Philosophy in end-of-life care
When it’s clear that a person will die, the last weeks and months become a very precious time. It is not only a time to say goodbye and grieve but also to ponder the existential questions: Have I lived a good life? Did my life make a difference? What will people remember about me once I’m gone? End-of-life care such as hospice and palliative care encompasses many services intended to ease this difficult phase. Psychotherapists help dying people and their relatives come to terms with major burdens; teams and their members develop effective strategies for providing good care work through supervision; pastoral care provides consolation based on religious teachings. But questions related to the end of life, which are part and parcel of a philosophical reflection on life, often remain unspoken.
Patrick Schuchter and his colleagues want to change this. As a trained nurse with many years of experience under his belt, the graduate of Philosophy noticed that both of this educational fields are highly relevant in hospice care. The search for an answer to the question why philosophy is not found in palliative care eventually led to the Philosophical practice in palliative care and hospice work research project, which is supported by the Austrian Science Fund.
Can philosophy help at the end of life?
Researchers want to establish philosophical practice as a form of support in palliative care.
Philosophy outside the ivory tower
“Looking back to ancient times, we see a different kind of philosophy, one that was much closer to people’s realities. Socrates, Epicurus, and Seneca practiced their trade through talking to others on the agora or at people’s homes. Today, philosophy seems to be confined to the ivory towers of academia, where intellectuals are among themselves,” Schuchter says. “As opposed to this, the movement of philosophical practice is about providing guidance in everyday situations. In our research project, we are trying to find out if this approach could also be useful in palliative care.”
The idea of philosophical practice was first developed in the 1980s. It is about an exchange with philosophically trained people who have the skills to transfer their knowledge to the realities of daily life. What’s important about this practice is that it does not champion a certain perspective on life; it merely offers inputs that help people form their own opinion. Today, philosophical practice offers are available around the globe and also in the German-speaking countries.
In the course of their project, Schuchter and his colleagues conducted qualitative interviews with 29 philosophical practitioners interested in this topic. Some of them already work in hospice or palliative care facilities. In these interviews, the researchers particularly focused on whether and, if so, in which contexts death, the process of dying, terminal illness, and grief already play a role in their work. The team also carried out an international survey, as a result of which they were able to develop a map of locations where philosophical practitioners offer their services.
Free associations in the face of death
As a next step, the services of these practitioners in terminal care were tested and assessed in several project stages. The researchers conducted five sessions of individual interviews with people who were in one way or another affected by death or grieving. “Among the interview partners, there was a woman who had recently survived a complicated surgery, a hospice worker who had just lost her father, and a cancer patient who, sadly, passed away shortly after we concluded the study,” Schuchter describes the study participants. After these talks, “visitors” – a word that not only denotes the people staying in hospices but also refers to the clients of philosophical practice – were interviewed. They answered questions related to how they perceived the talks and how relevant they found them. Group interviews and observations from workshops with a mobile palliative care team based in Graz and a caring community project in Eningen in Germany yielded further data.
From the various orientations found in philosophical practice, the so-called hermeneutic method turned out to be the most useful in hospice settings. “This approach centers around open dialogue. The practitioner listens as the person talks, and, slowly, the conversation is steered towards a philosophical topic, which can then be explored from various angles,” Schuchter explains. “This was the style I observed most frequently, and it seems to be the most suitable one for palliative care.” Critically questioning assumptions, defining concepts, and diving deep into philosophical texts – all elements found in such conversations – turned out to be very meaningful and productive.
In providing such care, the practitioners have to master the difficult task of finding connections between the topics the visitors are invested in and philosophical positions – which not only requires a thorough understanding of philosophical teachings but also takes empathy and rhetorical skills. “The aim is to discuss a phenomenon in its general sense in these conversations. It’s not about solving a problem or fulfilling an immediate purpose,” Schuchter emphasizes. “There are many different offers related to philosophical practice today – including loudly advertised and commercially oriented services in life counselling or conversations led along the guidelines of a rather unidimensional handbook. You have to choose wisely.”
Escaping the “pity trap”
The study results confirm first experiences gained in practice, showing that philosophical practice is relevant to end-of-life care and in health and social contexts in general. “You would think that methods such as psychotherapy, in which topics that people are moved by are also generally discussed, were similar to philosophical counseling. But all of the feedback, including those of people who have had a great deal of experience with therapy, suggests that philosophical practice offers a whole different kind of experience: it is a uniquely individual and specific way of dealing with life’s big topics. This was quite surprising to me,” Schuchter says. “It seems that the opportunity to explore your thoughts without restrictions or a concrete goal in mind is a relevant dimension of the human condition. One of the visitors – a terminal patient – reported back that it finally enabled him to escape the ‘pity trap’”.
The aim of this basic research project is to ascertain the relevance and possibilities of philosophical practice in hospice and palliative care. In talks with nurses and care professionals, the researchers are also discussing how it could be used in specific palliative care offers and also in education and training. A follow-up project – which is already in the planning stage – could explore methodological guidelines and the definition of quality criteria as well as test concrete models in organizations.
In the face of death, the social taboo associated with dying fades away, giving way to a clear view of an important passage in life. “Dying is a relevant phase of life. It’s a time when new insights and relationships are still formed. In this sense, a hospice is not a place to die but a place to live,” Schuchter says. “With the help of philosophical practice, we might be able to help make the conditions more suitable for this intense phase of life.”
About the researcher
Patrick Schuchter studied Philosophy in Innsbruck and Paris and trained as a professional nurse. Already during his doctoral studies at the University of Klagenfurt, he investigated the role of philosophy in palliative care. He is a Senior Researcher at the Center for Applied Nursing Research at the University of Applied Sciences, Hochschule Campus Wien, and at the University of Graz’s Center for Interdisciplinary Research on Aging and Care (CIRAC). The Austrian Science Fund has contributed funding in the amount of EUR 383,000 to the Philosophical practice in palliative care and hospice work project running from 2022 to 2026.
Publications
Thoughtful Accompaniment in Life's Final Stages: Philosophical Practice as a Complement to Ethics Consultation, in: Bioethics 2025
Last Questions – How Philosophical Practice Contributes to Developing Death Literacy, in: Palliative Care – Current Practice and Future Perspectives 2023
