Death and Medicine

Summary

The relationship between medicine and death has undergone a series of transformations since the early modern period: from the clergyman’s jurisdiction to the physician’s, from community ritual to institutional management, and from acceptance of mortality to its medicalization as a technical problem. The historiography of death in medicine is organized around competing narratives of secularization, sequestration, and resistance, with the modern hospice movement representing a deliberate counter-current to the medicalization of dying.

Historiographic Frameworks

Philippe Aries’s 1981 study portrayed a linear chronology in which a sacred, community-centered death culture gave way to a privatized and sanitized one, though this grand narrative has been widely critiqued for its teleological structure and Western-European focus.(Jackson (ed.), 2011) Geoffrey Gorer claimed in 1955 that the twentieth century witnessed the triumph of a “pornographic” culture of death in which death was sequestered from public view as if it were a dirty secret.(Jackson (ed.), 2011) Alan Kellehear proposed that historians of death should move beyond the religious and cultural baggage of good and bad death narratives toward a concept of “managing” death that accommodates the diverse experiences and emotions with which individuals approach dying.(Jackson (ed.), 2011)

The Doctor at the Deathbed

Ian Mortimer suggests that the supremacy of the doctor at the deathbed was established by 1700, when significantly higher numbers of medical men were called to the side of the dying to supplement or facilitate the healing powers of God.(Jackson (ed.), 2011) This transition did not immediately displace religious authority; rather, it introduced medicine as a complementary, and eventually competing, presence at the scene of dying. The physician’s role expanded from attempting cure to managing the process of death itself, a shift that would culminate in the institutional control of dying in twentieth-century hospitals.

The Hospice Movement

The first modern hospices were established by Christian organizations from the mid-nineteenth century for marginal groups neglected by medical practitioners, including in Lyon (1842), Dublin (1879), and London (1893 and 1905).(Jackson (ed.), 2011) These institutions represented a deliberate alternative to both the abandonment of the dying poor and the emerging medical tendency to treat death as a failure. Cicely Saunders launched the modern hospice movement in the 1960s to provide holistic palliative care addressing medical, psychological, spiritual, and emotional needs of the dying, explicitly rejecting the reduction of death to a clinical event.(Jackson (ed.), 2011)

The hospice movement thus represented a conscious reversal of the medicalization trajectory: while nineteenth- and twentieth-century medicine had progressively claimed jurisdiction over dying, Saunders reasserted the multi-dimensional character of death as a human experience irreducible to biomedical management.

See Also

• euthanasia — Voluntary termination of life and the shifting definition of the term
• medicalization — Extension of medical authority into domains of social and moral life
• medical-ethics — Ethical debates surrounding end-of-life care
• secularization — Displacement of religious frameworks by medical and scientific ones