Negotiating death in contemporary health and social care

Abstract

Holloway, M. Negotiating death in contemporary health and social care . Bristol : The Policy Press , 2007 viii + 216 pp. £60.00 (hbk) £19.99 ISBN 978-1-86134-722-0 ( pbk ) Holloway sets out in this book to provide a relevant knowledge base and a practice framework that is fit for purpose as a professional tool, and in so doing closely allies theoretical insights into death’s meanings in modern society with implications for contemporary professional health and social care practice. The author discusses attitudes and beliefs, issues of bereavement and grief, questions of euthanasia and assisted dying, assumptions and reality in respect of death in old age and end of life care, practices in regard to funerals and memorials, discussion of patterns and boundaries between public and private meanings of death, as well as current health and social care practice in respect of death and dying. Throughout the book the author makes brief and strategic use of case study material to illustrate discussion and in her final chapter usefully incorporates more detailed case studies to emphasise the ways in which theory can infuse and integrate with practice. Holloway articulates the often unstated but confounding influences in modern society that challenge our responses and actions, whether as general citizens or as professionals dealing with death and dying and highlights issues of personal control and choice, for example regarding timing and place of death, and human rights, for example balancing the rights of individuals and society in the context of euthanasia. Holloway argues that death is ‘complex’ in the social context of late modernity and valuably gives attention to sociological, philosophical and theological insights in addition to the more commonly aired ideas embedded in psychological and psychiatric perspectives. The aim of this broader examination is to provide a more integrated approach to the social as well as individual perspectives on death and, therefore, scope for better theoretical underpinning of practice and research. It is suggested that health and social care practice is not sufficiently co-ordinated in regard to an individual’s holistic needs at the end of life and also emphasises the importance of health and social care workers having time to provide necessary emotional support. Holloway consistently points out the relevance of paying close attention to religious and cultural dimensions, for example the need for practitioners to appreciate differences in how grief is expressed across cultures, but she does not lose sight of the fact that cultures are dynamic and so practitioners have to be sensitive to changing beliefs as well as tradition and also need to recognise that there are common features of grief that transcend cultures. The book is welcome and timely, given the demographic changes associated with an ageing population and the social, ethical and philosophical questions that arise. Holloway makes good use of a comprehensive range of references and helpfully includes ‘key questions for practitioners’ at the end of each chapter, to help the reader reflect on themes and their use in practice settings. The author also makes strategic use of vignettes, including material from the author’s practice, that exemplify key themes. I found the chapter on understanding bereavement and grief particularly helpful in regard to social care practice, as it includes a strong emphasis on the application of theory to practice in respect of attachment and loss, stage theories, continuing bonds and meaning-making. The same chapter includes a section on ‘special deaths’, such as murder, child death and drug overdose, to which could now be added, perhaps, the category of celebrity death, given the recent public attention to the deaths of Princess Diana and TV personality Jade Goody. Holloway argues that the general public are not sufficiently aware of advance care planning and advance directives and that as a result adults, whether young or old, tend to play a passive role in the way in which their end of life care is provided and managed. This may be particularly relevant in care homes, a setting where increasing numbers of older people receive end of life care and die but where, according to the author, staff typically lack confidence in talking about death and dying. Holloway usefully refers to pilot research that indicates the benefits of open discussion between care workers and service users, for example in regard to decisions on where to die, a finding that resonates with my own current research. Holloway is right to stress the central and enabling role of communication within good professional end of life care practice. The combination of thorough research, wide ranging theoretical perspectives and detailed examples from practice throughout the life course result in a fascinating and rewarding book that should appeal not only to those involved in palliative care but to health and social care professionals and academics across relevant disciplines.