Dying Well

Over at My Morbid Obsession, I'm taking a look at the concept of a "Good Death" in mid-nineteenth century America and particularly how that notion was challenged by death away from home in the Civil War. The reality of the impersonality of battlefield violence and destruction up-ended the customary practice of a domestic death with family gathered at the bedside to witness the beloved's last moments. Historian Drew Gilpin Faust has noted that up until the first decade of the 20th century, fewer than 15% died away from home. Hospitals were for the indigent, not for respectable citizens.

As the power of medicine to cure grew in the second half of the 20th century, increasingly Americans were dying in the hospital. According to Ira Byock, MD, 20% of Americans die in ICUs tethered to life-sustaining quipment. 50% of us die in hospitals. 30% in long-term care facilities. Death has been subsumed within a medical model and culture and occurs largely away from home.  

The tradition of the ars moriendi--the arts of dying-- of which I spoke in my last posting at My Morbid Obsession, have been to a large extent lost. And while we are no longer a predominantly Protestant Christian culture, our spiritual lives continue to impact how we die. We are whole people. As Byock suggests, dying is not a medical occurrence but an intensely personal one, encompassing the whole person. As a culture we have become alienated from death and dying, having become entranced by the power of medicine. Without denying the many blessings of modern-day medicine, we can begin to reclaim--in our own way-- the intimate experience of dying well among loved ones so evident in the 19th Century.

Enjoy the video below by Ira Byock, MD, Palliative Care physician at the Dartmouth-Hitchcock Medical Center, and author of many books on end-of life care. He addresses the question of why we are afraid of death.

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