Death brokering: constructing culturally appropriate deaths

Abstract

Death brokering refers to the activities of medical authorities to render individual deaths culturally meaningful. Social scientists and others agree that mortality provokes existential ambiguity in modern life requiring cultural coping mechanisms. In contemporary Western societies, medical professionals have sequestered the dying in institutions, and have classified the causes of death to explain suspicious death. Over the last decades, the institutionalisation of the dying process has been challenged by social movements and the sudden onset of some deaths while forensic medicine has struggled for professional legitimacy in the borderland between mainstream medicine and the legal system. I argue that medical death brokering persists in spite of challenges because medical experts offer increasingly flexible cultural scripts to render the end-of-life socially meaningful while accentuating death's existential ambiguity. Medical professionals help create the ambiguity they promise to resolve, reinforcing the cultural need for more expert death brokering.

The Social Practice of Rescue: The Safety Implications of Acute Illness Trajectories and Patient Categorisation in Medical and Maternity Settings

“…Our data add to the existing literature on the adverse consequences that can occur in the hospital for those who are categorised as not real emergencies (Dodier and Camus 1998) that is, 'neither in crisis nor completely stable' (Chapple 2010: 56), and the safety of outliers (Goulding et al 2012). It extends the lens upstream from the construct of institutional death brokering (Timmermans 2005) to the active management of the physiological aspects of acute illness. Adverse events in patient safety are often not primarily due to human error at the ward level but are 'rather a systemic -or networked -consequence of the ways in which health work is related to cultures of management, governance and science' (Jensen 2008: 322).…”

“…Not surprisingly, given recent policy emphasis on reducing the rates of avoidable death, which draw on cultural distinctions between the orderly and disorderly death (Bauman 1992, Bayatrizi 2008, Timmermans 2005, the rescue imperative provides a dominant organising frame across acute care. The logic of efficiency, effectiveness and safety in healthcare insists that cardiac arrests, an unexpected admission to ICU or death ought to be prevented.…”

“…Our focus on trajectories illuminates the physiological process of birth and the unfolding pathology of illness (and death). This frame provides a means for us to link the agency of those involved in organising the care of acutely ill patients with the wider socio-political factors beyond the clinic, such as governmentality and risk (Heyman 2010, Waring 2007, death brokering (Timmermans 2005) and the medicalisation of birth and death (De Vries 1981).…”

Cardiopulmonary resuscitation decisions in the emergency department: An ethnography of tacit knowledge in practice

“…In the context of end of life caring practices in the ED, Timmermans (2005) contends that resuscitation also takes on a significant role as a social ritual in the creation of an acceptable and culturally appropriate death. Resuscitation acts as a rite of passage, softening the abruptness of sudden death (Tercier, 2005).…”

Bereaved relatives’ experiences in relation to post mortem: a qualitative exploration in North East Scotland

“…Poor adherence to authorisation procedures in England and Wales may also mean relatives are less likely to provide consent (Henry & Nicholas, 2012). In addition, the results of post mortem can be inconclusive, often controversial and may be contested (Timmermans, 2005), and along with the increasing popularity of post mortem sampling, or minimally invasive autopsy of easily accessible organs and tissues, may influence reduced numbers of traditional invasive post mortem procedures (Rigaud et al, 2011). The provision of high quality support and information for relatives around post mortem that enables good decisions and guidance through processes is consequently a key part of current legislation and practice (HM Government, 2004;Scottish Government, 2006).…”