Dying with dignity

Death is a theme of central importance in all cultures, but the manner in which it is interpreted varies from society to society. Even so, traditional cultures, including Christian, Hindu and Jain religious traditions, exhibited a positive attitude to death and did not look upon it in a dualistic framework of good vs bad, or desirable vs undesirable. Nor was pessimism the dominant mood in their thinking about death itself. A fundamental paradigm shift occurred in the West in the eighteenth century when death was desacralized and transformed into a secular event amenable to human manipulation. From those early beginnings, dying and death have been thoroughly medicalized and brought under the purview of high technology in the twentieth century. Once death is seen as a problem for professional management, the hospital displaces the home, and specialists with different kinds and degrees of expertise take over from the family. Everyday speech and the religious idiom yield place to medical jargon. The subject (an ageing, sick or dying person) becomes the object of this make-believe yet real world. As the object of others' professional control, he or she loses the freedom of self-assessment, expression and choice. Or, he or she may be expected to choose when no longer able to do so. Thus, not only freedom but dignity also is lost, and lawyers join doctors in crisis manipulation and perpetuation. Although the modern medical culture has originated in the West, it has gradually spread to all parts of the world, subjugating other kinds of medical knowledge and other attitudes to dying and death. This is regrettable because traditional cultures may provide alternative perspectives, which, if taken seriously, may help correct some of the excesses of modern attitudes, introduce a measure of humaneness to the practice of medicine and surgery, and restore some freedom and dignity to the old, the sick and the dying. The argument is not in support of religious revivalism, but in favour of the values of cultural and individual autonomy and familial responsibility, combined in one holistic paradigm in which death, considered a normal aspect of living, is encompassed by life, and thus not its simple opposite. Prolongation of life, even when technically feasible, may fail to provide an acceptable level of quality of life and, therefore, of dignity.