10Jane Seymour and Christine Ingleton
Death 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|