The Sanitization of Death and Dying

Alan Friedman, Ph.D. and Craig Hurwitz, MD advocate for palliative care in HI’s Faculty Fellows Seminar on Health, Well-Being, Healing
By Saralyn McKinnon-Crowley
Death-bed scene, figures crowd around a dying person's bed in grief while final rites are being read. Stipple engraving by N. Schiavonetti, 1812, after R. Westall.
Death-bed scene, figures crowd around a dying person’s bed in grief while final rites are being read. Stipple engraving by N. Schiavonetti, 1812, after R. Westall.

How have medical advances over the long 20th century altered the ways western cultures represent illness, death, and dying? Before the turn of the 20th century, people living in North America and Britain commonly confronted death in their own homes. The bed was often the site not only of conception and birth but of death as well. The dead and dying were familiar, commonplace, and domestic, and, consequently, the practices and rituals associated with death and dying were typically supervised by women, who commanded the domestic sphere. Yet rapidly-changing advances in science and medicine over the course of the 20th century have dramatically altered our experiences and perception of death. Geoffrey Gorer argues in his essay, “The Pornography of Death,” that death has replaced sex as the ultimate taboo in the United States and the United Kingdom; it has become sanitized and discrete from our everyday lives. Medical doctors who were once mostly helpless at best or harmful at worst to the sick, have become, with medical advances, newly able to intervene in illness and promote healing.

As death became an enemy to be battled and was met with new resistance in hospitals, medicine became an increasingly respected profession. The doctors who directed these efforts, and the majority of whom were (and still are) men, were allowed greater control in treating patients, and they became licensed to take almost any steps necessary to prolong patients’ lives. Viewing the death of a patient as a professional failure rather than as an inevitability, medical professionals developed an approach to treatment that largely ignored patients’ comfort or agency for the sake of prolonging life. Only in the last few decades, due to groundbreaking work by pioneers such as Elisabeth Kübler-Ross, a psychiatrist who worked on near-death issues, have patient rights and palliative care emerged as medical priorities.

In last week’s Faculty Fellows Seminar, Dr. Alan Friedman (English and Comparative Literature) shared his research on the changing perceptions of illness, death, and dying in the U.S. and U.K. He traced the history of these changing perceptions through art, history, and literature, and discussed the impact of the Great War and the Flu Pandemic on doctors’ newfound abilities to intervene in death. At a moment in history when doctors were finally able to reliably contribute to healing, they were also confronted with death and destruction on an unmatched scale. Continuing advances in medical technology from the 1950s to the 1970s further contributed to a sense among doctors that their primary responsibility was to thwart death, which fostered impressions of hubris in the medical profession. Today, however, doctors such as Craig Hurwitz of Dell Children’s Medical Center in Austin are changing how doctors and patients alike think about illness and dying.

Dr. Hurwitz, who visited the seminar, recounted his path to becoming a doctor and eventually specializing in palliative care. His initial training was in pediatric oncology. The more time he spent with his patients, however, the more his perceptions of the doctor-patient relationship changed. Rejecting the notion that a doctor is responsible for his or her patients’ healing or death alone, Dr. Hurwitz believes that he can better serve his patients through palliative care: working to minimize patients’ suffering. Currently, Dr. Hurwitz serves (with Dr. Friedman) on the board of the Final Acts Project, and encourages his patients to heal and to process their experiences of illness, death, and dying through artistic expression.

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