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In palliative care, the focus of medicine shifts from cure to care. This shift invites a unique question: what does it mean to heal when cure is no longer possible?  

Increasingly, clinicians and researchers are turning to a biopsychosocial-spiritual model of care. This approach recognises that people’s experiences of living with a life-limiting illness are not only physical, but also psychological, social, and existential. Within this framework, practices such as biography and narrative medicine are gaining attention for their capacity to support meaning, identity, and connection at the end of life.

At the centre of this shift is narrative medicine, a field most closely associated with Rita Charon. Narrative medicine asks clinicians to develop what Charon describes as “narrative competence”. This is the ability to recognise, absorb, interpret, and be moved by the stories of illness. It is not simply about listening more carefully. It involves understanding illness as something that unfolds over time, disrupting a person’s sense of self, relationships, and place in the world. In this sense, clinical care extends beyond diagnosis and treatment to include the work of meaning-making.

Narrative medicine is often misunderstood as a set of discrete activities, such as writing or documenting patient stories. In practice, its ethical importance lies just as much in the everyday conduct of care. Scholars in medical ethics argue that the moral dimensions of care are not only found in major decisions such as end-of-life choices, but also in “low-profile” actions such as where a clinician stands, who they speak to, whether they make eye contact, and how long they pause to listen. These actions do not usually arise from conscious ethical decision-making. Instead, they reflect underlying assumptions about whose voice matters and how care should be delivered. Paying attention to these moments helps reframe narrative medicine as both a reflective practice and a way of approaching care that centres the person and their life.

This broader understanding also helps situate biography services within the field. Biography or life story work can be seen as a structured, applied form of narrative care. These programs are typically delivered over several weeks or months. They involve guided conversations with patients, which are recorded, transcribed, and shaped into a written or audio legacy document. The outcomes are often shared with family members and become part of how a person is remembered.

The value of this work is growing in recognition. Biography programs can support dignity, affirm identity, and create opportunities for reflection and relational closure. For patients facing life-limiting illness, the chance to articulate their story in their own words can be profoundly meaningful. Emerging research, including research on work undertaken through Eastern Palliative Care (EPC) Biography Program in Victoria, suggests that these interventions may also contribute to emotional wellbeing for both patients and their families. At the same time, the evidence base is still developing. Further research is underway through the University of Notre Dame in NSW to strengthen understanding of the impact of biography services.

However, the growth of biography services also highlights a significant tension within the system. Much of this work relies on a trained volunteer workforce, which raises questions about sustainability and recognition. The relational and interpretive skills required to facilitate biography are considerable. They involve deep listening, emotional awareness, and care in representing another person’s life as well as technical capabilities to produce the legacy document. Yet these capabilities are often positioned outside formal clinical roles.  

Programs such as the Palliative Care NSW Volunteer Support Service Program (VSSP) have played a critical role in addressing this gap. The program has supported the expansion of biography services in NSW from just two in 2018 to 18 in 2026. It has also provided training for volunteer managers and services seeking to build or expand biography and life story programs, supporting the development of skills required to deliver this work in practice.

This reliance on volunteers can be understood in two ways. On one hand, it reflects innovation and strong community involvement. On the other, it raises important bioethical questions about how different forms of care are valued and resourced. If supporting identity, meaning, and connection is central to holistic care, then the work that enables this should be properly funded and embedded within core models of care.

Timing is another critical issue. Unlike brief clinical interventions, biography programs require time to develop. They depend on building rapport, conducting multiple conversations, and allowing space for reflection. Referrals to palliative care, and to services such as biography, often occur late in the illness trajectory. This limits the capacity for patients to engage fully in the process. In some cases, it means the opportunity is missed altogether. Early referral is therefore not simply a matter of equity and service access, it is essential to delivering on the promise of quality biopsychosocial-spiritual care for everyone.

More broadly, the growing interest in narrative approaches can be understood as a response to the pressures shaping contemporary healthcare systems. Increasing administrative demands, time constraints, and a focus on measurable outputs can narrow the scope of clinical encounters. Narrative medicine offers an alternative. It reintroduces attention to personhood, context, and lived experience. It does not replace biomedical care, but complements it by recognising that effective care must engage with the full complexity of patients’ lives.

Within this context, practices such as biography do more than document life stories. They can shift how patients are positioned within care. Rather than being seen as passive recipients of treatment, patients become active participants in shaping how their lives and illnesses are understood. Storytelling, in this sense, is not separate from care, it is part of how agency, identity, and meaning are sustained at end of life. 

As research in this area continues to grow, there is an opportunity to more fully integrate narrative and biography-based practices into mainstream palliative care. This will require not only evidence, but also recognition of the ethical and relational dimensions of care that these approaches represent. For clinicians, allied health professionals, and aged care workers, the challenge is not simply to adopt new programs. It is to engage with the broader shift they represent and support the volunteer programs that make it possible.

Ultimately, the question is not whether narrative belongs in healthcare, but how deeply it is allowed to shape it. If healing at the end of life is understood as supporting the whole person, including body, mind, relationships, and spirit, then listening to and working with patient stories is central to the work of care itself.

Written by Sarah Whiteley