Restoration or transformation? Choosing ritual strategies for end-of-life care

Abstract

Ritual care of the dying is an important aspect of end-of-life care that can help to comfort and support patients as they come to terms with their mortality. We identify two distinctive ritual strategies, those of restoration and transformation, which organize and interpret the experience of dying. Restorative strategies are associated with rituals of modern medicine that imply that science and technology can transcend the existential limits of human life. Transformative strategies are associated with the ritual practices of traditional healers and religious communities that openly acknowledge such limits and assist the dying by helping them to find sources of hope and meaning that transcend personal existence. This discussion examines medicine's use of a ritual of restoration that employs excessively optimistic prognoses and treatment-focused discussions to respond to the spiritual and existential needs of terminally ill patients by reframing dying as a serious, but potentially curable, illness. The flaws in and harmful effects of this ritual practice are identified, followed by the argument that traditional rituals of transformation, such as those found in the Psalms, can be adapted by medicine to improve end-of-life care.