ABSTRACT
Introduction Birth and death, the two most human of events, have become increasingly medicalised in the last half century in many industrialised countries.This has transformed our way of dying, creating unintended consequences that have changed – and at times distorted – the contours of our end-of-life experiences. Because medical technology is increasingly effective at keeping people alive, even when the quality of their lives is minimal, death has become a decision in a way that it has never been before. Ever greater numbers of people must decide to die – or more precisely, to decide to stop fighting to live and to forego life-sustaining treatment in favour of palliative care. Increasingly, people die in a medical context – often a hospital – that is unfamiliar to them and populated primarily by strangers, filled with bright lights and the noises of machines.Currently, 85% of Americans die in some kind of healthcare facility (not only hospitals, but nursing homes, hospices, etc.). Of this group, 70% (equivalent to almost 60% of the population as a whole) choose to withhold some kind of life-sustaining treatment (Miles and Gomez 1988). It is highly likely that many of us will eventually face that same decision about ourselves; it is even more likely that we will be indirectly involved in that decision as family members and loved ones face death.
