Abstract
Pre-exital dying in Germany, as a vital conjuncture, possesses certain culture-specific and historically embedded guidelines of action and meaning-making. In this chapter, I will argue that decisions and meaning-making in dying take place alongside specific cultural models (Shore 1996). The introduction of the concept of cultural models is followed by an exploration of what counts as a ‘good’ dying in Germany and beyond, according to the existing literature. Subsequently, I will propose my own addition to how dying ‘well’ can be conceptualized in the case of contemporary Germany: Dying in dignity, introduced as the umbrella model of dying ‘well’ in Germany, is the unquestionable aim of each person involved in a dying process, and the prerequisite of any ’good‘ dying. By drawing on examples out of my fieldwork, I intend to show that there seem to be two especially important models which form essential parts of dying in dignity – the cultural models of autonomy and serenity. Both can inspire one and the same thought or action and melt with each other, and they also might appear as two parallel ways leading to dying ‘well’. However, they can be interpreted as conflicting as well, and even one and the same model can result in two totally different interpretations concerning how to deal with a concrete situation.
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Notes
- 1.
See e.g. Hattori & Ishida (2012) about how elderly Japanese persons contemplate a good death. See Van der Geest (2004) on what makes dying good and appropriate in Ghana. See Walter (2003) or Seale & Van der Geest (2004) for a view of different intercultural meanings of a good death. See Long (2004) for a comparative approach to ideas about a good death in Japan and the US. See Okamoto (2008) for ideals of a good death in a Japanese hospice. See Stonington (2012) for ideas of a good death in Thailand. See Tan & Manca (2013) on how physicians try to achieve a good death for dying patients with their families. See Wilson et al. (2009) on good deaths in rural Canada, and Desjarlais (2003; 2016) on good dying for the Yolmo wa in Nepal.
- 2.
A very important contribution to mortality studies in Germany, tellingly, is named “Sterben und Menschenwürde” – dying and human dignity (Dreßke 2012).
- 3.
Due to the history of Germany, dignity in connection to dying is an especially delicate issue. As the Holocaust and its murderous machinery is quite present in public and private consciousness, and as the Holocaust is seen as the ultimate evil and undignified event in human history, which created the most cruel way of dying, a dying person in Germany who says she feels herself to be dying in an undignified way is likely to make the strongest argument possible.
- 4.
Autonomy e.g. is not understood as a potentially objective fact that somebody is actually shaping her life according to an assumed inner self (see Pahl 2013). In academic discourses, autonomy is often closely linked to authenticity: Being, acting, thinking, and feeling according to one’s inner self (see Traphagan 2013, also for a cultural anthropological approach to the concept of autonomy). Anthropological contributions reflecting the multiple and indefinite meanings authenticity can have in relation to autonomy across the globe are given by Lindholm (2002) and Fillitz & Saris (2013). Influential reflections on autonomy and authenticity as philosophical and everyday concepts were given by Taylor (1995). Serenity is often used by scholars who explain certain religious or philosophical practices and their aims, but also applied in psychotherapy. The term often refers to the state of mind which occurs when a person realizes which things are up to her, which are not, and how to differentiate between them (Robertson 2010).
- 5.
For other examples on authors linking a ‘good’ dying (and a ‘good’ life generally) with autonomy, see Schwartz (2012: 272), Sandman (2005: viii), Long (2004: 915), Albrecht (2015: 341). Autonomy involves taking responsibility for oneself; this is thought to effect well-being and at the same time helps the individual not to become a burden on other persons.
- 6.
Exercising autonomy also inspires the commonly acknowledged necessity to formulate a living will. It usually happens that a doctor and a dying person talk about which life-prolonging interventions should be carried out or not carried out, these considerations resulting in formulating a binding, written patient’s provision (for a closer look at the impact, reach, and supposed need for living wills, see Stolz 2007).
- 7.
Described as important for dying persons by e.g. Kruse et al. (2007).
- 8.
This contrasts with common convictions of mortality studies and palliative care that one of the very important issues during the last weeks is “what comes after death” (Seeger 2007: 9; see also Frick & Roser 2012).
- 9.
Based on studies that show a high significance of spirituality for dying persons in Germany, e.g. by Kruse et al. (2007).
- 10.
E.g. Fegg (2015: 9) identifies completing, or ending, what has not yet been completed or ended as a psychological need of dying persons.
- 11.
Which are, of course, also to be considered as possible reasons for mood changes and changes in personality, but were most likely not relevant in the cases I use as examples here. The widest-spread medication effects in palliative care which I witnessed were caused by Lorazepam and morphine. High doses of Tavor (Lorazepam) are often applied in palliative contexts to relieve from panic and fear. However, it can also cause aggression or apathy. Against pain attacks or terminal shortness of breath, morphine is widely used, which might also have side effects like apathy and mood changes. The information stems from personal communication with different palliative care professionals and my witnessing of the medication effects on dying persons during fieldwork.
- 12.
Schwartz mentions the concept of positive and negative freedom in relation to death and dying here; however, distinguishing these two dimensions of freedom has a much longer tradition. An influential concept of positive and negative liberty was introduced by Fromm (1945) and Berlin (1969). For different contributions about positive and negative freedom with high impact on scholarly discourses, see Carter et al. (2007).
- 13.
A folk theory resembling the stage model of Kübler-Ross (1973).
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Menzfeld, M. (2018). Cultural models of dying. In: Anthropology of Dying. Springer VS, Wiesbaden. https://doi.org/10.1007/978-3-658-19826-8_5
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DOI: https://doi.org/10.1007/978-3-658-19826-8_5
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