America's Medicalization of Dying and Death

What is the “Medicalization of Death”
Since the Civil War, we as a society have created a deep wedge between the living and the dying. We opted for preservation in place of natural occurrences. I’d like to say we are coming out of an era of “trial.” Albeit a long “trial” of 140+ years. Yet, we can return to end of life planning and care intertwining the comforts of the modern age. 

Location, Location, Location
In our current 21st Century American society, death often and most likely occurs in medical settings like hospitals and assisted facilities, making it less visible and personal. The Western medical community tends to focus on prolonging life, sometimes at the expense of the person dying, the families and loved ones, and the overall discussion or preparation for death. 

The medical community, influenced by cultural norms, often focuses on life-extending treatments and interventions rather than on palliative care and the quality of life at the end of life. This can result in aggressive medical treatments that may prolong suffering instead of offering comfort and dignity in one's final days.

Cultural Attitudes
Our American culture often emphasizes youth, vitality, and progress, which has lead to a denial or avoidance of death. This cultural bias makes it difficult for our people to engage with the realities of dying and mortality. Traditional rituals around death and mourning have diminished or changed, leading to less community involvement and fewer opportunities for collective grieving and acknowledgment of death.

As a result, conversations about death and dying are often considered taboo, awkward, or uncomfortable. This avoidance directly leads to a lack of preparation for the end of life, both practically and emotionally and both for the individual and their loved ones. We often find ourselves unprepared for the loss of loved ones or for our own mortality, resulting in heightened fear and anxiety surrounding death.

The reluctance to confront death also impacts the way we support those who are grieving. Bereavement and mourning can be seen as disruptions to productivity and normalcy, leading to inadequate societal support for those in mourning. People may feel pressured to "move on" quickly, suppressing their grief rather than fully processing it.

Cultures that openly acknowledge and integrate the concept of mortality into daily life often demonstrate a healthier relationship with death. These cultures may engage in rituals, storytelling, and communal practices that honor the deceased and provide solace to the living. By acknowledging the inevitability of death, these societies can foster a deeper appreciation for life and a more compassionate approach to end-of-life care.

In urbanized and highly mobile societies, extended families are often spread out, leading to fewer intergenerational experiences and less exposure to the aging and dying process. We are not in close proximity to care for our dying. The movement of generational living is making its way back into American society, so we are sure to see the impacts of that societal shift soon. 

The American cultural emphasis on youth and progress can lead to a denial of death, making it challenging for individuals to face mortality. By shifting our cultural perspective to one that includes death as a natural part of the human experience, we can better prepare for it, support those who are grieving, and ultimately lead richer, more meaningful lives.

The Modern American Funeral Industry
The professionalization (and capitalization) of the funeral industry has further distanced people from the processes of death. Funeral homes manage the body, funeral arrangements, and interments, reducing the need for families to directly engage with the deceased.

Over the past century, funeral homes have become the primary entities managing all aspects of death care, from preparing the body to organizing the funeral service. This shift has significantly altered the way families and communities interact with death and dying. 

While studying for my undergrad in English Literature, I worked at a family-run mortuary. My hours started at 5pm through 8am, Thursday, Friday, and Saturday nights. I did that for three years. I am grateful for the experience of tending to families and their deceased, I knew that I was not there for a career because there had to be a better way to tend to bodies and help create a better bridge between the dead and the living left behind. I saw firsthand the damage a lifetime exposure to formaldehyde can do besides the barbaric act of embalming itself.

In earlier times, death was a more intimate and communal experience. Families and communities were actively involved in the care of the dying and then the deceased body, often preparing the body themselves and holding wakes and funerals in their own homes. This hands-on involvement fostered a deeper connection to the natural cycle of life and death, helping individuals and families to process their grief collectively.

However, as the funeral industry grew and became more regulated, these personal and communal practices were largely replaced by professional services. Ever wonder why a funeral home is called a “home” and usually replicates a living room? It's because we took the process outside of our own homes, where we would hold services in our own living rooms. 

Funeral homes offer a range of services designed to handle every aspect of death care, including embalming, cosmetology, and the provision of caskets and urns as well as interments. This approach ensures that families have minimal engagement in the logistical aspects of death. This approach, without integrating death doulas, grief work, and access to alternative interments, also maintains that deep gap between society and death. 

While the professionalization of the funeral industry provides convenience, it also has the unintended consequence of creating a sense of detachment. Families are less likely to have direct contact with the deceased, as the body is quickly transferred to a funeral home where it is prepared and stored until the funeral service. This separation can sometimes hinder the grieving process, as the physical presence of the deceased plays a crucial role in accepting the reality of death.

The commercialization of funerals has introduced significant financial burdens. The costs associated with modern funeral services, including embalming, viewing, and burial, can be prohibitive for many families. This economic aspect adds another layer of complexity to the grieving process, as families must navigate their financial limitations while dealing with their loss.

While the professionalization of the funeral industry has brought about significant advancements in the care and management of death, it has also distanced people from the more personal and communal aspects of the dying process. Balancing the benefits of professional services with opportunities for personal involvement may help to restore some of the intimacy and communal support that was once an integral part of dealing with death.

American Society Factors
Death is a significant source of fear and anxiety for many. To cope, people often employ psychological defense mechanisms like denial and avoidance, further distancing themselves from death. Without safe spaces to hold conversations and open discussions about dying and death, our society is mostly fearful of the end of life. 

We often hear people say, “I don't care what happens when I die, I’ll be dead.” However, the people who are left behind when you die will care. To plan your deathbed and after care and interment is the last gift to the people left behind. It gives them purpose to fulfill your dying wishes and be sure the interment is exactly as planned will give fulfillment to that care. It gives their love somewhere to go and their grief something to do. 

As mentioned earlier, a decline in religious practices and beliefs, there are fewer religious frameworks and rituals to help people confront and process death and grief. Creating community spaces to share dying and death care practices can help replace the communal support that some of our society lacks. 

Death in American media is often portrayed in sensationalized or fictionalized ways, which can distort perceptions and create a sense of detachment from the real-life experience of dying. 

This lack of representation can leave audiences unprepared for the nuanced and often painful journey of accompanying a loved one through their final days. It can also contribute to a culture of avoidance and denial around death, where people are less likely to discuss or plan for their own mortality.By sensationalizing and fictionalizing death, American media inadvertently created a barrier to genuine understanding and acceptance of death as a natural part of life. 

To counteract this, we come together as a community with shared experiences and educational programs to address the complexities of dying with greater honesty and sensitivity, helping to foster a healthier dialogue about one of the most profound aspects of human existence.