Transfiguration(s) of palliative care : the moral economy of end-of-life care in a Tanzanian cancer hospital

Palliative care is an internationally acknowledged concept focusing on patients with life-threatening diseases and their caregivers. It aims to meet individual physical, psychosocial and spiritual needs with a multidisciplinary 'holistic' approach. This idea, originating from Europe, is promoted globally as universal "human right to health" (WHO 2017). The article takes a closer look at the implementation of palliative care provision in a Tanzanian cancer hospital, where the number of cancer cases is constantly rising, and thus, those with a need for palliative care. In this place, concepts of global health meet local realities consisting of high numbers of advanced cases and scarcities of treatment and care. These constantly changing conditions are discussed in light of the newly introduced idea of 'transfiguration' and in relation to the concept of moral economy, as the implementation of palliative care is mainly driven by moral reasoning. The transfigurative processes evolve in different directions: On one hand, the initial idea of palliative care is intended to transfigure in-hospital caring practices. On the other, it is construed as an adaptive approach, which should fit into local hospital contexts. This article discusses the apparently opposed processes of transfiguration of and in palliative care.