Education And Debate

Historical and cultural variants on the good death

BMJ 2003; 327 doi: http://dx.doi.org/10.1136/bmj.327.7408.218 (Published 24 July 2003) Cite this as: BMJ 2003;327:218
  1. Tony Walter, reader in sociology (j.a.walter@reading.ac.uk)1
  1. 1 Department of Sociology, University of Reading, Reading RG6 6AA

    Dominated by religion in the past and by medicine in the present: the idea of what constitutes a good death has changed in different cultures and societies throughout history, perhaps nowhere more so than in our globalised, Western cultures. After a period of individualisation, shared experiences with fellow sufferers now seem to be increasing in popularity

    Here is an account of the death of a French peasant in the 19th century:

    “She contracted a summer cholera. After four days she asked to see the village priest, who came and wanted to give her the last rites. 'Not yet, M. le curé; I'll let you know when the time comes.' Two days later: 'Go and tell M. le curé to bring me Extreme Unction.' “1

    This woman died a good death according to the lights of her society, but this is very different from the good death of modern Western societies. Firstly, she wanted to see the priest, not the doctor; today, dying is ruled not by religion but by medicine. Secondly, she died in a local community in which everyone knew their script; today, palliative care encourages individuals to write their own scripts for dying, as they do for living. Thirdly, the ars moriendi of her time assumed that she would die in a few days of an infectious disease; today, we are struggling to learn how to die much more slowly of the degenerative diseases of old age.

    The good death depends on one's society and culture. Norms for the good death therefore vary widely within a multicultural society. In this article, I argue that cultural norms about the good death depend in particular on, firstly, the extent of secularisation, secondly, the extent of individualism, and thirdly, how long the typical death takes.

    Religion and secularisation

    In tribal societies, to belong …

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