New Books on Dying

Abstract

Questions about how people die, what constitutes a “good death,” what is “natural” in death, and how death should be handled by families, religious, and medical organizations, continue to occupy a prominent place in the American consciousness. While a myriad of studies have addressed these questions, particularly since the “problem of death” gained national visibility in the 1980s, the issues remain complex and unresolved. Individuals and institutions remain deeply ambivalent about death, and that ambivalence continues to shape how people experience their own deaths and those of their loved ones in the United States. Robert A. Burt, the Alexander M. Bickel Professor of Law at Yale University, begins his recent book, Death Is That Man Taking Names: Intersections of American Medicine, Law, and Culture, arguing that American society has been, and remains “death denying.” Death is viewed fundamentally as wrong, as a logical and moral error in American society. Rather than recognizing and embracing the irrationality of death, recent reform efforts have attempted to overshadow it, he argues. As a result, efforts to increase public visibility and rationality around death have been largely unsuccessful, leading not to reform but to “new guises for public concealment” which are temporary at best and allow for the continued abuse and suffering of dying people. Individuals and institutions need to embrace the inevitability of death, Burt argues, and the ambivalence that necessarily accompanies that acceptance. Only then can decision-making structures around death be developed that amplify rather than suppress this ambivalence. Based on a complex synthesis of recent thinking in philosophy, law, and ethics, the majority of this book explores how and why Americans have not embraced ambivalence around death. Beginning with Freud’s assertion that the denial of death is a fundamental component of human cognition, Burt traces the movement of death from the home into medical institutions in the nineteenth century. He then moves between different social institutions, first exploring how thinking about death has been shaped by changing understandings of self-determination with particular reference to the Quinlan decision and the Roe v. Wade decision in the 1970s and the experiences of legal professionals involved with these and other cases. Burt then devotes considerable attention to the ways physicians experience dying patients and to the issue of physicianassisted suicide, seeing examples in each of how well intentioned physicians inflict suffering on the dying. These themes are also explored through detailed discussion of abortion and the death penalty. Burt concludes this book with the argument that “intentional, unambiguous infliction of death in any context should be rigorously avoided and socially disapproved.” When decisions about death need to be made such as in end of life situations, its essential ambivalence should be recognized, amplified and used as a lens through which to evaluate the issue or decision at hand. He sees and supports this kind of structured ambivalence in specific voting guidelines in the designation of health-care proxies and in the process of terminal sedation rather than physician Soc (2008) 45:99–101 DOI 10.1007/s12115-007-9054-4