Who Is Hospice Work For? Rethinking Culture, Communication and Exclusion in Migration-Related End-of-Life Care
Abstract
Despite the comprehensive and general orientation of hospice and palliative care services in Germany, people with an international family or migration biography continue to access these services less frequently than the majority population. Existing research often explains this disparity through references to ‘cultural differences’, communication problems, language deficits or supposedly distinct family structures. Such explanations risk obscuring structural inequalities and reproducing processes of culturalization that locate responsibility for non-use primarily with migrants themselves.
Drawing on critical race theory and intersectionality, this paper conceptualizes hospice care as structured by power relations, dominant norms, and implicit assumptions about ‘normal’ ways of communicating, caring, and dying. The analysis asks to what extent cultural, linguistic, and familial categories of difference operate as mechanisms of Othering in hospice and palliative care, and how they contribute to social exclusion.
Empirically, the paper builds on ongoing research that synthesises findings from previous studies with qualitative analyses of interviews with professionals in hospice care in Germany. These insights reveal that dominant discourses frequently essentialise ‘the culture’, ‘the language’, and ‘the family structures’ of the Others, while leaving unexamined the middle-class, white, and monolinguistic orientation of hospice institutions themselves.
Non-German language is often framed in deficit terms, ignoring multilingual resources and shifting communicative responsibility onto patients and families. Similarly, migrant families are stereotypically perceived as extended and collectivist, which can lead to the non-offering of hospice services, despite empirical evidence of increasing family fragmentation, social isolation, and comparable care burdens across migrant and non-migrant groups.
Against this backdrop, the paper argues for a shift from culturalist explanations toward an understanding of hospice care as a site of power-laden communication shaped by structural discrimination. It outlines key implications for an inclusive hospice practice: questioning institutional power relations, de-ethnicising concepts of culture, and recognising multilingualism as a resource. Adopting a trans-categorical professional stance foregrounds individual life worlds while remaining attentive to intersecting categories of difference and inequality such as race, class and gender. In conclusion, the contribution highlights hospice work as a critical arena of culture and communication in migration societies, where global histories of inequality intersect with local care practices. It offers a theoretical and reflexive framework aiming to foster more inclusive and socially just forms of end-of-life care.
