Dying: A Social Perspective on the End of Life by Alex Broom (review)

Developed countries around the world will be facing an aging population within a few decades. One of the issues that this raises is end-of-life care. At present, there is a tremendous amount of discussion on end-of-life care in the medical realm, but there are also many influential social studies concerning end-of-life issues. The author of this book, sociology professor Alex Broom, has done an excellent job in this respect; with plenty of qualitative data, he has successfully mapped out how important social factors shape patients’ selves during the dying experience in a hospice setting.

This book is based on data from two sites of fieldwork over the past decade–Australia and the United Kingdom. Author Broom started his fieldwork in the late 2000s in Australia. He collected qualitative data about the experience of advanced-cancer patients in the community as well as of patients with different illnesses in the last four weeks of life and receiving in-patient hospice services in New South Wales (presented in chapters 3, 4, 8, and 9). Then, having been inspired by the research in New South Wales, Broom explored clinicians’ perspectives and feelings about patients’ end-of-life experiences. After collecting those data between 2012 and 2014, he wrote the material comprising chapters 2 and 6. In addition, Broom conducted research in the U.K. in the mid-2000s, drawing on qualitative data from National Health Services (NHS) cancer patients (discussed in chapter 7).

Throughout this book, the author manages to shed light on the tension between constraints and agency in the construction of dying experiences in hospice settings. To understand the book better, we could perhaps view the content within a framework addressing four aspects of the author’s inquiry: clinical, cultural, relational, and personal. First, the author discusses the clinical aspect of the end-of-life experience. In chapter 2, he argues that the social construction of the dying experience depends highly on biomedical expert knowledge. Lacking appropriate rhetoric, doctors felt it was very difficult to talk to dying patients and their family members about the futility of further treatment, Broom found. In chapter 3, he notes that although hospice is a place in which doctors can effectively manage patients’ pain and symptoms when dying, it is also the place that contributes to a sequestrated dying experience for the patients. For example, spatial isolation in hospice may disrupt physical, social, and spiritual dimensions of patients’ selves. Chapter 6 discusses the important role that nurses play in the construction of patients’ dying experiences. Nurses are potentially important mediators with professional knowledge in the doctor-patient relationship; they could enhance communication between doctor and patient and maintain patients’ and their family members’ emotional order in hospice.

The second lens through which readers might regard Dying: A Social Perspective is dying’s cultural aspect. In chapter 4, Broom describes the interplay between spiritual and religious beliefs as well as medical techniques constructs the normative expectation of both a “good death” and a “timely death” in hospice settings. For example, biomedical and religious knowledge are associated with particular moral codes–for example, encouraging patients to fight on until a natural death–in hospice settings. These moral codes prescribe when a person should die, and represent the meaning of death and dying. Euthanasia, or “accelerated death”, is rejected by the hospice institutional culture, with its roots in Christianity.

A third approach to understanding this book’s social perspective on the end-of-life is the discussion on relational aspects of dying. In chapter 5, the author argues that dying experiences are shaped by the dynamics of informal care and the tensions between individual desires and family values and needs. For example, the competence of family care for the dying patient influences whether the family sends the patient to the hospital before the advanced stage. Further, the family members’ expectation of a “good death” sometimes undermines the patient’s personal choice of dying trajectory. Chapter 8 pinpoints the relationship between...