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Half a century ago, the death of mothers in childbirth was commonplace, as was the death of infants. Happily, both are a rarity today. California Sociologist Robert Fulton estimates that the average American family can go for 20 years without encountering death, which is more than ever confined to old people. And the old people are more than ever out of the way, many of them in playpen "Sunset Villages." Their absence, and the universality of the hospital, means that dying is done offstage; gone are the hushed house, the doctor's visits, the solemn faces, the deathbed scenes that put death in life's perspective. Children of the TV generation are such strangers to natural death that on hearing that Grandfather is dead, they have been known to ask: "Who shot him?"
Physicians today write papers about the problems involved in "the management of death" and debate how to handle (in that most hideous of jargon phrases) the "terminal case." There can only be gratitude for the elimination of suffering—but "management of death" raises difficult questions.
One frequent problem is whether a patient "should be told." There is much medical opposition to telling him—mostly for good and sufficient reasons. But there may be other reasons not so good. Some psychiatrists have noticed that doctors tend to have a high degree of thanatophobia (fear of death). To them death is the enemy and its victory a personal defeat from which they naturally turn away. In addition, indications are that many doctors had above-average anxiety about death in their childhood, and Dr. Herman Feifel, psychologist at the Los Angeles Veterans Clinic, speculates that this is why they became doctors in the first place.
Patients often make it clear that they do not want to know the truth. Yet in a study of attitudes among the dying, Dr. Feifel found the patients eager to talk about the subject that was being so carefully avoided by physician, family and friends. Once the old liturgies asked God's protection from a sudden death; today it is expected that people hope to die suddenly. And they do. In automobiles and airplanes, through war or crime, death comes ever more abruptly, ever more violently. And after middle age, it comes suddenly through heart attack or stroke. There is hardly time to put one's life in order, in the ancient phrase, and to prepare for the end. In many a modern dying, there is no moment of death at all. Without realizing the momentous thing that is happening to them, patients are eased into the long, final coma. No matter how humane and sensible, this does raise the question of when and whether it is proper to "deprive a person of his death."
One doctor who devotes full time to giving people their death is Britain's Cicely Saunders of London's St. Joseph's Hospice, which cares almost exclusively for the incurably ill. The effort at St. Joseph's is to let each patient know he is dying and help him to live as thoroughly as possible during his last weeks or days. "This is the time in their lives when they can be emotionally and psychologically most mature," says Dr. Saunders. "You remember when Pope John said, 'My bags are packed. I am ready to leave.' We are helping patients to pack their bags—each in his own individual way and making his own choices."