Sociology Flashcards
Death and dying:
How has there been a recent shift in social and biological death? compare modern high societies to traditional low income
Traditional low income societies: the social processes associated with dying and death remain culturally ‘well scripted’.
- People know what to do ~normal grieving process-
- Know how manage the physical death of someone close to them (biological death)
- this helps to facilitate ‘ the social death’- via funeral sites and mourning customs
However in modern high-income societies:
- The intimate link between the biological and social death of individuals has gradually become more tenuous
- Improvements have been made people began to enjoy longer lives- longer with better health
- Therefore meanings and practices associated with many traditional death rites in the UK gradually lost much of their power as death now occurs after a prolonged deterioration with chronic diseases rather than being sudden
This means that the epidemiological shift has reversed the traditional sequence: social death now typically precedes biological death
Death and dying:
What do we mean when we say that social death typically precedes biological death? What percentage of people die within hosptials? What is the result of this with family and the individual?
The “work” of separating the dying from society within hospitals and nursing homes (this is social death) , routinely occurs well before their definitive biological deaths
Most people die within hospital (49%), communal establishment (22%), home (24%)
Without what anthropologist’s describe as the ‘sheltering canopy’ of cultural customs associated with death and dying (These are a script to follow when a family or friend dies) the individual and their families can find it difficult to achieve a satisfactory separation before and after biological death.
This is particularly true in futility cases (where 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.
This results in disorderly deaths
Death and dying:
What do we mean when we talk about disorderly deaths?
· A lack of cultural script for dying, results in ‘disorderly deaths’,
· Where deaths are painful because they typically occur in our temples of hope - the modern hospital
Before hospitals were temple of hope- as they were going to get better there
Death and dying:
What do we mean when we talk about the privatization of death? What has happened to modern societies (what denials and declines have there been?)
• Compared to pre-modern societies, today there is a reduction in the ‘public space’, both physical and discursive (both in terms of nearness and we do not like talking about it), afforded to the rituals associated with death & dying – sociologists refer to this process as the privatisation of death.- this is the opposite of death as community process
In modern societies there is a:
- DENIAL of death as it is not a central component of our lives
- DECLINE IN CULTURAL MOURNING -important personal and social consequences for the process of grieving for the death of a loved one
- DECLINE in importance of SACRED- as death is perceived as separated from life (people used to think that life prepared you for death)
- Decline in PERSONAL EXPOSURE to death and dying - as most now die from chronic rather than acute (in the past children would be more exposed to dead bodies- the boundary between living and dead is strong today
Death and dying
What did Illich say about the medicalisation of death and dying? What is his crituque about?
” The medicalisation of society has brought the epoch (era) of natural death to an end…the doctor, rather than the patient, struggles with death “ (Illich:1976:210).
This is critique of health care systems today is that hospitals as institutionalised system for the ‘containment’ of death & dying. To remove evidence of sickness and death away from the public gaze
What was once seen as normal parts of human condition- e.g pregnancy and birth (98% in hospital), childhood, aging and dying have become medicalised- and require intervention
Death and dying
What is the iatrogenesis? What is cultural iatrogenesis
One of the major outcomes of medicalisation is iatrogenesis- detrimental consequences of medical interventions (this is beyond just giving patients the wrong dose it involves broader social and cultural spheres of life)
cultural iatrogenesis’ - is how biomedicine undermines people’s ability to manage their own health, and the ability to cope with pain, suffering, and death
○ ‘There a pill for every ill’
‘over-treatment’ and ‘heroic medicine’ - reflect the view that 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.We loose sight of the need of that individual in the rush to keep them alive or get them better
Death and dying
What did Bauman (1992) say about the nosologies of biomedicine
- Bauman (1992) has argued that 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. =dying did not have a classification
- This perspective sees the biomedical model as generating the illusion that death can somehow be controlled
Death and dying
What are the 5 features of a good death (Kellehear 1990)
This was associated with the Hospice movement. The idea is an example of open awareness- a set of ideals to support individuals and professionals in their practice.
1) 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
In the past the openness of speaking about dying did not exist - now you try and be open and talk about it
2) Personal preparations and social adjustments: The settling of ‘emotional accounts’.
If you know and have spoken about dying you can start to prepare and settle things before you die- but the openness is importance
3) Public preparations: sorting out wills, putting practical affairs in orde
4) 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.
5) A Good death involves formal and informal farewells
Death and dying:
Whats the deal with a good death (Features on another card)
As ‘Good Death’ involves a gradual stop to social roles it requires the involvement of other people (personal as well as professional)- therefore it shifts death and dying from the private to the collective sphere, thereby promoting the social role of death in all our lives
It goes back to the 1960’s with the start of the hospice movement - it is not really occurring in hospitals
Hospices sought to institute alternative forms of dying and give more autonomy to the dying. It challeneged the isolation of the contemporary dying.- to ‘de-medicalise’ the dying process and change the practices of health care professionals.
Here ‘good death’ involves aggressive symptom management, and attention to the religious, social and psychological needs of the dying to achieve the normative goal of accepting impending death.
Before hospice care was a peripheral phenomena, now it is a wider shift in attitudes towards death and dying – the more recent open debates concerning the right of individuals to voluntary euthanasia across European health care systems are an example of this process.
The success of hospices led directly to the 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,- greater emphasis now placed on the emotional and psychological dimensions of the experience of dying.
Social dependency
From a sociological perspective what are the two linked analytical dimensions in understanding dependency in the old age?
1) Older age as socially structured dependency
2) Older age as socially constructed dependency
Social dependence What is socially structured dependency? Talk about social class differences, gender, and retirement ages
Structured social inequalities are mainly from material disadvantage that are strongly associated with social class difference s
These social disadvantages are sustained and accumulated over life course
• Therefore if lower social class at birth- this will pass you on to older life usually and will accumulate
• State pension works out after tax about 8000 a year - pension affected by working life
These disadvantages impact on freedom and agency of many, but not all, older people (not a homogenous group)
Social inequalities are also associated with difference in gender and ethnicity
Women have high LE than men, yet at retirement have less personal savings and lower pension rates- as women are likely to occupy less remunerated jobs and more likely to experience interrupted employment to take care of children/family - greater risk of poverty and higher rates of morbidity
Retirement age is socially constructed- reflects social consensus that older age brings with a reduction in productivity and health status affecting the ability participate in the labour market
Yet the official retirement age is a historical construction and has shifted both backwards and forwards for reasons other than the productivity or health in older age reflects economics and other factor
See the life course theory
Social dependency
What is the life course theory
drawn upon by academics and policy makers alike as a framework for understanding aging as a dynamic process
Considers that it stages in life are not static or fixed and not standardized
• Neither chronically or biology but are subject to historical change, cultural diversity (there are different things affecting people’s life), and individual agency
• It is getting away from putting numbers or ages around what people do
• It emphasizes the dynamics of social roles which are played by individuals over a lifetime
• It draws upon connected concepts of trajectories (changing level of individual participation within social structures like school, work, marriage, parenthood) and transitions mark the start and end of trajectory) to contextualize the ways that social roles change and develop over a lifetime (there are shifts and movements in pathways)
Social dependency
What is socially constructed dependency?
Despite more recent challenges (‘ notions of healthy aging’) there continues to exist a dominant set of social and cultural expectations rooted in age and life stage based construction, concerning the processes of transition to older age
I.e the idea of dependence
- The transition within the life course from working to retirement/old age focuses attention on the binary – independent to dependent
- They are judged according to their success or failure in maintaining the independence as long as possible
- Many of these are found in public policy i.e If they are dependent- we need to put in place things - they continue to be rooted in age and stage based constructions
- A key concern of elderly is in maintain this independency -dependency in adulthood is regarded as undermining the central values of self-respect and dignity and is therefore a social construction
- However if older age is socially constructed as period of dependency- it acts as barrier to active aging
We do not value what older people can provide - Lack of Social participation has been found to lead to poorer health outcomes
Social dependency
What are some of the issues of provision of social care for older people? i.e the nationally set eligibility criteria of 2003, then the care act of 2014
- Exists a ongoing debate about the actual and potential strain on the public spending that is due to aging population
- This arises from what is known as the ‘dependency ratio’
- This is the proportion of the population who are working and paying tax, the proportion that are not in work and depend on the tax
- We are getting a wider difference between these
- Costs projections in EU member states will increase
- LT care to 2.4% of GDP
- Healthcare for elderly 8.2% of GDP
- Pensions to 12.6% of GDP
- About 1/4 of the GDP
- Fair access for care services was nationally set eligibility criteria introduced in 2003 to standardise decisions about levels of care provision were made, and to overcome geographical inconsistence - there was four bands of needs
- However it has gradually lost its utilizes as local authorities faced an increasing demand for these services while also experiencing reductions in funding from central government
- A point was reached when directly funded care became available only to those with critical personal care needs- the higher of the four bands
• In 2014: the care act was introduced, this introduced the right to assessment for anyone including carers and self funders in need of support
• Principle is that support should be less about firefighting (coping with unanticipated individual crises) and more about prevention with the ultimate goal of helping people stay independent
• This is what it is used
However principle is not being met due to funding issues