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Dying: A Social Perspective on the End of Life

For the contemporary sociologist, death is very much a moving target. Philippe Ariès (1981) described how during the twentieth century death turned invisible and disappeared into secluded medical spaces. Paradoxically, even when that happened, medicine did not embrace death as an object of professional management: its goal was not handling and monitoring morbidity, but overcoming it, or at least postponing it as much as possible. Around the 1960s, however, critics of medicine began challenging this attitude toward death. They condemned what they characterized as a modern culture of death denial, arguing that patients suffered unnecessarily when physicians pretended they could cure illnesses that were terminal. Today we can see that these critics were influential enough to undermine much of what they criticized. As historian Peter Filene put it, they repeated the argument that death was being denied ‘‘until it became a platitude.’’ ‘‘The chant became its own refutation’’ (1998:49) and instigated a transformation in the social, professional, and institutional management of death and dying. Sociologist Alex Broom’s book, Dying: A Social Perspective on the End of Life, takes on analyzing this transformation’s outcomes. This project is extremely important: critical social scientists have been highly effective in analyzing death denial, yet have overall shied away from examining the social and institutional structures that their own writing has inspired. The book’s object of analysis—the social construction of dying processes—changes as one writes about it. Institutions such as hospice and new professional orientations such as palliative care are becoming ever more influential in medical communities and in public discourse on death and dying. Broom, a prolific scholar who has already contributed a great deal to research in the area, does an incredible service to our thinking by taking on this topic. The book is based on fieldwork that Broom conducted in Australia and the United Kingdom during several periods between the mid-2000s and 2014. Broom interviewed dying people, family caregivers, and clinicians who specialize in hospice and palliative medicine, as well as non-palliative care physicians and nurses whose work is relevant to end-of-life care. (He also draws on diaries that several terminal patients wrote in their last weeks.) Broom treats the social construction of dying as intersubjective: numerous actors and institutions partake in shaping dying processes, hence analyzing these processes requires examining how their actions, views, and experiences interact. The book’s first part (Chapters 2–6) investigates the various groups involved in shaping dying processes today. Its last chapters (7–9) analyze several core issues related to the management of death and dying: alternative medicine and what Broom calls ‘‘survivorship discourse,’’ gender, and embodiment. Many of the chapters cover topics that deserve entire books, and some of them— for example, nursing at the end of life— have already been the center of such books (e.g., Chambliss 1996). Still, reexamining these topics is warranted given how much the field has changed. At the end of several chapters, Broom acknowledges that he has merely scratched their topics’ surface; and indeed, much of what the book does is highlight what research has yet to be done in various areas. This strategy of covering vast ground in broad-brush strokes is effective in mapping the end of life as a research field, but it also left me wondering if chapters Reviews 291