reshape approaches to end of life. Ariès’ work on the history of attitudes toward death was foundational to a set of nostalgic arguments (Hart, et al., 1998, p. 66; Wood & Williamson, 2003, p. 10). In contrast to the era of the ‘wild death’ – the forbidden and invisible deaths of the mid-20th century, discussed in the previous section – Ariès described the deathways of agrarian societies, and the European Middle Ages in particular, as the era of the ‘tame death.’
In Ariès’ historical narrative, for most of European history, death was largely familiar and, as such, not a fearful event. This familiarity with death constituted a pervasive ‘general attitude’ toward death throughout human history: death was an ever-present possibility for which one should be prepared and, furthermore, the individual was the primary agent directing preparations for their own death (1981, pp. 5-28). Ariès argued that death was familiar and not frightening, thus ‘tamed’ relative to modern attitudes. Contemporary sociologist Clive Seale (1998) counters that the claim of a reduced fear of is difficult to substantiate, but agrees the argument for death as familiar was most likely true, citing that people ‘knew what to do’ when death occurred (p. 51). For example, Ariès (1981) cites numerous literary illustrations in which the dying person knows the proper way to live out their last moments: how to position their body in preparation for death, what to say to the people who witnessed their death and so on (p. 14-17).
It was in this era that death became an individualized moment. In the early Middle Ages tombstones and monuments to the deceased were personalized for the first time, containing details about the life of the deceased in an apparent attempt to convey a sense of their identity (1974a, p. 52; 1981, p. 293). Christian images of the Last Judgment changed from depictions of the day God would judge humanity as a whole, to depictions of God judging of the life of the individual. According to Ariès death was still familiar and thus ‘tamed’ but, in addition, death became what completes the life of the individual and the moment in which one discovers their true identity
(1974a, p. 52; 1981, p. 293). This development, along with the spread of accepted preparations for death, contributes to the developing ideals of good versus bad deaths, which reflected the character of the dying person depending on how closely a specific passing aligns with the dominant customs.
According to Kellehear (2007), the long, slow transition from nomadic to sedentary life, which gave rise to more predictable, gradual deaths – as opposed to the sudden, traumatic dying more common in hunter-gatherer societies – created the opportunity for dying people to prepare for their own deaths.17 Thus, ‘dying’ became a social identity in itself, a role one plays, allowing for the possibility to exercise some amount of control over dying. Not control in a medical or epidemiological sense, as doctors were few and far between and, for pastoral peoples in Europe in the Middle Ages, modern medicine didn’t exist. Rather, control in the sense of mitigating consequences to the community following the death of a member. Thus, a good death in these smaller-scale agrarian societies was one that affirmed the social and economic orders – in which social obligations did not go unfulfilled, in which the land, wealth and/or agricultural equipment necessary to ensure the survival and, hopefully, the prosperity of the community and future generations was passed on. Arguing against Ariès, Kellehear asserts that these social and material preparations were so important to the family and community that it is unlikely they were left entirely to the control of the dying person (p. 99). However, there is agreement that the dying person was at the center of these preparations and kin and kith were the ones who carried them out.
It is to this type of dying that the death awareness movement looked in order to develop their articulations of the ideal of the good death. As noted, Aries’ conceptualization of the history
of death and dying was at the center of understandings of the good death (Hart et al., 1998, p. 66), and many of the later arguments against the medicalization of death rely on this history, most notably Illich’s (1976) Medical Nemesis.
One of the primary arguments advocates of the movement for death awareness made is that death is a natural part of life, rather than an enemy to be battled or denied. In describing the death of a family friend in the Swiss village in which she was raised, Kübler-Ross’ (1969) describes the “‘old-fashioned’ customs” she witnessed: spending his last days at home, leaving final words to friends and loved ones, distributing his belongings and land, leaving tasks for his children to complete, and being laid out in his home following death for loved ones to pay their respects (p. 5). This scene is presented as evidence of the possibility for peace and dignity through the awareness and acceptance of death. Furthermore, Kübler-Ross comments that she, a child when this took place, was not excluded from any of these preparations and contrasts that with the practice of sheltering children from death by not allowing them to see dying family members or discuss their deaths, which was common at the time. When children are allowed to participate in preparations for a loved ones’ death, she argues, they come to see death as a natural part of life (p. 6). This version of dying is contrasted with the “lonely, mechanical and dehumanized” (p. 7) deaths she witnessed in modern hospitals.
The ideal of the good death that arises from this view of death as a natural part of life is one of open communication, preparedness, acceptance, dignity and peace. While Kübler-Ross states that she does not want to do away with sedatives, pain medication or infusions, the idea of natural death is a reaction to what proponents saw as dehumanizing technology and medical practices. As Illich (1976) is often quoted as saying, “the medicalization of society has brought the epoch of the natural death to an end” (p. 77). Hospice emerged and spread partly as a response to
the ‘loss’ of natural dying, in part because it offered an updated version of a natural death: “in bed, at home and under benign medical care in which interventions to ensure painlessness are balanced with the autonomous choices of the dying individual and their close companions” (Seymour, 1999, p. 693). These ideals of a natural and good death, which were inspired by the particular version of the history of death and dying overviewed here, have been incorporated into contemporary ideals of the good death and have laid the foundation for subsequent discourses surrounding end of life. It is to the contemporary advocacy for death acceptance that we now turn.