Death in Old Age

The topic of death in old age is very timely and important for several reasons, including that by talking about death in old age we can create a much-needed space for debates about death. In Western societies until recently, the topic of death generally was perceived to be something of a taboo. Until the beginning of this century, the sociological literature on death and dying built its theoretical paradigms upon Philippe Aries’s (1981) assumption of the taboo of death in modern society. However, from the 1970s onwards, the topic of death has gradually become less unmentionable as the ‘thanatological revolution’ animated death studies across Western Europe and the United States. Since then, the number and quality of studies dedicated to death have been growing (Broom 2015; Hockey 1990; Holloway 2007; Lawton, Julia 2000; Kellehear 2009; Neimeyer 1995; Walter 2020). Moreover, the popularity of self-help manuals about how to secure a ‘good death or ‘death with dignity’ – works ranging from Jane Feinman’s (2006) How to Have a Good Death to Lyons and Winter’s (2021) We All Know How This Ends) has increased, while images of death – especially of sudden and heroic death – have frequently been presented on TV screens and other media. With these trends making death more visible, today’s culture can no longer be described as a culture of ‘death denial’ or the ‘death taboo’ (Walter 2020). Yet, even though death is no longer always invisible, death in old age still remains a topic that is removed from the everyday experience of many people and is not explored (Gawande 2014; Zimmermann 2012). In our society, death in old age – which is often a medicalized, prolonged, lengthy and complex process – is hidden from public view (Carr and Luth 2019; Lloyd 2015).We avoid planning for it and feel awkward around old people who are grieving. However, precisely because death is now most likely to occur at the end of a long life, it is important to know how to ensure the quality of the end-of-life care for the elderly as well as to understand their views and values in relation to ‘the greatest event’ in life, as death is portrayed in Rilke’s poem ‘The Song of the Life and Death’.

Death is ‘not the problem of the dead, but of the living, and that means us’ (Oz 1972: 240). Hence, by confronting mortality and by broadening our understanding of the role of death in old age in modern society, we can throw light on the cultural values that influence how we understand mortality in the West. Coming face to face with mortality not only makes life seem vulnerable and fragile; it also enhances our receptiveness to morality because the awareness of mortality can make one a more moral person (Genna 2020). The sense of mortality is the essential part of why our lives matter, why we care, why we take on responsibilities and why we value freedom, justice and dignity (Hägglund 2021). Although we need to admit that it would be disparaging to live with the continual awareness of our mortality, there is a need to acknowledge that now is a unique time to talk about death in later life. We have been led to rethink mortality in contemporary times because people who live under the protections of modern medicine, and who will be kept alive for longer than would have been conceivable even a century ago, now perceive death as not their problem, as something very distant that they know little about, and have no desire to consider (Engelhart 2022). In other words, the engagement with the issue of death in old aged has never been so important as now, when new moral dilemmas are triggered by the deferral of dying to old age and, at the same time, there is an absence of ethical attention to death in old age (Davis 2020). Because of the absence of conceptualizations of death in old age in today’s cultural narratives, and because people no longer expect to die before their old age, they feel immune from death and see it as a very distant topic. Hence the issue of death in the elderly – which is often death from disabling, chronic and degenerative diseases, which may take many months or years – tends to be kept well hidden in the background. Yet the marginalization of death in old age can impact the quality of the end-of-life care, and this means this issue requires urgent rethinking in our ageing societies.

As many studies show, despite COVID-19’s age-specific mortality pattern, several governments – including Britain’s – have shown total disregard for social and public health responsibilities towards elderly people by not prioritizing the protection of the aged (Calasanti 2020; Calvert and Arbuthnott 2021; Clarke 2021; Dodsworth 2021; Martin and de Saille 2022). In other words, together with the pandemic, there has been ‘a parallel outbreak of ageism’ (Ayalon et al. 2020) or discrimination against older adults rooted in the acceptance of the difference between old and young as justifying the exclusion of the aged (Calasanti 2020). By neglecting its obligations to increase efforts to protect the elderly who have been at the greatest risk from the COVID-19 pandemic, and by employing the ageist rhetoric and accepting ‘the brutal fact’ that losing people in old age ‘does not cause as much economic or social disruption as losing children or people of working and childbearing age’ (MacKenzie 2020: xxv), the UK government has been relaying on and reinforcing ageist prejudices and stereotypes. The UK policy of managing the health crisis, rooted in viewing the pandemic as affecting ‘just some elderly in care homes’, and comments that people dying from COVID-19 are ‘just essentially all over 80’ have scapegoated the elderly. According to Caroline Abrahams, director of the charity Age UK, it is ageism not to be concerned about the elderly dying of COVID-19. Tedros Adhanom Ghebreyesus, director-general of the WHO goes further, describing this policy as ‘moral bankruptcy at its highest’.

Moreover, the pandemic has revealed the faultlines in British society in terms of poverty, lower incomes and higher-risk jobs and ethnicity, as well as regional disparities in healthcare resources and access to health and care services. The COVID-19 crisis has not only exposed and supplemented the existing discrimination against older adults and fuelled many injustices, but has also revealed the structural problems that exist in the UK medical and care systems, both seen as struggling to provide palliative and hospice care. Hence, it is important to question how we should proceed in terms of the quality of end-of-life care after the current crisis has abated. To learn lessons from the COVID-19 pandemic about how older people should be protected and how the quality of the end-of-life care should be ensured, we should acknowledge that although the pandemic has disrupted daily routines, and brought tragedy and disorder to concrete human lives, the coronarius crisis, like other collective threats, has also created an opportunity to review and revise people’s priorities and to mobilize for change. A new value of solidarity, together with the inequalities connected with age, ethnicity, race, and class revealed by the pandemic, might mean that COVID-19 can contribute to enlarging the scope for social change and for much-needed reforms of the health and care systems.

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