The Object of Gratitude in Palliative Care: A Phenomenological Study

The paper explores the phenomenon of gratitude within palliative care, where expressions of thanks from patients and families occur despite associations of end-of-life care with loss and suffering. Prior research has framed gratitude either as a personality disposition or as an emotion linked to well-being in positive psychology. However, the essence of what patients and families are grateful for in caregiving relationships has not been deeply analyzed. Drawing on von Hildebrand’s notion of an “objective good for the person,” the study asks: What is the object (essence) of gratitude in palliative care? Understanding this can clarify what is essential in caring relationships and the impact of palliative care for patients, families, and professionals.

The introduction references two major strands: (1) gratitude as a dispositional trait in social psychology and positive psychology (e.g., McCullough, Emmons; Seligman; Watkins) and (2) gratitude as an emotion arising in interpersonal contexts. Healthcare studies show gratitude is common at end of life and can benefit both recipients and expressers (e.g., scoping reviews and surveys by Aparicio, Centeno, Carrasco; Day’s meta-narrative review; Althaus et al.). Media often portray palliative care negatively, yet family letters and qualitative reports reveal rich gratitude expressions tied to care experiences. Theoretical grounding includes von Hildebrand’s categories of goods (objective vs. merely subjectively satisfying), Aristotle’s ethics, and phenomenology (Husserl; van Manen). Debates on health definitions (WHO; Huber et al.; Larson; Svalastog et al.) provide context for reframing “health” beyond cure to well-being, adaptation, and personhood, which is pertinent to palliative contexts.

An interdisciplinary phenomenological study was conducted to access the essence (objective structure) of lived experiences of gratitude in palliative care. Following Husserl’s phenomenology and von Hildebrand’s insights, the team prioritized experiential data over theoretical comparison. Data sources included: (a) relatives’ gratitude letters received by a hospital palliative care support team; (b) personal experiences of family members and health professionals; (c) press releases and public gratitude accounts across services and contexts; and (d) relevant biomedical and philosophical literature on gratitude. Key international authors (e.g., from the UK and Switzerland) were invited to seminars to present research and discuss gratitude, adding external perspectives. Clinicians and philosophers conducted a dynamic, iterative analysis combining social science reflexive/empiric methods and philosophical epoché-reduction to unfold meanings. The process began with local letters, extended to other public accounts to avoid site-specific bias, and iteratively reflected on underlying meanings behind appreciated care aspects (e.g., pain control, humanity, healing vs. curing). Readings informed interpretation of experiential accounts. Seminars with experts, a family member, and a professional helped assess representativeness. Discussions and reflections were recorded, and the analysis integrated results with ongoing reflective discussion.

• Overarching object of gratitude: The category of an “objective good for the person” best captures gratitude in palliative care. Families recognize something truly good is addressed to them even amid hardship; gratitude is inherently relational and linked to the gratuitous logic of a gift beyond reciprocity.
• Patients and families: The object of gratitude is not restoration of prior health (often impossible) but “healing” understood as deep, existential relief. Patients and families value the active, fully engaged presence of professionals who listen, recognize needs, and accompany them. This presence functions as a catalyst for relief from existential suffering (loss of meaning, fear, isolation, burden, approaching death). Gratitude arises from being affirmed as unique persons with dignity, receiving person-centered, compassionate care that brings peace, serenity, and the experience of wholeness despite ongoing decline.
• Nature of presence: Beyond physical proximity, it encompasses whole-person engagement (physical, emotional, cognitive, relational, spiritual), enabling co-regulation of distress and access to inner resources.
• Professionals: Receiving gratitude often surprises professionals (they view actions as routine duties). Gratitude reveals to them the positive consequences of their work, reinforcing motivation and confirming the meaning/mission of their vocation. It fosters well-being, peace, and a sense that their work “makes sense,” providing a transformative and protective resource against burnout. Reciprocal recognition emerges: professionals recognize personhood in patients; patients recognize personhood in professionals.
• Shared core: Both perspectives converge on the centrality of considering the whole person and affirming inherent value and dignity, which grounds the object of gratitude.

The findings address the research question by clarifying that, in palliative care, gratitude centers on an objective good: the affirmation of personhood and deep relief from suffering through the active, meaningful presence of caregivers. This reframes the role of palliative care beyond cure toward healing as existential relief and integrity. For patients and families, gratitude signifies being seen, accompanied, and supported in what matters most at the end of life; for professionals, it confirms vocation and meaning, strengthening engagement and potentially protecting against burnout. Conceptually, the study integrates phenomenology and ethics (objective goods) to articulate gratitude as a gift-based relational dynamic, not a transactional outcome, emphasizing person-centered practice and the therapeutic value of presence.

This first report identifies two primary objects of gratitude in palliative care: for patients and families, healing as deep relief of existential suffering facilitated by the professional’s active, whole-person presence; for professionals, the confirmation of professional meaning/mission in caring to the end. Both rely on recognizing persons in their entirety and affirming their inherent dignity. The work underscores gratitude’s relational nature and its positive impact on patients, families, and caregivers. Future research could systematize data collection across settings and cultures, and examine mechanisms by which presence and affirmation produce deep relief and professional resilience.

• The study is phenomenological and exploratory (“first results”), relying on experiential materials (gratitude letters, public accounts), reflective analysis, and expert seminars rather than systematic sampling or quantitative measures, which may limit generalizability.
• Data are drawn largely from specific services and cultural contexts, potentially limiting transferability.
• The work does not provide a detailed empirical examination of competing health definitions or a comprehensive, systematic review; rather, it uses targeted literature to inform interpretation.