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4. Good Death, Bad Death (II): Here and Now
- University of California Press
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F O U R d GOOD DEATH, BAD DEATH (II) Here and Now More people are alive today than at any time in history. How will all these lives end? In the past, acute infections and contagious diseases were the leading causes of death. Infants and children were at especially high risk, as were women during and after childbirth. Famine, accidents, and violence also claimed many lives. It is different today in countries with effective public health systems. People are much more likely to escape deadly epidemics and survive into adulthood. Death is now more patient, waiting for us not only to sow our wild oats but also to see them raise their own lively crops. When it is time for Death’s harvest, the work is often accomplished through conditions that we have lived with for a while, such as heart disease and cancer, but also through lifestyle influences, such as heavy drinking and smoking.We are also about four times more likely to die in a hospital than in all other places combined. How well all these lives end depends somewhat on the nature of our terminal condition but also on issues of value and meaning that influence the way we treat one another.Through all these changes,the quest for a “good death” continues. NOTHING HAS HAPPENED TO NOBODY Humane and effective care of dying people has become a higher priority in recent years. The emergence of the hospice/palliative care move9 3 ment, death education courses, peer support groups, and a useful clinical and scientific literature are all contributing to this welcome change. Unfortunately, though, many people still do not receive the benefits of comprehensive and skillful assistance and so experience stress and suffering that could have been prevented. In this chapter I focus on the aspects most relevant to our concern about the good death in our own times. I also discuss the deritualization and reritualization of the dying process and identify value conflicts and ambiguities. Into the Valley of Death with Stetho- and Ophthalmoscope Dying was momentous in band-and-village societies such as the Lugbara and Kaliai and also throughout Christendom from its formative years onward. How a person died and how society responded were intense concerns . Dying had to be done right if the departing soul was to prosper and society to regroup and remain viable. There were practical matters, such as redistribution of assets, but at the core was the sacred, a subtle exchange with the gods, a mysterious contact between the mortal and the immortal. These consequential dealings could not be left to chance. The passage from life was therefore swaddled in ritual. This hardy and resilient tradition still exists today, sometimes above and sometimes below the surface. The modern health care system, though, has fostered quite a different attitude toward the dying person. Every scientific or clinical advance carries with it a cultural implication, and often a symbolic one. The invention of the stethoscope in 1816, for example, can be viewed as having set in motion the process by which physicians come to distance themselves from their patients. Our informant here is Sherwin B. Nuland, M.D., surgeon and medical historian. He continues: Seen from the strictly clinical perspective, a stethoscope is nothing more than a device to transmit sounds; by the same kind of reasoning, an intensive care unit is merely a secluded treasure room of high-tech hope within the citadel in which we segregate the sick so that we may better care for them. 9 4 / C H A P T E R F O U R [3.237.46.120] Project MUSE (2024-03-29 00:35 GMT) And now he reaches the point of main interest to us here: Those tucked-away sanctums symbolize the purest form of our society’s denial of the naturalness, and even the necessity, of death. For many of the dying, intensive care, with its isolation among strangers, extinguished their hope of not being abandoned in the last hours. In fact, they are abandoned to the good intentions of highly skilled professional personnel who barely know them.1 The tucked-away sanctums, though, are not sacred places where comforting and purifying rituals are performed by religious adepts. The imam, minister, priest, rabbi, or shaman who ventures into the intensive care unit often encounters a less than hospitable environment. Nuland criticizes the high-tech approach to the dying person as a denial of the...