Between hope and acceptance: the medicalisation of dying

TLDR

The concept of medicalisation, coined by Ivan Illich in the 1970s, frames modern medicine’s overreach into death as a negative, pejorative influence that has displaced natural dying, prompting the rise of palliative and hospice care to restore dignity at the end of life. This article investigates how doctors can reconcile technical interventions with a humanistic approach when caring for dying patients.

Abstract

Palliative care has encouraged medicine to be gentler in its acceptance of death, yet medical services in general continue to regard death as something to be resisted, postponed, or avoided. David Hart examines the challenge facing doctors to balance technical intervention with a humanistic approach to their dying patients We have grown used to speaking of medicalisation as a byword for all things negative about the influence of modern medicine on life and society. The term has become synonymous with the sense of a profession reaching too far: into the body, the mind, and even the soul itself. Its use is now almost always pejorative, negative, and antagonistic. When Ivan Illich developed his original critique of medicalisation in the mid-1970s, he highlighted its particular impact upon the dying process in modern culture and could claim that modern medicine had “brought the epoch of natural death to an end” (box 1).1 #### Summary points In the mid-1970s, Ivan Illich launched a powerful attack on the “medicalisation” of dying The rise of palliative care has been one response to calls for greater dignity at the end of life Yet the wider medical system continues to regard death as something to be resisted, postponed, or avoided The charge of creeping medicalisation has also been levelled at palliative care All physicians face the problem of balancing technical intervention with a humanistic orientation to their dying patients RETURN TO TEXT Yet well before Illich a climate of concern was already developing about contemporary means of dying and medicine's part in them. The emergence of terminal and hospice care, and subsequent endorsement of the specialty of palliative medicine, is a clear expression of this. Concerns about improving care at the end of life began to surface on both sides of the Atlantic during the 1950s. In Britain attention focused on …