If nothing is pure, we should die

Death and dying

Gerd Göckenjan

To person

Dr. rer.pol., born 1946; Professor of Health Policy at the University of Kassel, Arnold-Bode-Str. 10, 34109 Kassel.
Email: [email protected]

Dying well is a topic in public space. In the interests of spreading palliative care, good striving is now also the subject of legislation. In the article, among other things, material on dying in normal and palliative wards is presented.


Dying is an omnipresent occurrence today, which happens quietly and largely unnoticed by others in institutions and in small groups of those directly affected. Although many people die every year, around one percent of the population, this is not an issue that citizens absolutely need to concern themselves with. [1] Dying and death receive little attention beyond the "public" deaths, which are heavily positioned in the media. The signs and symbols that once surrounded these phases of life have become rare and unobtrusive or are missing entirely. When someone is dying, it rarely gets out, a death that has occurred is hardly worth any information: no mourning clothes, no funeral parades, no ringing bells, no condolences. Farewell rituals are limited to the bare essentials and the smallest group of relatives.

Dying and death are - according to an older, still widespread view - suppressed and taboo in modern society: [2] a dubious diagnosis. It is more correct that dying and death are now more than in the past private events that are communicated according to the rules of propriety of privacy and are not subject to public obligations. This understanding is supported by other social circumstances. Above all, dying is an affair of the elderly and therefore an event that has been prepared and awaited for a long time. In old age, the networks of relationships are thinned out, relationships with direct relatives are relaxed, obligations and responsibilities decline or are only perceived to a limited extent. And - the usual places of death are institutions, hospitals and homes. But younger people also die - of course. Then everything occurs for those affected that made up the older death scenarios: the often sudden, incomprehensible loss that tears apart life and dependency relationships and can lead to a cascade of social problems of survival and succession.

Death is necessary and incomprehensible, says the philosopher, and that is independent of who is affected. Death is the "meta-empirical tragedy", a void that suddenly "breaks open" and "the being, which suddenly becomes invisible as if through a miraculous eclipse, suddenly falls through the trapdoor of non-being". [3] This incomprehensible change of state forces one to misunderstand, to not take it seriously, to let oneself rest. Death cannot be thought without personal distancing in the available forms of objectification, in the speech of the mortality tables, the statistics of the causes of death, the memento-mori breviary, but for the philosopher these are all trivializations of the tragedy of disappearing.

It always remains a question of perspective, of being met or not met. "For me, my death is the end of all things ... the end of the whole universe ... for the universe (but) not a great catastrophe, it remains an unnoticed incident and a meaningless extinction that does not disturb the order of things." [4]

This irresolvable dilemma of perspectives is reflected in the public themes. It is wrong to say that dying and death are not spoken of. Rather, we see a division of the topic: there is actually little to say about death in our society: it is the incomprehensible non-being, remains essentially on its own. Instead, a lot is said about dying, it is a widely discussed topic: a public issue. With dying processes and processes are addressed, dying is understood and feared as a phase of life. Today - since the 1970s - death has been discussed primarily as this process phenomenon. Its theming is closely linked to the ideas of the hospice movement.

Demands can be made of dying: dying should be humane, worthy and good. That is the consensus in public discourse. Dying processes can be analyzed and divided into phases that give meaning and options for action, as Elisabeth Kübler-Ross did. [5] She has thus become a co-founder of the good, accompanied dying. From this perspective, the most optimistic design opportunities seem possible. They are discussed today under the possible heading of "terminal care" and the newer organizational idea of ​​"network farewell culture". According to the ideas, such networks should be thrown over the entire death process, but especially over institutional death and here over death in homes, which is considered to be the worst dying. [6]

Dying is what people fear today; Interviews and surveys confirm this. [7] In contrast, there is little disturbing associated with death, with non-being. Fears of dying expressed relate primarily to the physical dimensions and medicalized dying: Fears of having to suffer pain and other agony, or of being exposed to unnecessary lengthening of life and apparatus medicine. Accordingly, when asked about the ideal of dying - "How would you like to die?" - preferred to die quickly and painlessly. In a survey mentioned above, 80 percent of those questioned would like to die suddenly and unexpectedly, while 20 percent would prefer to die consciously and prepared. [8]

The contradictions are clear enough here. In the public discourse, the dying ideal of accompanied dying is represented almost exclusively in the sense of the hospice movement. In contrast, the majority of the German population by no means have ideas of a conscious experience of the last phase of life, of dying as a life experience, but rather the wish that death should occur quickly and without complications.

In this regard, the very unanimous expressions of will to want to die at home are less to be understood as a desire for well-functioning outpatient care, possibly palliative care, but rather as a hope, if someone has to die, to be torn from everyday life as directly as possible become. The phrase: "I have nothing against dying, I just don't want to be there when the time comes." (Woody Allen) [9] is less puny than precise formulation of this dominant ideal of death.