia.

Culture is a system of shared ideas, concepts, rules and meanings that underlies the way we live--and approach death. Cultural diversity refers to more than ethnic diversity: age, gender, sexual preference, capabilities, education, place of residence, and occupation (including the health professions) contribute to diversity of culture. Clinical decision making involves values and ethical principles, which are influenced by culture--not only of the patient but also of the carers and health professionals. Care of patients approaching death involves the whole healthcare system--but may need, from time to time, palliative care specialist input, including specialised cultural competence. Education and training of palliative medicine specialists in Australia needs to include a focus on cultural competence.

The interface between palliative medicine and specialists in acute-care hospitals: boundaries, bridges and challenges.

Palliative care teams have made an important contribution to improving the care of patients with incurable illnesses in Australian hospitals over the past 20 years. Co-location of hospital-based palliative medicine specialists with other specialties allows communication and exchange of ideas on issues relevant to the medical care of such patients. Shared management of complex cases maximises comprehension of patient distress and optimises the support provided during hospitalisation. Tensions arising across the interface provide opportunities for both groups to improve the relief of suffering in the acute-care setting. Palliative medicine in the private sector has some advantages, but specialists also face specific challenges, including the cost of certain drugs, access to the multidisciplinary team and reimbursement issues.