A Social History of Dying

Abstract

Our experiences of dying have been shaped by ancient ideas about death and social responsibility at the end of life. From Stone Age ideas about dying as otherworld journey to the contemporary Cosmopolitan Age of dying in nursing homes, Allan Kellehear takes the reader on a 2 million year journey of discovery that covers the major challenges we will all eventually face: anticipating, preparing, taming and timing for our eventual deaths. This book, first published in 2007, is a major review of the human and clinical sciences literature about human dying conduct. The historical approach of this book places our recent images of cancer dying and medical care in broader historical, epidemiological and global context. Professor Kellehear argues that we are witnessing a rise in shameful forms of dying. It is not cancer, heart disease or medical science that presents modern dying conduct with its greatest moral tests, but rather poverty, ageing and social exclusion.

The Art of Enduring Contradictory Goals: Challenges in the Institutional Co-construction of a ‘good death’

“…The concept of 'good death' builds on a well-documented tradition of sociological, anthropological and historical analyses of dying in modern societies (see, for example, Ariès 1981, Hart, Sainsbury and Short 1998, Kellehear 2007, Green 2008, Hahn and Hoffmann 2009. What a distinctive society regards as a 'good death' is in this strand of literature generally linked to societal modernisation and individualisation processes.…”

“…Dying is increasingly individualised (McNamara 2004, Seale andvan der Geest 2004) and the ideal of 'good death' is increasingly subject to public debate (Green 2008). What is at stake nowadays, especially in contexts of old-age dying and dying of degenerative diseases, is the question of keeping control by shaping and 'timing' death (Kellehear 2007), for instance by suicide or euthanasia (Kruse 2007, p. 166ff).…”

“…This conception of dying a 'good death' is, however, tailored to autonomous patients suffering from malignant diseases such as cancer, where a death prognosis is relatively clear and a certain time of preparation for death may be expected (see Kellehear 2007). The capacity to be aware and self-determined furthermore needs a considerable amount of resources, mainly knowledge and communication skills (Schneider and Stadelbacher 2012) but also economic and social resources.…”

End-of-life Care and Rituals in Contexts of Post-migration Diversity in Europe: An Introduction

“…This is foregrounded in studies of the palliative care provided to dying migrants (see, Spruyt 1999, de Graaff and Francke 2003, Evans et al 2011, Gunaratnam 2013, Salis Gross et al 2014. Dying in European late modernity is characterised by a shift from sudden death (for example, from accidents, violence or infection) to slower dying caused by chronic disease and which to a certain degree can be managed and planned by specialist institutions, above all by a highly elaborate medical system with impressive powers to maintain and restore life (Walter 2003, Kellehear 2007, Walter 2012. The manageability of dying, however, also demands that numerous decisions be taken, leading to the construction of the ideal-typical autonomous patient who is expected to be in a position to take prospective decisions and, by doing so, to determine his or her dying.…”

“…This has particular significance in migratory contexts: 'good deaths' may be idealised as taking place 'at home' surrounded by loved ones (see for example, Ariès 1981), whereas dying alone or in a foreign or unfamiliar environment may indicate a 'bad death' (Seale 2004). Increasingly however death takes place in institutions of curative or palliative care, where the biomedical aspects of dying can be well-controlled by care professionals, but potentially at a cost to the dignity of the dying person (Kellehear 2007). Producing a 'good death' furthermore involves the appropriate handling of bodies and the social organisation of bereavement rituals after the medically determined moments of death -a dimension often overlooked by public health and health care professionals (Venhorst 2013).…”