Modern society provides little emotional or spiritual comfort to facilitate the process of dying, which is often suffered in loneliness amid strangers and machines in a dehumanized hospital environment. People have difficulty in dying with dignity under such conditions, isolated from the rest of society, surrounded by a conspiracy of silence, denial and dissimulation. Alternative images of dying, with honour and creativity, are available only to the few.
Modern society is a death-denying one. Terminally ill patients are segregated from the larger society. Cancer, AIDS and other terminal diseases popularly mean death, excruciating pain, exclusion from one's social and physical environment and a burden on society. Grief and mourning are considered abnormal. Dying is a taboo. Doctors operate out of a paradigm of saving terminal patients from death rather than caring for them as they die. As the saviour the physician does everything possible scientifically to cure his patients. The patient faces an assault rather than being aided to cope. In the final phases of life the physician is ill-prepared to facilitate the death for the patient. Some doctors are willing to use euthanasia which is another way maintaining control over the care of patients and avoiding the dying process. In some situations the patient is not even told that s/he has a terminal disease and has no way of knowing what is happening or of coping with his own death.
Even when the patient's wishes are known, the doctor is not always informed. One study on patients with a life expectancy of 6 months showed that doctors were not aware that half of their dying patients had asked not to be revived if they suffered a heart attack. Half the dying patients spent more than 8 days in intensive care, or in a coma or on a mechanical ventilator. Half of those who died suffered moderate or severe pain for most of their last 3 days, at levels that would not normally be allowed by medical staff, even as a result of post-operative infection.
Dutch doctors claim that the Netherlands does not have sufficient palliative care facilities – for example, no hospices for the dying – whereas Britain has 200.
When people die after prolonged suffering, doctors say that they did everything possible to save the patient, not that they put the deceased person though hell.
A painful, prolonged death should be viewed as a bad outcome, like a misdiagnosed cancer; it is an outcome worse than death.
Telling the truth to a patient takes time; they break down, get depressed. This failure to tell the truth creates a public attitude that some diseases like cancer are completely incurable because no one has ever heard of someone being cured. We could provide better care for the dying if we asked what dying patients' preferences were, and if there were generally more open discussion of patients' odds of survival.