Palliative Care Nursing: Principles and Evidence for Practice

By Sheila Payne; Jane Seymour et al. | Go to book overview

10
Overview
Jane Seymour and Christine IngletonDeath is both a fact of life and a mystery: we cannot report back once we have gone through the process of dying; we cannot evaluate the care that we were given or suggest ways in which it might have been done better. Although dying is regarded as one of the most critical stages of life, the quality of the experience of dying very largely depends upon others. At a societal level, value is placed on a humane approach to dying: there is a desire to serve people well when they die, in ways that protect their dignity and give comfort to them and their companions when they most need it. However, the way in which these aims are achieved has been radically transformed over the last century. Until the fairly recent past, death was something that took place at home within the family. There may not have been much that could be done to relieve physical suffering, but people knew how to manage death and how to behave around a dying person, who was embraced as part of the family unit and ministered to by relatives, friends and loved ones. A religious leader may have been called, and perhaps a doctor, but they would not be central figures in this scene (Ariès 1981). Moreover, death was a frequent visitor across the generations, not something that tends to happen primarily to older people as in modern society. Nowadays, in spite of efforts to the contrary, death at home is less common than institutional death. Even when death does occur at home, it tends to be overseen by technical and clinical 'experts'. Modern dying has some particular features that can make caring for dying people difficult:
Clinical technologies and the potential of new treatments to offset death have made a diagnosis of dying difficult and the process of dying much longer than it used to be. Not recognizing imminent death means that some people die in pain and distress which could otherwise be relieved.
Clinical training in the twentieth century has tended to encourage the view that death is a failure and has, to some extent, prioritized bodily or

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