Hospice Care and Changing Attitudes Toward Death

Cultural Attitudes Toward Death and Dying

Attitudes toward dying, death, and bereavement are very dependent upon culture. Some cultures embrace death as a natural part of the life cycle and do not attach fear to it. Other cultures treat death as a taboo subject, approaching it with considerable fear and avoidance. As Quadagno (2008) notes, "In many preliterate societies, the dead are imbued with special powers and considered potentially harmful to the living. Many customs and funereal rituals surrounding death represent efforts to ensure the well-being of the community." However, individual attitudes toward death and dying can vary widely even within a single community. Modern funerary and mourning practices reflect a broad range of feelings — some people still avoid the topic of death entirely, while others are much more comfortable confronting it.

The Rise of the Hospice Movement

One of the most significant movements in modern medicine has been the hospice movement. After years of medicine seeking to intervene and prevent death at all costs, the medical community has begun to recognize that death denial and avoidance may not always serve the patient's best interests. This shift in attitude is reflected in many ways. Perhaps the most controversial example involves physicians who engage in euthanasia or assisted suicide to alleviate a patient's pain and suffering. Many people find this practice deeply troubling because it interferes with the natural cycle of life. On the other hand, others find prolonging life at the expense of quality of life to be equally problematic.

Fortunately, these two extremes do not represent the only options available. As Quadagno (2008) explains, "the two extremes of dying in pain or seeking relief by means of euthanasia do not exhaust the possibilities for the stricken patient. The goal of the hospice movement is to allow the terminally ill to die easily and at peace, without pain, in their own homes, special units of hospitals, or hospice facilities."

How Hospice Programs Work

Hospice programs are distinctive health care programs in that they are oriented toward dying rather than preserving life. They are specifically available to terminally ill patients, and their goal is to ease the transition between life and death. However, this does not mean that medical care is withheld. On the contrary, palliative care is generally a central component of the hospice experience. While life-saving treatments are not employed during hospice care, various methods are used to manage pain and promote comfort. This makes a profound difference for patients and their families.

Referral to hospice programs does not increase the quantity of a patient's life, but research has shown it can significantly improve quality of life (Devi, 2011). Moreover, hospice and other palliative care management programs can decrease caregiver distress, which may make family members more accepting of death and dying (Devi, 2011). This shift in perspective may contribute to broader societal acceptance of aging and death. Deaths supported by a skilled hospice team are often spared some of the most difficult elements associated with unmanaged dying — family members can be present throughout the process, pain is controlled, and most hospice professionals are experienced in helping families navigate grief.

References

Devi, P. S. (2011). A timely referral to palliative care team improves quality of life. Indian Journal of Palliative Care, 17(Suppl), S14–S16.

Quadagno, J. (2008). Aging and the life course: An introduction to social gerontology. McGraw-Hill.

Tan, Y. S., & Cheong, P. Y. (2011). Experiences in caring for the dying: A doctor's narratives. Singapore Medical Journal, 52(3), 140–145.