A little orange frowns at a dead orange in pieces

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In The U.S. We Live Long, But Die Hard

In this essay, April Schueths examines how death is treated in American culture and asks us to consider how we could make death and dying easier in the U.S.

“Don’t touch that body, it’s disrespectful,” my grandfather, a mortician, shouted at me from across the funeral home. He found me, a curious nine year old at the time, standing in front of an open shiny, blue casket, about to touch the face of an older woman I had seen at our local nursing home. It wasn’t uncommon for me and my brothers to stop by the funeral home, where my grandparents also lived, and find a deceased person in a casket in preparation for a viewing.

Death was a part of our day-to-day lives, so talking about death was common for my family. However I’ve found many people work hard to avoid this topic. It can be scary and frightening. It’s almost as if we forget about our mortality and that we will all die someday. Death is a natural part of life, but can create intense anxiety when it’s sanitized and hidden.

Our Death-Denying Society

Western societies have been described as death denying (Kellehear 1984). Zimmermann and Rodin (2004) provide three examples used to support this thesis: 1) We remove death from our lives by avoiding thoughts or conversations about death. For example, the majority of Americans do not have their end of life plans, or advance directives, in writing; 2) We use technological advances to delay death (i.e., the medicalization of death). Even adults with advance directives have no guarantee that physicians will follow through on their wishes. Death, after all, is seen as failure. And, 3) We separate the dying from society in medical facilities. Even though most Americans would prefer to die at home, eighty percent of Americans die in medical facilities, including hospitals or nursing homes.

Lee (2009: 55) argues, denial about death doesn’t make it less painful:

Modern Americans die hard. We live longer thanks to new advances in modern medicine, but we die with less equanimity than our grandparents did. We meet our own death with fear and despair because of anticipated pain and the helpless depression of hopelessness of any afterlife.

Chronic health conditions, such as heart disease or cancer, rather than acute emergencies, such as a heart attack, have become the main cause of death in the United States. Wu and Jennings (2013) in The Sociology Project point out that people tend to now live longer with chronic diseases, but experience ongoing medical complications that eventually lead to death. They argue that, “our social institutions adapt to the changing social contexts and conditions that they face” (550).

Is the death positive movement an example of adapting to changing social contexts?

Death Positive

Perhaps the death-denying thesis is a bit too simplistic (Zimmerman 2012). An increasing number of groups have been working to change the way we experience and perceive death. For example, more people are using hospice care and palliative care, with a focus on alleviating suffering. At the center of these services “is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so.”  Although many people still don’t have access to palliative care, the hospice movement has become quite mainstream.

A better example of a move toward death acceptance is the growing popularity of the death positive movement. Check out the video below where Caitlin Doughty, a mortician, death theorist, and founder of The Order of the Good Death talks about, “Accepting that death itself is natural, but the death anxiety of modern culture is not.”

This movement includes social activities across the U.S. such as, Death Café. People, many times strangers, meet to share food, in particular cake, and engage in a directed discussion of death. It’s not a grief support group or a place to prepare end-of-life plans, rather it’s a place to “to increase awareness of death with a view to helping people make the most of their (finite) lives.” To find a Death Café near you, just click here.

Conclusion

Could the recent rise of the death positive movement indicate that U.S. society is becoming more death-accepting? As much as we like to place things in neat boxes, this issue is more complex than simply picking one or the other. Zimmerman and Rodin (2004: 127) argues that we cannot simply categorize western views on dying as either death-denying or death-accepting:

The solution…is not changing the ‘attitude’ towards dying, but changing the material conditions that the dying and those caring for them have to face. This includes creating financial support for lay caregivers and allocating more funding to home care. It also includes making conditions in the hospital more welcoming for patients and families who want to stay with their dying relatives.

One thing is for sure. The context of U.S. society is changing, so it’s likely that the way we view death and dying will continue to evolve. Students of sociology can play an important role in advancing this discussion and striving to change the material conditions of the dying which ultimately serve the public good.

Dig Deeper:

  1. College students across the U.S. are now able to enroll in thousands of Death and Dying courses across a variety of disciplines. Does this curriculum change signal a cultural shift on how we view dying? Explain.
  2. Read this brief overview on palliative care from the World Health Organization (WHO). In your own words, what is palliative care? Discuss at least two strategies the WHO recommends when treating people with life-threatening conditions.
  3. How comfortable are you and your family and friends talking about death? What social factors (i.e., race/ethnicity, culture, religion, etc.) contribute to your comfort level?
  4. Take a look at the National Hospice and Palliative Care Organization website on end-of-life planning. In your view, which of the planning resources are most important? Do all people have equal access to these resources? If you’re not sure, here’s a resource from Carr (2012) to help with this question. Explain your answers.

References:

  • Carr, Deborah. 2012. “The social stratification of older adults’ preparations for end-of-life health care.” Journal of Health and Social Behavior 53(3): 297–312.
  • Kellehear, Allan. 1984. “Are we a ‘death-denying’ society? A sociological review.” Social Science & Medicine 18(9): 713–721.
  • Lee, Sok K. 2009. “East Asian attitudes toward death—A search for the ways to help East Asian Elderly dying in contemporary America.” The Permanente Journal 13(3): 55–60.
  • Zimmermann, Camilla, and Gary Rodin. 2004. “The denial of death thesis: sociological critique and implications for palliative care.” Palliative Medicine 18(2): 121–128.
  • Zimmermann, Camilla. 2012. “Acceptance of dying: A discourse analysis of palliative care literature.” Social Science & Medicine 75(1): 217–224.

Image by kev-shine via Flickr.