Making People Live or Letting Them Die? Biopolitics and Palliative Care for Older Persons Living in Slums in Brazil.

Abstract

In Brazilian favelas, the delivery of palliative care for older adults is significantly influenced by the interplay between public policy shortcomings and the socio-cultural dynamics of these communities. The objective of this study was to understand the configuration of palliative care practices offered to older adults, in the context of the home, within vulnerable slum communities. This descriptive, exploratory study used a qualitative approach and was conducted in the homes of palliative care patients assisted by the outreach university project Compassionate Community, in the favelas of Rocinha and Vidigal, Rio de Janeiro, Brazil. Participants included volunteer health professionals and local volunteers. Data were collected through observation and semi-structured interviews and analyzed using Foucauldian-inspired Discourse Analysis. Results indicate that palliative care practices for older adults are shaped by the limited development of public policies aimed at alleviating human suffering in life-threatening conditions in Brazil, combined with the historical, social, and cultural context of favela territories. Consequently, palliative care provision emerges through micro-political arrangements informed by local knowledge and power dynamics, shaping the discourses and practices of those involved.