A critical discourse analysis of British Columbia's palliative care benefits eligibility
Bibliographic record
Abstract
British Columbia’s Palliative Care Benefits (BCPCB) is a provincial program implemented by the Ministry of Health that offers coverage of medications for symptom management through the PharmaCare BC Palliative Care Drug Plan (Plan P), as well as medical supplies and equipment through local health authorities for eligible patients. BCPCB is available to B.C. residents who have reached the end stage of a life-threatening illness and wish to receive palliative care services at home. Utilizing Fairclough’s Dialectical–Relational Critical Discourse Analysis, this thesis analyzed how BCPCB registration and a companion policy, the Home and Community Care Policy Manual: Home Health Services, governs practices that determine service users’ eligibility for BCPCB, as well as determining resource allocation based on perceived level of the service user’s need, function, illness burden and urgency. This analysis aimed to show how the BCPCB and Policy Manual are constructed within socio-historic discourses of biomedicalism, medical paternalism, empiricism, ableism, postcolonialism, and neoliberal orientations of the provincial government. The BCPCB and Policy Manual define eligible service-users as patients with “life-limiting illness” who are determined by a physician to be in the last 6 months of life. To be considered eligible, service users must also agree to receive palliative care services in the home and consent to comfort care as the focus of treatment. Vague and discriminatory prognostication practices outlined by the BCPCB are implemented by physicians to determine service user eligibility to BCPCB, while unclear and ableist-oriented approaches to determine resource allocation is outlined in the Policy Manual and implemented by nurses once service users are deemed eligible for BCPCB. The discourses of the BCPCB and Policy Manual can be seen as produced within neoliberal governing practices that prioritize efficiency in the production and consumption of health services over the redistribution of healthcare costs equitably among society. Current health care practices and structures that rely on narratives and discourses based on deficit, physical function, prognostication, and illness burden perpetuate health inequities for service users at the end of life. Nurses are ideally positioned to challenge discourses and practices that compromise the human rights of people living with life-limiting illness.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.016 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.040 | 0.034 |
| Scholarly communication | 0.015 | 0.006 |
| Open science | 0.002 | 0.006 |
| Research integrity | 0.004 | 0.007 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".