Death is the inevitable conclusion of life, a universal destiny that all living creatures share.   It’s an age-old idea that a good life and a good death go together. Death and dying have become unbalanced in high-income countries, and increasingly in low-and-middle-income countries; there is an excessive focus on clinical interventions at the end of life, to the detriment of broader inputs and contributions.

      The story of dying in the 21st century is a story of paradox. While many people are over-treated in hospitals, with families and communities relegated to the margins, still more remain undertreated, dying of preventable conditions and without access to basic pain relief. In this present era, process of dying represents unbalanced and contradictory picture of death.  

Even though medical advances continue to increase life expectancy, they have raised an entirely new set of issues associated with death and dying. For example, how long should advanced medical technology be used to keep comatose people alive? How should the elderly or incapacitated be cared for? Is it reasonable for people to stop medical treatment, or even actively end their life, if that is what they wish?

          Before the 12th century he describes a period of “Tamed death,”  where death was familiar, and people knew how to die. The dying and their families accepted death calmly; they knew when death was coming and what to do; dying was a public event attended by children.

    Death can occur through conflict, accident, natural disaster, pandemic, violence, suicide, neglect, or disease. The great success with antibiotics vaccines has perhaps further fuelled the fantasy that science can defeat death. But this temporary success as only has been the result of discovery of germ theory and antibiotics.

     In true sense, Death still remains invincible.

   The fear of death also involves the fear of separation.

     As families and communities want more and more hospital care, when critically sick, health systems have occupied the centre stage in the process of dying.  Dying people are whisked away to hospitals or hospices, and whereas two generations ago most children would have seen a dead body, people may now be in their 40s or 50s without ever seeing a dead person. The language, knowledge, and confidence to support and manage dying are being lost, further fuelling a dependence on health-care services.

 

   Death systems are the means by which death and dying are understood, regulated, and managed. These systems implicitly or explicitly determine where people die, how people dying and their families should behave, how bodies are disposed of, how people mourn, and what death means for that culture or community.

Death systems are unique to societies and cultures.

    The increased number of deaths in hospital means that ever fewer people have witnessed or managed a death at home. This lack of experience and confidence causes a positive feedback loop that reinforces a dependence on institutional care of the dying.

     Medical culture, fear of litigation, and financial complexities contribute to overtreatment at the end of life, further fuelling institutional deaths and the sense that professionals must manage death. Social customs influence the conversations in clinics and in intensive care units, often maintaining the tradition of not discussing death openly. More undiscussed deaths in institutions behind closed doors further reduce social familiarity with and understanding of death and dying.

     How people die has changed radically over recent generations. Death comes later in life for many and dying is often prolonged. Futile or potentially inappropriate treatment can continue into the last hours of life. The roles of families and communities have receded as death and dying have become unfamiliar and skills, traditions, and knowledge are lost.

    At first only the rich could expect that doctors would delay death. However, by the 20th century this expectation had come to be seen as a civic right.

         ‘Natural death’ is now the point at which the human organism refuses any further input of treatment.

       Corporatization of health care has projected medicine as a purchasable commodity and consequently resulted in an illogical distribution of health care. People, who can afford, spend millions in the last few days of their life, just to have only a few more days to live. Resources spent in such a futile quest are equivalent to thousands of times the money for food and medicines for the poor who lose lives for fraction of that expense.

     Death is not so much denied but has become invisible to people. People now have less understanding and less acceptance of death. The death is more perceived as failure of medical treatment rather than an invincible power or a certain final event.

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