Palliative Care and Thanatechnology

The field of palliative care continues to grow and evolve over time, according to various societal and technological contexts. The recent publication of the Oxford Textbook of Public Health Palliative Care represents a pivotal step in the evolution of the field, shining a light on more inclusive and populationbased public health approaches to reframe death, dying, loss and caregiving. It also introduces preliminary conceptual work intended to bridge often perceived divides between increasing technological advances and the social model of public health palliative care. This points to the need for further consideration of the nexus between palliative care and thanatechnology. The term thanatechnology was coined by Sofka in the 1990s with reference to then current and emerging communication technologies that could be used to facilitate death education, grief counselling and thanatology research. Sofka and colleagues later described it as ‘a conduit for living, dying, and grieving in contemporary society’. Over the following decade, the use of various digital technologies spread widely to influence nearly all aspects of modern life, including a variety of social media platforms used in both professional and non-professional contexts. However, implications of this growing use, from a thanatological perspective, may not be obvious to users. Mortal as human existence is, digital footprints are not necessarily washed away in the sands of time. Indeed, it has been highlighted that social media platforms are ‘full of dead people’., It is these types of digital death and digital afterlife that characterize thanatechnologies in their capacity to maintain humanity through, for example, memorialization and the conscious cultivation of digital legacies to be left behind. For the bereaved, some may find a perpetual online presence comforting whilst for others this may cause distress; importantly, instructions can be issued in advance to accommodate individual preferences but users need to be aware of how to do this. Recognition of the need to support people in making informed choices about options available can be found in guides developed for the general population by national palliative care organizations. See for example, Palliative Care Australia’s ‘Guide to a social media afterlife’ (https://palliativecare.org. au/wp-content/uploads/2015/08/PCA001_Social-Media -Guide_ONLINE.pdf). Apart from social media presence, other key examples of using thanatechnology include the consideration of digital assets and use of end-of-life planning software (see for example, https://www.mywishes.co.uk). The remit of palliative care includes the promotion of holistic health and wellbeing, during periods both before and after death, for everyone living with dying, loss and bereavement. It is not surprising, then, that both professional and informal caregivers have adopted the use of digital technologies to enable care and achieve personalized goals of care. Although not labelled as thanatechnology, a variety of digital technologies have pursued common goals under terms such as ‘e-health’ and ‘m-health’, with digital health now the globally recognized field of digital technologies used for health and healthcare. Applications of digital health in palliative care were evident during early stages of the COVID-19 pandemic in the form of communication, virtual communities of practice, and the sharing of online resources to support both formal and informal contexts of care. But there are other, less obvious, examples of digital health interventions that may provoke a cognitive dissonance for those who might fear the use of technology will compromise humanistic care; these include the use of big data, virtual or augmented reality, robotics, machine learning and other artificial intelligence. Importantly, the thanatological basis of thanatechnology provides a critical social context and humanistic focus for the broader field of digital health, such that these factors can ensure digital health interventions are not confined to physical hardware, software or informatics and clinical symptomology. Digital health developments that are informed by a thanatechnological perspective can influence palliative care such that it is both digitally enabled and