The Quest for a Good Death : (Re)Creating Natural Death in Hospital Settings

In France, medicine is heavily involved in the care of dying patients, as 58% of individuals die in hospital (IGAS, 2009; Observatoire de la fin de vie, 2011). In a 2015 exploratory qualitative study among 12 hospital physicians belonging to different medical disciplines, a research team composed of a physician and a sociologist investigated the conditions of the dying process, starting from the hypothesis that doctors seek to stage a natural death (Harvey, 1997; Seymour, 2000), in response to health care professionals’ and lay people’s representations of a natural and good death. In this presentation, we will show that physicians across disciplines put in place an informal medical protocol for dying patients. They medically monitor the dying process, whilst letting the physiological process of death take its course. There is thus a subtle and permanent balance between medicalization and an emphasis on natural dimensions of the end of life process. In the ICU, physicians switch the oxygen supply to 21% (which is akin to ordinary air) when a decision to stop treatment has been made and death is imminent. « We seek to put them [the patients] back to natural conditions » says an ICU physician. This organization of death is underpinned by a paramount principle: medicine must not induce death. Health care professionals and family alike await the patient’s natural death. When it takes a few days, all involved face a disturbing wait and experience what we term performativity at a loss: they don’t know how to care for the patient. We will also show that the standardization of end of life is characterized by the deletion of pain and anxiety of the dying patient, through the use of medication. A calm, serene and (most often) unconscious patient corresponds to a contemporary ideal of death.