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Palliative Care, Migration and Belonging: Reflections from an Evolving Ireland

Author: Dr Kumaresan Cithambaram

Published: April 2026

Keywords: Migrant, palliative care, end-of-care

The most recent census showed that 12% of people residing in Ireland are non-Irish nationals (CSO, 2022), alongside significant numbers of refugees and applicants for international protection. This shift in demographics is evident in GP surgeries and primary care centres, hospitals and hospices, and now it makes its way into cancer wards and hospices. For Irish palliative care services, it is part of their everyday experience.

Life-limiting illness intersects with migrants’ experiences of displacement, economic downturn, separation from loved ones or negotiation of foreign systems. Sickness can trigger previous trauma or magnify social isolation. For some, the question at life’s end is not just about symptom control or prognosis; it is about belonging. Where is home? Who will be there?

Cultural Meaning and the Experience of Dying

Serious illness is always interpreted through cultural and spiritual frameworks. Research in multicultural palliative care has consistently shown that beliefs about truth-telling, autonomy, family decision-making, and suffering vary across cultures (Cain et al., 2018). What may be framed within Irish services as “open disclosure” or “advance care planning” can, in other contexts, feel abrupt or culturally dissonant.

In my experience, migrant individuals receiving palliative care have often shared how Irish palliative care practice is shaped by Western bioethical traditions that prioritise individual autonomy. Yet many migrant families operate within more collective frameworks, where decisions are shared or where explicit discussion of death is considered harmful. When we interpret hesitancy as “denial” or “non-engagement,” we risk misreading cultural meaning. In such moments, humility becomes more important than expertise. Asking gently, “How would you like us to talk about this?” or “Who should be involved in decisions?” may seem small, but it signals respect.

Language as a Bridge or a Barrier

In palliative care, words matter. Discussions around prognosis, symptom control, and advance care planning are emotionally laden in any shared language context. When English is not the first language, vulnerability is compounded. Language has been identified as a barrier to healthcare on the international level (World Health Organisation, 2018). There are interpretation services in Ireland, but access can be variable within the community and out of hours.  Too often, family members, sometimes children, are asked to interpret discussions that carry enormous emotional weight.

The ethical discomfort of such situations is palpable. When we rely on informal interpretation, nuance is lost. Silence may be misinterpreted. Questions may remain unasked. Professional interpretation should not be seen as an optional add-on but as fundamental to safe and compassionate care.

Structural Realities and Social Vulnerability

Being an immigrant can have a drastic effect on the experience of serious illness. Those residing within the international protection system in Ireland may have to deal with potential geographical displacement, diminished privacy and financial limitations as part of coordinating care. Even as Ireland has moved towards reform of the old Direct Provision system, people going through it are typically socially and economically marginalised. Barriers faced by migrants in accessing cancer services, including lack of awareness, language difficulties and cultural stigma, were also highlighted in research commissioned by the Irish Cancer Society (TASC, 2021). It is not unreasonable to assume that comparable barriers could exist in regard to engagement with specialist palliative care; however,  empirical work in this regard and within Ireland remains scarce. For doctors, this structure matters. Patients may be unable to attend appointments due to barriers in transport, insecure work, anxiety regarding jeopardising immigration, or apathy. Compassion requires structural awareness.

Family, Distance and the Question of Home

The question of place is one of the most poignant issues in relation to migrant palliative care. Some migrants have strong transnational family relationships. When sickness is severe, the urge to go “home” to die can be strong, but this may be too expensive or not medically possible. For others, family members may not be able to travel to Ireland in time. The emotional burden of dying in a land that is home but not home is hard to express. I have heard from clinicians who recount patients being anxious not because of their symptoms and declining health, but out of fear of whether their families from abroad will be able to visit. In these moments, palliative care is as much about obtaining visas and managing logistics as it is about pain control. Migration may also disintegrate traditional support systems. The local community is not necessarily a strong network for all migrant individuals. Social isolation can be severe, especially in those who have moved alone for work. This diversity must be recognised: “migrant communities” are not homogeneous.

Towards Culturally Responsive Irish Palliative Care

Being culturally responsive does not require becoming fluent in all belief systems. It is about practising cultural humility, recognising uncertainty and inviting patients and families to determine what matters. This means regular access to professional interpreters, education of clinicians in culturally informed care and working together with migrant community organisations. It also requires research. There is still a great paucity of empirical studies in Ireland regarding migrants’ experience in accessing palliative and end-of-life care.

A Broader Ethical Imperative

Palliative care, at its core, is about dignity. Dignity is not independent of culture; it is inhabited within social-spiritual-relational worlds. Palliative care provision must be accessible to all as Ireland’s population continues to diversify, both clinically and ethically. We usually talk about migration in political or economic terms, but in palliative contexts, migration becomes fundamentally human. It is about stories that pass across borders, languages spoken at bedside, rituals that give meaning to death.

If Irish palliative care is genuinely person-centred, it must not only ask, “How do we treat symptoms? but also, “How do we respect identity?” In so doing, we reaffirm that compassionate care is for all who call Ireland home, all whose homes have been in Ireland, whether for generations or a life lived in transit. A health system is measured not just by its technical proficiency but also by how attuned it is to vulnerability in all of its expressions. Migration complicates serious illness, but it also challenges us to deepen our practice. In bearing witness to migrant voices at the end of life, we are reminded that palliative care is, above all, about a common humanity.

References:

Cain, C., Surbone, A., Elk, R., & Kagawa‐Singer, M. (2018). Culture and Palliative Care: Preferences, Communication, Meaning, and Mutual Decision Making. Journal of Pain and Symptom Management, 55(5), 1408-1419. https://doi.org/10.1016/j.jpainsymman.2018.01.007.

World Health Organisation (2018). Health of refugees and migrants Regional situation analysis, practices, experiences, lessons learned and ways forward. Available at: https://cdn.who.int/media/docs/default-source/documents/publications/health-of-refugees-migrants-euro-20183634ea84-ab36-48ff-8502-ba50d5f7d437.pdf?sfvrsn=162e3f07_1&download=true.

TASC. (2021). Migrant Communities Needs Assessment. Dublin: TASC (Think-tank for Action on Social Change), Available at: https://www.tasc.ie/assets/files/pdf/migrant_cancer_needs_tasc.pdf.

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