TALKING ABOUT DEATH AND DYING – What are the cultural and historical and reasons for not talking about death? Today, we have a philosopher’s perspective on the silence that is seeing so many die without dignity.
A decade into the 21st century, a number of people still die unjustifiably delayed, painful, poorly supported and undignified deaths in Australian hospitals and other health-care institutions.
This happens despite considerable progress in the area of official statements and legislation designed to give greater control of dying to individuals, and to make the dying process as comfortable as possible.
The progress has resulted from the interaction of many factors, including the education, the relative secularisation and democratisation of society, and the rejection of traditional authorities (including medical paternalism).
All states in Australia have guardianship legislation that provides for substitute decision making and, in most cases, advance health directives, both of which extend individuals’ decision-making powers beyond their loss of competence.
Medical codes of ethics and clinical guidelines explicitly indicate the importance of respecting patients’ rights, goals and values, as well as good communication, advance care planning, and recognising when continuing treatment is more harmful than beneficial.
A crucial turning point
Why then, despite these developments, do bad deaths continue? And why do the conversations that need to happen prior to, and during the dying process, fail to take place? The short answer is that while important cultural forces have in recent years been challenged, they continue to exert considerable influence.