The Maintenance of Life: Preventing Social Death Through Euthanasia Talk and End-of-Life Care - Lessons from the Netherlands

The landscape of death and dying has changed. Today, death most often does not happen in an instant, it is more typically a long process of life mixed in with decline and social losses that eventually and sometimes many years after an initial onset of terminal or serious illness culminates in some combination of social and biological death. British sociologist Clive Seale (1998) suggests that changes in death and dying have been accompanied by changing tactics for maintaining social life. He suggests two strategies that that have developed in response to modern death including the development of a kind of therapeutic discourse which is used to transform social losses that occur at the end of life into something meaningful and euthanasia practices where patients choose to alter the exact time of their death to have death of the body more closely coincide with death of the social being. The Maintenance of Life is about what has developed in one present-day society to address social death and modern dying. It is based on a 15-month qualitative study of home death in the Netherlands with general practitioners, end-of-life patients and their family members. The book develops from two study findings: (1) that euthanasia in practice is predominantly a discussion, which only rarely culminates in a euthanasia death; and (2) that euthanasia talk in many ways serves a palliative function, staving off social death by providing participants with a venue for processing meaning, giving voice to suffering, and reaffirming social bonds and self-identity at the end of Dutch life. Through the mainstream practice of euthanasia talk, space has been created within healthcare which helps people live longer as active participants engaged in Dutch social networks at the end of life. Using direct observation and in-depth interviews with patients, families and physicians, this book looks critically at Dutch euthanasia policy and broader end-of-life practices from a cultural perspective and in comparison with U.S. end-of-life practices and policies. It concludes with a discussion of what lessons the U.S. may take from the Dutch experience maintaining life at the end of life. This book is a part of the Ethnographic Studies in Medical Anthropology series.