Between hope and acceptance: the medicalisation of dying

doi:10.1136/bmj.324.7342.905

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David Clark (d.clark@sheffield.ac.uk), professor of medical sociology

Academic Palliative Medicine Unit, University of Sheffield, Trent Palliative Care Centre, Sykes House, Sheffield S11 9NE

Palliative care has encouraged medicine to be gentler in its acceptance of death, yet medical services in general continue to regard death as something to be resisted, postponed, or avoided. David Hart examines the challenge facing doctors to balance technical intervention with a humanistic approach to their dying patients

We have grown used to speaking of medicalisation as a byword for all things negative about the influence of modern medicine on life and society. The term has become synonymous with the sense of a profession reaching too far: into the body, the mind, and even the soul itself. Its use is now almost always pejorative, negative, and antagonistic. When Ivan Illich developed his original critique of medicalisation in the mid-1970s, he highlighted its particular impact upon the dying process in modern culture and could claim that modern medicine had “brought the epoch of natural death to an end” (box 1).1

Summary points

In the mid-1970s, Ivan Illich launched a powerful attack on the “medicalisation” of dying

The rise of palliative care has been one response to calls for greater dignity at the end of life

Yet the wider medical system continues to regard death as something to be resisted, postponed, or avoided

The charge of creeping medicalisation has also been levelled at palliative care

All physicians face the problem of balancing technical intervention with a humanistic orientation to their dying patients

RETURN TO TEXT

The rise of palliative care

Yet well before Illich a climate of concern was already developing about contemporary means of dying and medicine's part in them. The emergence of terminal and hospice care, and subsequent endorsement of the specialty of palliative medicine, is a clear expression of this.

Concerns about improving care at the end of life began to surface on both sides of the Atlantic during the 1950s. In Britain attention focused on …