Appropriate Death

Death is considered an appropriate occurrence of human experience when it is not out of place according to personal and cultural norms. Whether regarding our own death or the death of others, we always refer to a complex aggregate of many ingredients or criteria of appropriateness when we label a death. It is a person's concrete way of dying but also his or her life (one's age, self-fulfillment, and morality) that are concurrently referred to as quintessential conditions of appropriate death. Therefore, almost no death is experienced as fully appropriate.

Concept

The term appropriate death was introduced in the 1960s by clinicians. Their aim was to improve the care of the dying in a time when most people were in denial about death and talking about good death, by consequence, would be contradictory. Appropriate death has a more neutral connotation: It is a death that is to be accepted, as in the final stage of dying described by Kübler-Ross. Still, substantial confusion exists in the end-of-life literature on how to use the term appropriate and to differentiate it from other terms, including healthy, peaceful, or natural.

It is essential to recognize that the idea of appropriate death also guides, albeit as an unspoken or implicit label, how we all think, feel, and act in any experience of death and grief. Mainly scholars and practitioners of care for the dying use the concept of appropriate death in explicit terms, often with reference to a phrase of the psychiatrist Avery Weisman: It is “a death that someone might choose for himself had he a choice.”

The concept is clearly relational: It is the social context that makes a specific death into an appropriate death and, even within the same time and space, a death can simultaneously be appropriate for some and inappropriate for others. Therefore, it is necessary to establish who defines appropriate death, that is, whether death is considered appropriate by the dying person, his or her family, physician, religious leader, or counselor. Moreover, the idea of appropriateness may refer to one's own death or to the death of another. Finally, it is important to ascertain whether appropriate death is related to the process of dying or to that of grieving.

Dying

In 1961 psychiatrists Avery Weisman and Thomas Hackett described four principal requirements of what they defined as appropriate dying. One who dies should have a reduction of conflicts; as little physical, emotional, and social pain as possible; a continuation of significant relationships; and a fulfillment of prevailing wishes. Weisman noted that although such conditions are almost beyond reach, it is still important to at least aim for a death that is as humane and dignified as possible.

The social perspective of appropriate dying is historically variable. Until a few generations ago, it was considered appropriate to die a saintly or religious death. It was associated with the last rites and with the presence of family and clergy at the deathbed. Such representation is still vivid for those who believe in a hereafter, and it is also popular in movies and other art forms. Yet, from the 18th century on, it was the doctor who became the practical manager of a profane death and who decided at what moment death had taken place. Whereas death in the 19th century was linked to moral judgment, in the 20th century evil was no longer connected to hell and sin, but rather to [Page 64]illness and physical pain. The task of the hospital doctor was to deliver appropriate death by alleviating pain, rather than purifying one's soul. Finally, since the rise of palliative and hospice care and psychological discourses, natural death without protracted medical intervention is regarded as most appropriate.

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