What are the problems with death
Jan P. Beckmann
How society deals with dying and death from the perspective of philosophy
An old saying goes: “What a person is becomes apparent when it comes to dying.” Dying is the ultimate way of human existence. It ultimately expresses what it means to be a person, to have dignity and autonomy In this respect, the proverb contains equally claim and criticism: the claim that man would like to be and remain himself also and especially in dying and the criticism that this could be denied him: to die as one lived has, in dignity and autonomy, is the desire of everyone.
The fulfillment of this wish is inconceivable without the assistance of society. A person not only needs the help of others when he is born, he is also dependent on accompaniment on his last walk. The claim and criticism of the saying can be extended to society as a whole: What society is becomes apparent when you look at it looks at their dealings with the dying. What does it mean for the self-image of a society when people at a young age (e.g. people with AIDS) are socially isolated or in the middle of life (e.g. people with terminal cancer) die in human speechlessness or in old age in complete isolation? How does society react to the fact that 80% of the dying spend their last days and weeks in clinics or old people's homes, although nine out of ten people would like to die in their familiar surroundings if possible? The critical potential of these and similar questions can hardly be overlooked. And yet society as a whole leaves dealing with the dying to a small group of idealists, who selflessly look after the dying in hospitals, old people's homes, hospices and self-help groups and are occasionally exposed to social isolation.
The reasons for the broken relationship between society and the dying are presumably of a complex nature and, for the most part, not yet adequately explored. In this regard, sociologists, psychologists, physicians, nursing scientists, theologians and especially thanatologists are faced with fundamental research tasks. It's about working out a New culture of dying and death. Philosophy must also make a contribution to this within the framework of its competence. It traditionally does this in a threefold manner: through reassurance of reality, through self-assurance and through ought-assurance. Specifically: The philosophers investigate the question of what man is and what dying and death are, they analyze the self-relationship of man who knows about his mortality and still or precisely because of this wants to realize his own life plan, and they research the ethical obligations which everyone has to fulfill towards themselves and towards others. The philosophers do this by a) clarifying terms, b) analyzing problems and c) identifying possible courses of action. A few examples of this are given with a view to the topic of this conference.
Explanation of terms
It is no coincidence that the hospital is one of the numerically most important places of death today. Hospitals are institutions that, as the name suggests, are dedicated to the sick and their healing. But is dying a disease? As a rule, there are ways and means of healing for illnesses: where they are not yet there is searched for. For the dying, however, there are neither means for a "cure", nor is there any reasonable prospect of looking for it. Although the process of dying can be lengthened with the current possibilities of intensive care medicine, there is no cure in the end as in the case of Illness, or at least the stabilization of an acceptable life, as in the case of chronic illnesses, but ultimately death, the occurrence of which can be postponed but not averted.
Does the lack of differentiation between dying and illness tempt you to try to continue "healing" efforts even if the prognosis is poor, because everything else could look like a "capitulation" of medicine and science? On the other hand, if one accepts the distinction between dying and illness, is there a risk that the doctors will withdraw in the event of an inferior prognosis because, in terms of what they are actually doing, namely healing, nothing can be done? There is no question that the dying person also needs a doctor in a special way with regard to pain treatment. As you can see, a clarification of the terms is helpful, if not necessary, and the same applies to thinking about the resulting consequences. Above all, the question that needs to be clarified is: Can one exclude dying from the conceptual field of illness in the narrower sense in order to save the dying person from a senseless and often painful prolongation of his dying, and at the same time justify that the dying person will continue to benefit from medical help that he absolutely needs for a humane death?
What was said last, or rather what was asked about, has to do with another term that will be mentioned again and again at this conference: the term of terminal care. It is certainly no coincidence that the humanitarian appropriate treatment of the dying is referred to as "accompaniment". To accompany a person does not mean prescribing where the path is going, but on the contrary: the semantics of the expression "accompanying" actually requires that the companion asks the companion where they should go. Accompanying someone as they die means doing what the dying person wants, as far as the companion is able to do so. For example, the answer to the questions of whether you hold the hand of the dying person or say a prayer or do something similar will not depend on your own emotional, religious or other convictions, but solely on the wishes and will of the dying person.
Are dying and death phenomena of repression? Today there is much more to suggest that it is in our society Refusal to discourse phenomena acts. Everyone knows about his death and society as a whole is confronted with dying and death every day. And yet there is no talk about it, there is hardly any dialogue, neither between individual people nor within society as a whole. To what extent this phenomenon of refusal to discourse has to do with an irrational trust in the possibilities of technology and science remains to be investigated.
Another problem in need of analysis is the question of human unity. The modern conception of the human being as a combination of body and mind, as it was essentially shaped by Cartesianism, still plays an important role. In terms of the history of science, this mind-body model has been of enormous importance for the development of medicine. Because only the conception of the separation of body and mind has made it possible to subject people qua physical beings to the concept of natural scientific law, to understand the body as a kind of "machine model" that can be "repaired" and whose "parts" can be " "can exchange" without questioning the human being as a "whole". Over the centuries, insights have been gained that have become of great importance and help for future generations that can hardly be dispensed with.
In the meantime, however, there are increasing signs that this human model is less and less suitable for the enormous developments in areas such as intensive care medicine, but above all in transplant medicine, in the sense of preserving the Humanum meet. Whatever the individual solutions in this regard, there will be no avoiding the need to critically reconsider the Cartesian conception of the unity of man, which is a duality of body and mind, and possibly to develop it towards a new point of view who are in the spirit of man Phenomenality his body and his body in the Intentionality sees his spirit, and so understands his unity as an indissoluble one. This is the only way to address questions such as the possibility of extending life through intensive care medicine or the transplantation of organs while preserving humanity.
Consequences and options for action
In addition to clarifying terms and analyzing problems, philosophy is also responsible for reflecting on the ethical principles that concern human existence in general and the process of dying in particular. These are above all the principles of human dignity and the Autonomy of person. Both dictate that not what is technically possible, but what is appropriate to the human being should be done. Hospitalization, medicalization and proceduralization of dying and death are absolutely subordinate to these principles. A society that listlessly watches the danger of the dying person's dignity being neglected and the possibility of his premortal loss of autonomy, contradicts itself. At the moment of dying, it suspends exactly what it always needs for its own existence and legitimation: respect for dignity and the right to self-determination of each individual. The problem today is not the recognition of these basic principles of human existence, but their implementation. Concerning this, four final demands are allowed:
- A greater dissemination of knowledge about dying and death is necessary in order to effectively counter the speechlessness and helplessness of many and of society as a whole. A reinforcement of the Thanatology as an interdisciplinary, even cross-disciplinary science of dying and death, the development of a special thanatopedagogy would be another consequence. Young people in particular are most likely to be open to such a dialogue.
- Further development and discussion is required not only with regard to medicine in general, but especially with regard to dying and death Medical ethics. The same is not a special ethic and does not apply only to medical professionals. Rather, medical ethics is embedded in the ethical reflection of the principles affecting people in general. Their knowledge and the ability to reflect ethically therefore apply equally to doctors, nurses and patients, and thus to everyone.
- In order to preserve the wishes and will of the dying person, a stronger one is required legal anchoring of its autonomous dispositions (So-called "patient wills"). It cannot be acceptable for society and legislators to morally recognize dispositions which the individual has made in healthy times and after careful consideration, but do not give them a legally precisely defined status. Such a legal definition is not ultimately also required to protect doctors and nurses.
- The Cooperation between the clinic and the family doctor This needs to be intensified in order to ensure that the dying, if at all possible, remain in their familiar surroundings while at the same time providing full medical, in particular palliative care.
The demands mentioned here are not based on the assumption that dying and death could and should be made the subject of detailed institutional regulations; the individual ideas and wishes in a secularized and pluralistic society are too different for that. These demands are still based on the assumption that their fulfillment as such would bring about a new culture of dying and death. Rather, such a culture must be created by individuals and society as a whole. It is important to improve the institutional and structural conditions for this.
© Friedrich Ebert Foundation | technical support | net edition fes-library | March 1999
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