The invisible dimension: abuse in palliative care families

The family as the unit of care underpins the philosophy and practice of palliative care. Through this model of service delivery, palliative care professionals attempt to provide holistic, quality end-of-life care to terminally ill patients and their families. The research on palliative care families to date, however, constructs the family unit as functional, articulate, cohesive and, thus, able to adapt to the impact of a terminal diagnosis, albeit with professional intervention if required. This notion of the family as monolithic and unproblematic masks the existence of family issues that have the potential to impact negatively on the care that patients receive, and thus constrain the palliative health professional in facilitating quality end-of-life care. Through a review of current literature, this paper identifies such an issue--that of abusive family relationships--which has been hitherto neglected in palliative care research. It is suggested that the issue of abusive family relationships needs to be identified and responded to at some level if the goal of providing holistic care and facilitating a "good death" for all terminally ill people receiving palliative care is to be achieved. The continued invisibility of this issue does not resolve the problem of abuse and could result in the implementation or continuation of practices that may in fact be damaging.