{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:35:19Z","timestamp":1791678919600,"version":"4.3.4"},"reference-count":32,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000245","name":"Michael Smith Health Research BC","doi-asserted-by":"publisher","award":["RT-2023-3265"],"award-info":[{"award-number":["RT-2023-3265"]}],"id":[{"id":"10.13039\/501100000245","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliat\ufffdCare"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>Evidence suggests that people experiencing inequities and who are highly marginalized (e.g., people impacted by racism, sexism, discrimination, stigma, mental illness, substance use issues, disability, and the effects of homelessness; also referred to as structurally vulnerable individuals) often die alone, in pain, and not receiving the care they need. Some research even points to highly marginalized people not feeling worthy of care. The need to consider equity in the context of palliative care has recently emerged but little attention has been paid to how ethical decision-making generally, and relational ethics, specifically, could provide guidance in the care of highly marginalized people who are on a palliative trajectory. Relational ethics offers a model of care and decision-making framework that emphasizes how clients, healthcare providers, and larger social structures are interwoven and acknowledge that structural conditions can position people to have less choice than others. Relational approaches in the context of palliative care for highly marginalized people have the potential to provide a lens to better support the delivery of equitable palliative care. This critical essay explores relational ethics as a way to approach equity in palliative care to support clients facing structural vulnerabilities. We discuss relational ethical considerations to approach collaborative partnerships between clients, healthcare providers, and the larger community with the goal of aligning care with clients\u2019 values. An ethical case for how a relational ethics approach might be used to promote equitable access to palliative care will be explored, highlighting how such approaches have the potential to better align client wishes with their needs and to ensure decision-making and care delivery is trauma-informed, harm reduction focused, and culturally respectful. Relational ethics can support social change in equity and palliative care by contributing ethically informed ways of caring for\/with\/about highly marginalized people.<\/jats:p>","DOI":"10.1177\/26323524241293820","type":"journal-article","created":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T02:31:28Z","timestamp":1731033088000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Using relational ethics to approach equity in palliative care"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5600-1043","authenticated-orcid":false,"given":"Kristina A.","family":"Smith","sequence":"first","affiliation":[{"name":"Institute on Aging & Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2381-4712","authenticated-orcid":false,"given":"Kelli","family":"Stajduhar","sequence":"additional","affiliation":[{"name":"Institute on Aging & Lifelong Health, University of Victoria, Victoria, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,11,7]]},"reference":[{"key":"bibr1-26323524241293820","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.1604"},{"key":"bibr2-26323524241293820","doi-asserted-by":"publisher","DOI":"10.3747\/co.24.3698"},{"key":"bibr3-26323524241293820","doi-asserted-by":"publisher","DOI":"10.1177\/0269216320917875"},{"key":"bibr4-26323524241293820","doi-asserted-by":"publisher","DOI":"10.1177\/02692163231164729"},{"key":"bibr5-26323524241293820","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2017.03.020"},{"key":"bibr6-26323524241293820","doi-asserted-by":"publisher","DOI":"10.1186\/1475-9276-11-59"},{"key":"bibr7-26323524241293820","doi-asserted-by":"publisher","DOI":"10.1007\/s10916-022-01803-5"},{"key":"bibr8-26323524241293820","doi-asserted-by":"publisher","DOI":"10.1097\/ANS.0000000000000146"},{"key":"bibr9-26323524241293820","unstructured":"Stajduhar KI, Mollison A. Too little, too late: how we fail vulnerable Canadians as they die and what to do about it. Report, University of Victoria Institute on Aging and Lifelong Health, Canada, November 2018."},{"key":"bibr10-26323524241293820","unstructured":"World Health Organization. Closing the gap in a generation: health equity through action on the social determinants of health. Report, Commission on Social Determinants of Health, Switzerland, 2008."},{"key":"bibr11-26323524241293820","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-019-0396-7"},{"key":"bibr12-26323524241293820","doi-asserted-by":"publisher","DOI":"10.1111\/soc4.12969"},{"key":"bibr13-26323524241293820","doi-asserted-by":"publisher","DOI":"10.1080\/09699260.2019.1702334"},{"key":"bibr14-26323524241293820","unstructured":"British Columbia Provincial Mental Health and Substance Use Planning Council. Trauma-informed practice guide. Report, BC Centre of Excellence for Women\u2019s Health & BC Ministry of Health, Mental Health and Substance Use Branch, Canada, http:\/\/bccewh.bc.ca\/wp-content\/uploads\/2012\/05\/2013_TIP-Guide.pdf (2013, accessed 22 June 2024)."},{"key":"bibr15-26323524241293820","unstructured":"Vancouver Coastal Health. Harm reduction, https:\/\/www.vch.ca\/en\/health-topics\/harm-reduction (2024, accessed 22 June 2024)."},{"key":"bibr16-26323524241293820","unstructured":"Virani A, Everett B, Adurogbangba M, et al. Ethical analysis of prescribed safer supply policy in British Columbia: final report and recommendations. In: A review of prescribed safer supply programs across British Columbia: Recommendations for future action. Report, Office of the Provincial Health Officer, Canada, pp.62\u201396, https:\/\/www2.gov.bc.ca\/assets\/gov\/health\/about-bc-s-health-care-system\/office-of-the-provincial-health-officer\/reports-publications\/special-reports\/a-review-of-prescribed-safer-supply-programs-across-bc.pdf (2023, accessed 22 June 2024)."},{"key":"bibr17-26323524241293820","first-page":"127","volume-title":"Toward a moral horizon: nursing ethics in leadership and practice","author":"Bergum V","year":"2012","edition":"2"},{"key":"bibr18-26323524241293820","volume-title":"Relational ethics: the full meaning of respect","author":"Bergum V","year":"2005"},{"key":"bibr19-26323524241293820","volume-title":"Justice and the politics of difference","author":"Young IM","year":"2011"},{"key":"bibr20-26323524241293820","unstructured":"Fraser N. Justice in the age of identity politics: redistribution, recognition, and participation. 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