**1. Introduction**

Rituals take place throughout our lives, but they become more visible during pivotal moments (Van Gennep 1960; Turner 1969). Being confronted with illness and death is a defining moment in life (Metcalf and Huntington 1991; Van Uden and Pieper 2012). Emotions and questions rise to the surface which cannot all be dealt with in a rational way. Rituals can help to provide a sense of meaning in situations we do not fully understand (Van Beek 2007).

Palliative care settings provide rich ground for rituals. When nothing can be done in terms of curing illness, rituals can provide an important source of meaning. The spectrum of rituals in palliative care settings is broad. It goes from more or less formalized rituals, such as a wake at the bedside of a dying person and religious rituals such as the anointment of the sick, to daily care practices with a ritual dimension, such as placing photos on the bedside table to make the dying person's social network visible. Practices with a ritual dimension, or ritualized acts, are practices that go beyond the mere instrumental or functional aim of the act. Those acts combine an instrumental and a symbolic dimension, referring to meaning(s) outside the act itself. 'Something' is added, which is useless from a medical perspective but meaningful to the persons involved (the healthcare professional and/or the patient). In the context of palliative care, there are numerous examples of ritualized acts that provide a sense of meaning to patients, families and healthcare professionals. Van der Geest (2005, p. 140) describes how the act of fluffing up a patient's pillow by a nurse is not just an instrumental act of making the patient more comfortable. This small and simple act also shows that the nurse is concerned with the patient, which in return might fill the patient with a positive feeling. The symbolic dimension of care is present in this seemingly small act. It exemplifies a caring relationship and shows that the patient is valuable to the nurse (Van der Weegen et al. 2019).

In this article, we will explore rituals and ritualized care practices in a hospice in the Netherlands. The research is guided by two research questions. First, we want to know what kind of rituals and ritualized care practices are taking place in the hospice. Second, we aim at understanding these practices from a cultural perspective, i.e., to what cultural values do these practices refer? To answer the second research question, we will make use of the concept of death mentalities, as coined by the French historian Philippe Ariès (Ariès 1974; Jacobsen 2016), in which practices are linked to views of life and death.
