The Meaning and Value of Death
Journal of Palliative Medicine Vol. 5, No. 2, pp. 279-288, May 2002
Byock, MD, Research Professor of Philosophy, University of Montana
at the W. K. Kellogg Foundation National Leadership CGA Seminar
a clinician it seems disrespectful to discuss the “meaning and value” of
death. The preciousness of life underlies all clinical disciplines and
preservation of life is a paramount clinical goal. Understandably, for
clinicians death is the enemy to be conquered and when it occurs it represents
death is non-being. The essential nature of life entails activity, purpose and
making order from disorder. Death is the antithesis of life. Non-life is
inactive and despite its stillness, death is chaos. Life generates it’s own
meaning. In contrast, on its face death appears devoid of meaning and value.
philosophically I cannot know anything with certainty about death, I must accept
that death itself may (or may not) be meaningless. Nevertheless, it is apparent
that the fact of death profoundly impacts our understanding – and experience
– of meaning in life. Although it
remains unknowable, death’s relationship to life is essential and as profound
as the relationship of darkness to light. Death need not illuminate life
into the meaning and value of death can be approached from cultural, individual
and communal perspectives.
and the meaning of individual life
death represents ultimate ego annihilation, it is no wonder that people have an
aversion to thinking and talking about death. Thanatologist Herman Feifel quotes
seventeenth century French writer and moralist, La Rochefoucauld, “One can no
more look steadily at death than at the sun.”1 Contemplating
non-being is a Gordian knot and attempting to understand death is inherently
frustrating and can provoke considerable anxiety. Indeed, a number of
psychologists, including Freud, have considered death to be the root source of
all human anxiety. It is interesting, however, that it is equally frustrating,
though less anxiety-provoking
to contemplate non-existence before one’s conception and birth than after
one’s death.2 It may not be the absence of one’s being that
causes emotional pain, but the loss of having been. The anguish of anticipated
loss of relationships to others and the world is not evoked by contemplating
people and the world before birth.
human capacity to conceptualize time and, therefore, to conceptualize the future
underlies the meaning of death.2 We can only speculate on other
species’ understanding and orientation toward death. Ethological observations
reveal that animals flee from perceived threats to life instinctively, although
these instincts can be overridden in special circumstances – dare we say, for
“a higher purpose”? – such as the defense of young off-spring.
lower animals may not be able to conceptualize the meaning of death, it seems
humans have no choice but to try. Anthropologists have long posited that humans
are inherently “meaning makers.” Biologic evidence for an innate drive to
make meaning include split-brain experiments with people born without
connections between the two cerebral hemispheres or who have had the corpus
callosum of their brains severed to control epilepsy. Presented with disparate
images shown to the right and left halves of their visual cortices, such
individuals reflexively strive to interpret and explain the disparate images as
a meaningful whole.
when a problem cannot be overcome, it is a trait of human nature, individually
and culturally, to assign it a meaning. Faced with the ultimate problem and
unalterable fact that life ends, human beings impulsively strive to recognize
some meaning in death.
of death confronts us with questions that go to the very nature of existence.
What is the nature of life? Is
there continued existence beyond life? Does
life have meaning? What is the meaning of my own life? These questions, asked in
an infinite variety of ways, are part of the human confrontation with death.
questions define our place in the world and our relationship to others.
They hold profound relevance to human life – as individuals and
collectively, as families, communities and societies. A society’s and
culture’s orientation toward the meaning of life and death underpin moral
values and ethical norms of behavior.
inquiry of this nature is familiar to philosophers and theologians, most people
actively avoid the subject of death. However, even for the least introspective
among us, the ever-present fact of mortality constantly threatens to wake us
from the dream of life.3 When
sudden death, serious injury or terminal illness strikes our family or circle of
friends, the foundation of our world feels shaken. From the moment an
individual, himself or herself, is
diagnosed with a incurable illness, death becomes the alarm that won’t stop
ringing. Even during remissions or times of relative health, its distant ring
can be heard.
intrusion of death forces us to look at the things we want most to avoid.
Hitherto, philosophical issues which seemed abstract and avoidable acquire
concrete relevance and immediacy. Existential concepts such as the
“aloneness” of each individual in the universe become all-too-real when one
is faced with the approaching and inevitable loss of everyone we know and love.
The person living with progressive illness directly experiences the profound
implications that issues of meaning and value of life hold for us in the way we
live, individually and collectively.
and the Meaning and Value of Death
cultural and individual orientations toward death are intimately interwoven. We
are at once a product of our culture and a participant in its ongoing evolution.
It is well-recognized that denial, or perhaps more accurately,
suppression is psychological defense mechanism that marks the orientation
of Western culture toward death.4 The culture tends to avoid serious
consideration of death and avoidance behavior is readily documented.
when confronted with unsettling news of the death of someone they’ve known,
contemporary westerners typically avoid questions that search for some meaning
in death. Instead, in a manner that deflects deeper inquiry, typically people
seek to ascribe a reason for the specific death. We hear people ask, “Was he a
smoker?” or, “Was she wearing her seat belt?” as if in assigning an
explanation for an individual’s demise, one’s distance from death can be
preserved. On the surface the
numerous examples of violent deaths in contemporary films, computer games and
other types of pop culture might seem inconsistent with this cultural trait.
However, such fascination with violence and gory death more likely represents an
array of defense mechanisms such as reaction-formation or desensitization than
any sort of mature effort to incorporate death within our individual
psychological or collective cultural makeup.
avoidance of death is so deeply rooted in our individual psyches and culture, it
may be presumed that a world without death would represent a Utopia.
Kastenbaum conducted a simple, but intriguing experiment that suggests
otherwise. 5 In a two-phase written survey, 214 university students
enrolled in a course on death-related topics were asked to concisely express
their feelings about living in a world without aging and death. The assignment
was given prior to any readings or course work. Initial responses were 88%
clearly positive. Typical written comments were, “You bet! Does it start
now?” and “I love it! This makes my day!” Students were then given a
written homework assignment with specific instructions to consider and list a)
the “effects a world without death would have on other people and society in
general,” and b) “the effects a world without death would have on the way
you live and experience your own life.” The initial survey question was then
repeated. The result was a dramatic reversal of frequencies with 82% giving
negative responses and 18% positive.
concerns about the absence of death on society clustered around issues of
overcrowding, mandatory birth control, loss of rules governing human
relationships, the conservative influence of massive numbers of elderly, the
potential for economic systems to falter (“Kids wouldn’t get their
inheritances...”) and the erosion of religious beliefs.
Worrisome impacts on individuals’ lives included
the category, “loss of meaning,” Kastenbaum reports the following quotes as
characteristic: “I just cannot think of myself going on and on, and things not
coming to an end. I’d have to ask myself what life is all about, and I don’t
know that I can answer that question.” “I have a real hard time imagining
what it would be like to live in this kind of life. To be honest, I don’t know
what life would mean to me if I knew it was just going to go on and on...”5
course, the implications of this thought experiment are limited. Two-hundred and
fourteen university students who elect to take a course on death and dying do
not constitute a representative sample of the human population. Still, the
consistency and dramatic reversal of responses warrants consideration. Perhaps,
as theologians, philosophers and poet’s have long suggested, life without
death would be so monotonous and devoid of intensity, pathos and joy as to
render the human condition meaningless. Indeed, it is not necessary to say that death gives life meaning to note that death may be necessary for life to have meaning.
Development through Confrontation with Death
empiric evidence from the biographic and medical literature has established that
an individual’s confrontation with death can serve as a stimulus for personal
an essay written about a year after his diagnosis of esophageal cancer,
Dr. Bill Bartholome eloquently described his own personal adjustment to living
with the knowledge of death’s approach.
“It’s been a little over a year now since I discovered I have a
fatal disease. In trying to explain to family and friends what having this
period of time has meant to me, I have found it helpful to characterize it as a
gift.... It has allowed me time to prepare my family for a future in which I
will not be physically present to them. It has given me the opportunity of tying
up all the loose ends that our lives all have. I have been provided the
opportunity of reconnecting with those who have taught me, who have shared their
lives with me, who have touched my life. I have been able to reconnect with
those from whom I had become estranged over the years, to apologize for past
wrongs, to seek forgiveness for past failings.
even more than all these, this gift has provided me the opportunity of
discovering what it is like to live in the light of death, to live with death
sitting on my shoulder. It has had a powerful effect on me, my perspective on
the world and my priorities... I like the person I am becoming more than I have
ever liked myself before. There is a kind of spontaneity and joyfulness in my
life that I had rarely known before. I am free of the tyranny of all the things
that need to get done. I realize more than I have ever before that I exist in a
web of relationships that support and nourish me, that clinging to each other
here against the dark beyond is what makes us human...I have come to know more
about what it means to receive and give love unconditionally...
live in the bright light of death is to live a life in which colors and sounds
and smells are all more intense, in which smiles and laughs are irresistibly
infectious, in which touches and hugs are warm and tender almost beyond
belief... I wish that the final chapter in all your stories can have a chapter
in which you are given the gift of some time to live with your fatal illness.”15
stimulus for personal development that occurs in response to an individual’s
confrontation with death arises from questions that define existential and
spiritual realms of life. What is the nature of existence? Who am I? Who or what
or where was I before I was born? Will “I” exist after death?
to live with knowledge of impending death such questions assume poignant
relevance. Some people experience severe spiritual or existential distress while
others develop a seemingly paradoxical sense of “rightness” that
characteristically involves realms of inner life. A number of clinically
reported accounts of positive subjective experience with life’s end document a
transition through a sense of spiritual or existential distress to a sense of
“wellness” despite full acknowledgment that death is near.7, 16, 17,
18, 19 Recognition of these poles of human experience engendered by
death’s approach — from severe distress on the one hand to a profound
sense of wellness on the other — and the demonstrated potential for some
individuals to move through suffering, make it imperative for clinicians who
care for dying people to understand something about spiritual, existential and
religious experience as they relate to life’s end.
clinical evaluation and end-of-life research, I rely on a working definition for
spirituality comprised of three themes: response to mystery, connection to
something larger than oneself which endures into an open-ended future, and an
experienced source of meaning.
inherent mystery of existence is at once awe-inspiring and terrifying. In
responding to that mystery people seek to discover some meaning within their own
lives and within life in general and strive for a sense of connection to
something larger than oneself that will endure into the open-ended future.
Listening for one or more of these themes has been helpful in understanding
people’s expression of profound distress on the one hand and seemingly
paradoxical sense of personal well-being on the other.
and spirituality are distinct constructs. In the context of the present inquiry,
religion may be considered a subset of spirituality. Religion refers to a
coherent set of beliefs, values, eschatology,
knowledge, techniques, rituals, customs and practices toward fostering a
sense of connection and meaning and a way of dealing with the mystery of
existence. Religions often involve specific beliefs related to a deity or
supreme being, but this is not a requirement. Religion is a principal way
through which human beings have reached out to one another – in community and
across generations – to provide guidance and support in confronting death. Not
surprisingly, people who have a deep religious faith often find it provides a
deep well of strength and source of comfort in dealing with illness, caregiving,
death and grief.
arose in reaction to theistic religion. A contemporary dictionary defines
existentialism as, “A philosophy that emphasizes the uniqueness and isolation
of the individual experience in a hostile or indifferent universe, regards human
existence as unexplainable, and stresses freedom of choice and responsibility
for the consequences of one’s acts.”20 It might well be presumed
that existentialism and spirituality are opposites, mutually exclusive ways of
approaching reality. In fact, an existential perspective may not obviate
spirituality — and even religion in the broadest sense. Recent advances within
physical and theoretical sciences, including chaos theory, suggest that within
the haphazardness of reality there may be an underlying pervasive order. Even if
there is no master plan, the intricacy of patterns and “laws” of
mathematics, astrophysics, quantum mechanics, and molecular biology reveal a
subtle, esthetic intelligence within the very fabric of physical reality.
from the most coldly rationale perspective, one cannot escape the implications
of death on the meaning of life as individuals and, more particularly, life in
relation to others. Earth is but a
speck of rock hurdling through space. The
circumference of the earth is 24,901 miles at it’s widest point, less miles
than many of us drive each year. All of us are but tiny creatures, living
precariously on its surface, held by the mysterious happenstance of gravity,
hurtling through deep space on this speck of rock, with only a thin blanket of
air to warm and protect us from the frigid ravages of the Milky Way's galactic
void. Whether or not there is an
active or watchful deity, human beings are still faced with the reality of
living on this earth.
strictest, least sentimental existentialists, while decrying any notion of
meaning within the puny, insignificant human condition, are nevertheless faced
with the predicament of living together, for whatever time we each have. An
overarching question remains, “what are we going to do about it?
and the Meaning of Community
impact of death on human life extends beyond the fact of our individual
mortality. For although human beings are individuals alone
humanness may have no meaning out of context of our connection to one another.
This is not merely a philosophical assertion. There is ample evidence for a
biologic basis for relationship and love — both in terms of a need for love
and a drive toward it. In fact,
empiric data suggest that human interaction, including physical touch, is
essential for primate development — and human well-being.21
etiology of pediatric failure to thrive syndrome – a
condition associated with high mortality due to secondary malnutrition
and infection and with universal developmental delay – is the deficiency of
human touch and caring interaction. The naturally occurring experiment of
foundling homes provided stark empiric evidence that, even with adequate
nutrition, shelter and support for bodily functions, humans can become ill and
die from a deficiency in human touch at critical developmental stages.22
Harlow’s well-known studies demonstrated a similar syndrome in juvenile
primates engendered by absence of a responsive mother.23
again, death informs our understanding of human life. Our shared mortality poses
fundamental questions of our relationship to one another and our essential
responsibilities one to another.
Bartholome’s observation that, “Clinging to each other here, against the
dark beyond, is what makes us human,” may be literally true.15
Perhaps, in addition to our opposable thumbs, 46 chromosomes or specie specific
genome it is how we are with one another in the face of death – including how
we care for one another – that confers our humanity.
presence of people with advanced, incurable illness who are experiencing
physical distress, disability and physical dependence in the process of dying
confronts communities with the need to respond in some fashion.
services should communities and society as a whole extend to people who are
dying. How, and how much, should individuals and their families pay
for such services? Are certain
services so basic that they must be available for all? Should the availability
of other services be based solely on one’s ability to pay? What responsibilities do we have to those who are dying: our
family members, friends, neighbors, and those we don’t know?
What responsibilities do we have as individuals, and collectively as a
society? And what, if any,
responsibilities do the dying — all of us — have to those we leave behind?
A culture’s orientation toward these
questions underpins moral values and ethical norms of behavior.
a 1978 article entitled, The Ethics of Terminal Care, Harold Vanderpool
four fundamental features of human worth — respect for the individual,
inclusion in community, concern for the body, and considerations of a broader
purpose — are offered as ethical guidelines for terminal care.”24
Laurie Zoloth-Dorfman has written:
to another, recognizing that the other is the bone of the bone and the flesh of
the flesh that is given in common, locating the mutual body as the site
of the moral gesture is fundamental to ethical reflection . . . it requires a
radical rethinking of all that occurs to the other.
All of the yearning, all of the loss, is, in fact, my loss.
This responsibility for the narratives great and small, for the dreams of
the other, for the temptations of the other, for the responsibility of the
other, creates a mutual commandedness. The
encounter is intensely personal. The
death of the other, the illness of the other, her vulnerability, is your own.”25
Zoloth-Dorfman is describing here is a covenantal relationship of people within
community. That each of us will die
is inevitable. What has come to be
miraculous is to die in fellowship. The
vision she offers is one in which people are being born into the welcoming arms
of community — and dying from the reluctant arms of community.
in the Meaning and Value of Community
What is the fundamental responsibility of communities, or society, to its members as death approaches? If one accepts that any responsibility exists at all, it is, most generally, a responsibility to care.
barest essential components of human care at the end of life would seem to be
the following: The provision of shelter from the elements.
In essence, we say to the other, “We will keep you warm and dry.” The
provision of hygiene. “We will keep you clean.” Assistance with elimination.
We say, “We will help you with your bowel and bladder function.” The
offering of food and drink and assistance with eating.
“We will always offer you something and help you to eat and drink.”
The keeping of company, non-abandonment. “We
will be with you. You will not have
to go through this time in your life entirely alone.” Efforts directed at
symptom management, the alleviation of suffering. “We will do whatever we can, with as much skill and
expertise as available, to lessen your discomfort.”
Meaning and Value of Death in Clinical Practice
of distributing collective ownership for these basic obligations and discharging
them in a proportional fashion, modern society delegated almost exclusive
responsibility for care for its dying members to the clinical professions.
conscious motivation was, of course, to provide the best care possible. It is,
however, also true that professionalization has served as a mechanism by which
society has manifest its cultural avoidance of death. One result of assigning
official responsibility for care of the most ill, infirm elderly and dying
people to doctors, nurses and hospitals and nursing homes has been to distance
society’s members from these potent reminders of our own inevitable illness,
infirmity, physical dependence and death. In medicalizing care for “the
dying”, individuals with advanced and incurable illness are objectified and an
inherently messy process is sanitized. This transformation finds symbolic
expression in the traditional white coats and uniforms that distinguish and
separate doctors and nurses from patients and in the ubiquitous rubber gloves of
post-modern medicine. After death, the person officially becomes a corpse and,
in many places by law, the body is sent to a mortuary.
of serious existing deficiencies in end-of-life care and the on-going debate
over proposals to legalize physician-assisted suicide have included harsh
criticism of doctors for reinforcing patients’ denial of death. Although some
degree of criticism is warranted, contemporary clinicians have been placed in an
awkward, and in some circumstances, untenable position vis a vis death.
Physicians, particularly, have been assigned a shamanesque role within society
as cultural defender against death. Doctors are trained to do battle with death.
Selection processes at all stages of medical training favor warrior traits. This
is particularly true for specialties most likely to encounter dying patients
such as surgery, emergency medicine, internal medicine and it’s
sub-specialties and critical care.
training is concentrated in hospitals, which in our secular society
these places an unrelenting opposition toward death is modeled and rewarded.
Medical students, interns and residents learn early on that straight talk of
death is interpreted as weakness, equated to a student giving up, or
not having the wherewithal to know what to do next.
quite recently, physicians who worked in hospice and palliative care risked
subtle ostracism within the medical profession for seeking to care for dying
patients, as if the proximity to death tainted the individual clinician. When
hospice was first introduced in the United States it was considered to be within
the domain of nursing. (As with all nursing, hospice was considered to be
“women’s work,” undoubtedly a factor which contributed to its diminished
status within the culture of medicine.) In the early 1980's, while attending an
emergency medicine conference, I mentioned in passing to a group of physician
colleagues that I worked as a part-time medical director for a hospice program.
One of the group reacted by abruptly taking a step back and asked, “Why would
a doctor do that?” His expression conveyed how distasteful and unseemly the
notion was for him. Of course, things have changed and palliative and
end-of-life care have begun to enter the mainstream of medicine.26
the past twenty years society in general, and the caring professions in
particular, have begun to culturally acknowledge and integrate an acceptance of
life’s end. Fueled by the aging of the baby boom generation and the infirmity
of their parents’ and by documented, widespread deficiencies in care27
in the midst of the assisted suicide debate, society has begun asking a second
layer of questions: What value is there in the last phase of life? Can there be
any meaning and value in the process of dying?
Can there be value in grieving? Can there be value in caring for people
as they die? 3, 11,14,30
disciplines of hospice and palliative care continue to make critical
contributions to this process of social and cultural maturation. It is, of
course, proper for the caring professions to shoulder the technical components
of society’s fundamental responsibilities toward its members as they die.
Clear communication, ethical decision making, and meticulous, competent
and, when necessary, intensive management of symptoms are basic standards and
reasonable expectations for care.
and nurses cannot guarantee that all symptoms will be fully controlled,
nor that every person will die well. But on behalf of society, clinicians can
commit to doing whatever is necessary to alleviate physical distress. We can
commit to not giving up, to never abandoning patients.
Whatever else we cannot do, we can commit to be present for another. This
is the ground substance of human responsiveness.
Whether or not society acknowledges a responsibility to provide organ
transplantation, experimental chemotherapy or even physician-assisted suicide,
we can acknowledge a social responsibility to provide the basic elements of
human care and honor an inalienable human right to die accompanied, in relative
comfort, and in a clean, dry bed.
this point we have approached the subject of the meaning and value of death from
the perspective of exploration, observation and description. A complementary,
equally valid approach exists. Since meaning and value are subjective human
constructs, it is reasonable to consider whether meaning and value can be
consciously, deliberately created.
Within a generative orientation toward meaning and value, notions of social and clinical responsibility to others are expanded. As beings in relationship to one another, human beings’ response abilities extend beyond the barest obligations of meeting the physical or basic emotional needs of dying people. We also possess the freedom and human capacity of responding in creative, even loving ways to people who are dying, engaged in caregiving or in grief. The discharge of social responsibility is, ultimately, about our ability — and willingness — to respond to one another.
instance, we have the capacity to bear witness, metaphorically saying to the
other, “We will bear witness to
your pain and your sorrows, your disappointments and your triumphs. We will listen to the stories of your life and will remember
the story of your passing.” Bearing
witness may not be an obligation in the same sense as other fundamental
components of end-of-life care. However, it offers the potential for creating or
strengthening relationships between individuals that are of profound value to
the people involved.
review and the soliciting, telling and receiving of persons’ stories is
another tangible example of components of care that extend beyond attending to
basic biological and emotional needs. Anthropologists suggest that peoples’
stories play an important role in knitting the fabric of human community. The
letters of concentration camp victims, of passengers in planes headed for crash
landings and, most recently, the note to family from a doomed Russian naval
officer trapped in submarine Kursk, all give evidence of the importance of
narratives in the human response to death. 28 Telling the story of a
loved one's dying,
and receiving the story of another, can both be creative acts. In telling
personal stories of life’s end
people honor loved ones who have died and renew, refresh and sometimes re-frame
cherished connections. In receiving a story as inherently intimate as the dying
of a lover, grandparent, parent, sibling, close friend or child, new connections
are made and each person's
Care at Life’s End and its Contribution to Meaning and Value
love is quite possibly the most creative response to the terrifying and
awe-inspiring mystery of life. The loving connection between two people creates
something new in the world, something of inherent meaning and value to the
care must be medically and technically competent. However, there is no reason to
be found in law or ethics that prevents care from also being tender and loving.
Beyond shelter, company and competent symptom management, people can be cared
for in a manner that treats them as one would treat an honored guest.
clinicians can offer counseling for people who wish to reconcile strained or
broken relationships before they die. Palliative
care can encompass anticipatory guidance to facilitate bringing significant
relationships to “completion” in the sense that people feel that
there is nothing left unsaid. In providing care that assists people in
strengthening connections with others, we can foster the creating of meaning and
I am not the first to suggest that the word “community” has properties more akin to a verb than a noun. The very nature of community has to do not only with some shared history and traits, but also with a mutual sense of belonging and in actions that reflect the recognition of some degree of shared “stake” in life. Community does not merely occur, it is created.
I had the opportunity of spending a day at Oregon State Penitentiary with 18
prison hospice volunteers, several of whom are convicted murderers. Each of
these men has already been in prison for 5 to 10 and described having “hit
bottom” with depression during their early years of confinement. Each is
facing a very long sentence and a number of them are “lifers”. As inmates
they have little dignity, and few rights.
is no material advantage to an inmate to participate in the hospice program.
They do so without compensation and must maintain their regular 40 hour a week
job. The training takes long hours and is emotionally charged. One after
another, as they told their unique stories, these inmates expressed that being a
hospice volunteer adds value and meaning to their lives.
felt like I was peering into the equivalent of J.B. Haldane’s “primordial
soup” in which life was being formed. In this instance, as in prison hospice
programs around the country, we are witnessing creation of community at its most
rudimentary, fundamental level.29
community-based efforts focused on improving end-of-life care and social support
have begun to emerge. In my adopted home town of Missoula, Montana we are
engaged in a long-term, community-based research and demonstration project to
study and improve the quality of life’s end. We are exploring what it means to
be living “in community” rather than merely “in proximity” with one
another with regard to the experiences of dying, caregiving, grief and loss.14,30
And our community is not alone. Indeed, an increasing number of communities in
the United States and Canada are communicating and collaborating in development
of similar community-wide efforts.
clinical professions – and the disciplines of hospice and palliative care in
particular – have leadership roles to play in the continued maturation of our
contemporary society and western culture’s response to death. Care can be
provided in a way that acknowledges the full range of human experience and
potential within the people we serve, including peoples’ capacity to adapt and
individually and together –
through the very end of life. It is possible to declare that people inherently
have dignity. We need only act in a
manner that honors the dignity of each person’s unique being to make the
declaration come true.
are profound advantages to both clinicians and those they serve in this process.
By providing care that is not only competent but genuinely loving, we invest
even the most mundane aspects of clinical work with meaning and value. In so
doing we can contribute to a sense of meaning and value in the lives of the
people we serve.
and Practice of Rituals as Creative Cultural and Social Responses to Death
of making of meaning in face of the apparent chaos of death would be incomplete
without considering the role of rituals. Every religion, as well as every ethnic
and regional culture, encompasses traditions, customs and rituals in response to
death. Since the early stages of the scientific revolution, public attitudes,
adherence with traditional customs and rituals surrounding death have steadily
eroded. There has been a tendency to view such rituals as superstitious or
is now evidence that this trend is beginning to reverse. Organized, informal
vigils within the neighborhood surrounding the impending death of a beloved
individual may include prayers, singing and placing flowers and luminaria along
the person’s front walk. It has become fairly common for hospice and
palliative care programs to offer music as a means of soothing and honoring a
dying person. Although traditional funerals and formal religious services may be
on the wane, memorial services remain well-attended. In addition to offering a
chance for people to grieve together, contemporary memorials are often lively
celebrations of the deceased individual, encompassing photographs and videos of
the person along with music and readings that held meaning for the deceased or
hold meaning for friends and family.
is possible to see the renewed interest and spontaneous generation of new ritual
forms as a sophisticated, well-considered effort to respond to the tragedy of
death by making meaning, investing shared time and activity with meaning.
is central to the meaning and value of human life as experienced by individuals
and by communities. Death does not
give meaning to life, but it does provide the backdrop against which life is
responsibilities of human beings toward one another are defined by the need to
respond to the facts of illness and death and contribute to the meaning and
value of individual and communal life. Acting on behalf of society, the clinical
professions bear critical responsibilities for caring for those who are dying
and bereaved. However, over-reliance on professionals as a means of denying or
distancing ourselves from death and grief can diminish the fullness and richness
of living and erode the experience of meaning and value in our lives.
acknowledging and honoring basic obligations, individuals, families and
communities have the capacity to respond to the ultimate problem of death in a
creative manner including the performance of rituals that reflect and advance
values of human worth, dignity and enduring connection. The clinical professions
can lead by setting standards for excellence and by providing care that is not
only competent but unabashedly loving. In so doing, meaning and value are
created by direct intention.
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Meaning and Value of Death
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