Social Organisation of Death and Dying

Question 1

Social death + biological death

Answer 1

Distinct set of funeral rites and mourning customs which serve to facilitate a ‘social death’ of a person following their ‘biological death’

In modern-high income societies, link between biological and social death has become more tenuous

Question 2

Why have meanings and practices of traditional death rites gradually lost their power?

Answer 2

In the past, death typically came suddenly, resulting from traumatic injuries or acute infectious disease

With rising standards of living, improvements in public health infrastructures, and more effective biomedical therapies, people have begun to enjoy longer lives

Question 3

What epidemiological shift has reversed the traditional sequence of dying?

Answer 3

Death now typically comes after prolonged deterioration associated with chronic disease in later life

Social death typically precedes biological death

The “work” of separating the dying from society within hospitals and nursing homes, routinely occurs well before their definitive biological deaths

Question 4

What is the ‘sheltering canopy’?

Answer 4

How anthropologists describe the cultural customs associated with death and dying

Question 5

How do individuals achieve a satisfactory separation before and after biological death?

Answer 5

Through the ‘sheltering canopy’ of cultural customs

Question 6

What are ‘futility cases’?

Answer 6

Situations in which death is imminent, and where a consensus is reached that life-sustaining interventions are not provided

The end of biological functioning appears to be medically discretionary i.e the decision when to ‘turn-off’ life support.

Question 7

What are ‘disorderly deaths’?

Answer 7

Such circumstances as futility cases

Lack of a cultural script for dying

Situations are made all the more painful because they typically occur in our temples of hope - the modern hospital

Question 8

Why are we anxious about death?

Answer 8

Denial

Death calls into question the most fundamental assumptions upon which our social lives are constructed within modernity i.e individual identity, acquisition of material possessions etc

Question 9

What is the ‘privatisation of death’ that sociologists refer to?

Answer 9

In present-day Britain there has been a diminishing of the ‘public space’, both physical and discursive, afforded to the rituals associated with death & dying

Question 10

What has the decline in culture of mourning meant for the process of grieving?

Answer 10

Important personal and social consequences

More rigid corporeal boundaries, both symbolic and actual, that exist between the dead and the living

Question 11

What does the decline in culture of mourning reflect?

Answer 11

The decline in importance of the ‘sacred’ within modern secular societies

Decline in personal exposure to death and dying (associated with epidemiological transition)

Question 12

How have hospitals been critiqued in terms of death and dying?

Answer 12

Healthcare systems in modern industrialised societies would see hospitals as institutionalised system for the ‘containment’ of death & dying (Illich, 1976)

Hospitals seen to be the institutional expression of the modern desire to remove evidence of sickness and death away from the public gaze (Mellor and Shilling, 1993)

Question 13

What does Illich’s 1976 ‘Medicine of Life’ thesis assert?

Answer 13

More and more aspects of daily life have been brought into the biomedical sphere of influence

This social process refers to those experiences that were once seen as a normal part of the human condition, such as pregnancy, childhood, ageing and dying

Question 14

What is iatrogenesis?

What are the consequences?

Answer 14

Detrimental consequences of medical interventions

Goes beyond inflicting direct clinical harm on patients, for crucially, it also involves the broader social and cultural spheres of life

Question 15

What does ‘cultural iatrogenesis’ refer to?

Answer 15

The way in which biomedicine is seen to have undermined people’s ability to manage their own health, and the ability to cope with pain, suffering, and death

Question 16

What do critical constructs such as ‘over-treatment’ and ‘heroic medicine’ say?

Answer 16

The institutional focus on intervention and treatment has, until the recent past, too often blinded the medical profession to attending to the needs of the dying patient

That is, dying has too often been confused with illness within the hospital environment

Question 17

What does Bauman (1992) argue?

Answer 17

The nosologies of biomedicine (classification of diseases i.e ICD-10), have inadvertently reduced death to nothing more than a series of pathological anatomical and physiological processes

This perspective sees the biomedical model as generating the illusion that death can somehow be controlled

Question 18

What does Kellehear’s notion of ‘Good Death’ argue?

Answer 18

It is an example of ‘open awareness’. It is intended as a set of ideals to support individuals and professionals in their practice

Argues that the image of the Good death can act as an ‘ideal type’ against which descriptions of the actual dying experience of an individual may be set

Question 19

Five features of Kellehear’s ‘Good Death’

Answer 19

Awareness of dying:
A personal and social process of greater openness about the prognosis of an illness where it known that there is a high probability of death

Personal preparations and social adjustments:
The settling of ‘emotional accounts’

Public preparations:
Sorting out wills, putting practical affairs in order

The relinquishing, where appropriate of formal work roles:
Too often it is automatically assumed that dying individuals are beyond the age of retirement. This is not the case with AIDS and forms of CHD and cancer

Formal and informal farewells

Question 20

How does the ‘Good Death’ promote the social role of death in all of our lives?

Answer 20

Requires roles of other people (personal and professional)

Involves a gradual stop to an individual’s social roles, therefore promotes social aspect to death

In doing so, it shifts death and dying from the private to the collective sphere, thereby promoting the social role of death in all our lives

Question 21

How and when did hospices come about?

Answer 21

1960s - beginnings of ‘hospice movement’

Initiated from within charitable sector (outside of NHS) to pioneer ideology of the ‘good death’

Sought to institute alternative forms of dying and give more autonomy to the dying

Here, the ‘good death’ involves:
Aggressive symptom management
Attention to the religious, social + psychological needs of the dying
Achieving the normative goal of accepting impending death

Question 22

What did the ‘hospice movement’ do?

Answer 22

Challenged the isolation of the contemporary dying

Sought to ‘de-medicalise’ the dying process and change the practices of health care professionals

Now constitutes part of a much wider shift in attitudes towards death and dying

Question 23

Give an example of the shift in attitudes towards death and dying

Answer 23

Recent open debates concerning the right of individuals to voluntary euthanasia across European health care systems are an example of this process

Question 24

What has the success of hospices led to?

Answer 24

Development of the palliative care medicine specialism, and an associated shift in professional practice

Today, the ‘medicalisation’ of death approach has become much less pervasive in health care systems

Professional attitudes have changed, with much greater emphasis now placed on the emotional and psychological dimensions of the experience of dying