December 02, 2013

The Social Construction of Death

Headshot 3.13 cropcompressBy Karen Sternheimer

In Philadelphia, an emergency room nurse named Barbara Mancini was arrested for providing her 93-year-old terminally ill father with a lethal dose of morphine. Her father was in hospice care, meaning that no further treatment was possible and death was imminent; the goals of hospice care are to ease pain and provide comfort for the dying patient. He was in kidney failure and apparently in a significant amount of pain.

Prosecutors contend he just wanted pain relief from pain, not death, and so they are charging her with assisted suicide. Her family supports her action and is coping with both their loss and Mancini’s legal troubles.

This case brings up issues about assisted suicide that are frequently asked by ethicists and often appear on state ballots. Recent research from Pew’s Religion and Public Life Project found that a slight majority of Americans favor this practice in some circumstances, a number that has shrunk compared with previous studies in 1990 and 2005.

What do controversies over assisted suicide teach us about the social construction of death?

Although death is a physiological process, and for people of faith, a spiritual process, how the living make sense of death is deeply social, a process rooted for some in religious beliefs, for others in beliefs about the importance of the self, and through our interactions with others.

In western societies, we tend to think in binaries; one of the most primary binary being that life is the opposite of death. But in some cases, death is a slow and painful process, perhaps where one is not entirely living but not yet physically gone.

Ironically, because we tend to value the lives of humans over other species we have a more difficult time hurrying the death of a dying human than we do for other animals. We recently experienced the loss of our cat, who was in kidney failure. We wanted nothing more than for her to  keep living, and so we administered subcutaneous fluids once, and then later twice a day in order to help her body IMG_1752 flush the toxins that began to build up as her kidneys stopped working. We decided that we would do whatever we could to prolong her life, but we didn’t want to prolong her death.

For several months, she led what we considered to be a full feline life: jumping on her favorite perch to watch passing birds out the window, sitting on humans’ laps, and enjoying meal time (plus the occasional table scrap). But then she started losing her balance and couldn’t hold down food. Still, she seemed content, so we fed her by syringe and kept giving her the fluids. As she grew weaker, we knew the end was near.

But it was hard to let her go. Hearing stories of other cats and dogs who went peacefully at home, we thought about keeping her comfortable at home as long as possible. She grew too weak to walk and we carried her to the litter box, and she still seemed content. She still enjoyed lap time and cuddling, even eeking out a weak purr sometimes. Like most animals, she hated going to the vet, and we thought we’d try to avoid having her final moments at the place she despised.

One morning she had a seizure; I watched in horror at what I thought could be her painful death right before my eyes. She survived, panting and weak. Thankfully, we were able to take her right into the neighborhood veterinary clinic and they ended her suffering in a peaceful and caring manner.

The vet told us that we did the right thing by bringing her in; she could have had more seizures, a stroke, a heart attack, or other complications as her body shut down over a period of days. She said that people idealize death, thinking that death is naturally peaceful, something that happens in our sleep, but the reality is that it often involves a lot of suffering.

So why do we allow humans to suffer and prolong this process? People can tell us their wishes and even write an advanced directive to let family members and health care providers know under what circumstances they wish to end treatment. What does this tell us of how we construct meanings about death?

We live in a time of mixed blessings: medical advances mean that we can sometimes stop the process of death if someone is ill or injured. As life expectancies have increased and childhood mortality rates have dramatically declined, we don’t have to deal with death as often as our ancestors did; when we do it is typically mediated by doctors and hospitals. Because death has become more foreign, it is all the more frightening, and we can often delay death even when we know that someone will not get better.

What are some other ways in which we construct meanings of death? How might these meanings vary across time? Across cultures?

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Comments

That was a very hard decision. I'm curious what will be her final sentence.

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