'Beyond the Reach of Palliative Care': A Qualitative Study of Patient and Public Experiences and Anticipation of Death and Dying

The demands and costs of health care resulting from increasingly ageing populations have become a major public health issue in the United Kingdom and other industrially developed nations. Concern with cost containment and shortage of resources has prompted a progressive shift in responsibility from state provision of care to individual patients and their families, and from the institutional setting of the hospital to the domestic home. Under the guise of choice and patient centredness, end-of-life care is framed within a discourse of the 'good death': free from distress and discomfort and accompanied by significant others in the preferred place, usually assumed to be home. The promotion of the 'good death' as a technical accomplishment enabled by pre-emptive discussion and advance care planning has sidelined recognition of the nature and significance of the pain and suffering involved in the experience of dying. There has been little research into the disparity between policy and professional assumptions and the lived reality of end of life. In this paper, we present findings from a qualitative study of how terminally ill patients, bereaved family members, and members of the public understand, anticipate, and experience death and dying. These findings contribute to an important and timely critique of the normative idealisation of death and dying in health policy and practice, and the need to attend closely to the real-world experiences of patients and the public as a prerequisite for identifying and remedying widespread shortcomings in end-of-life care.

The smell of bare death: Encountering life at the graveyard of Lampedusa

What smell does border death leave to the inhabitants of borderlands? Is the encounter with the dead bodies of the migrants who perished in the Mediterranean Sea telling in how we articulate discussions around (necro)politics at the external borders of Europe? Based on one-year of fieldwork on the island of Lampedusa (Southern Italy), Door to Europe, and frontier for irregular border crossing, I argue that border death has consequences for both the migrants and the inhabitants of borderlands. The paper will trace such consequences through the testimony of Vincenzo, the old cemetery gatekeeper of Lampedusa, the witness and bearer of knowledge around the nameless bodies buried in Lampedusa's cemetery since 1996. This approach will help considering the extent to which the encounter with migrants’ dead bodies – bare life in death – allows ethnographers to speak of the inherently violent system that scholars referred to as necropolitics or thanatopolitics, and the otherwise irreducible force of life, which manifests itself beyond any possible attempt to reduce it or silence it.

“I Want to Bury It, Will You Join Me?”: The Use of Ritual in Prenatal Loss among Women in Catalonia, Spain in the Early 21st Century

Prenatal loss, such as miscarriage and stillbirth, may be understood as the confluence of birth and death. The most significant of life’s transitions, these events are rarely if ever expected to coincide. Although human cultures have long recognized death through ritual, it has not typically been used in cases of pregnancy loss. Interest in prenatal losses in the fields of medicine and the social sciences, as well as among the general public, has grown significantly in recent years in many countries, including Spain, as evidenced by increasing numbers of clinical protocols, academic books and articles, public events and popular media coverage. Even with this growing attention, there are still no officially sanctioned or generally accepted ways of using ritual to respond to prenatal losses in Spain. However, despite a lack of public recognition or acceptance of the use of ritual, we found that women in the autonomous community of Catalonia, in Spain, are employing ritual in various fashions, both with and without the support and acceptance of their family, friends or community, to process their losses and integrate them into their lives.

Slippage: An Anthropology of Shamanism

If our knowledge of shamanism has been so abidingly partial, so impressively uneven, so deeply varied by history, and so enduringly skeptical for so long, how has its study come to occupy such pride of place in the anthropological canon? One answer comes in a history of social relations where shamans both are cast as translators of the unseen and are themselves sites of anxiety in a very real world, one of encounters across lines of gender, class, and colonial incursions often defined by race. This article contends that as anthropologists have cultivated a long and growing library of shamanic practice, many appear to have found, in a globally diverse range of spirit practitioners, translators across social worlds who are not unlike themselves, suggesting that in the shaman we find a remarkable history of anthropology.

'Good' and 'Bad' deaths during the COVID-19 pandemic: insights from a rapid qualitative study

Dealing with excess death in the context of the COVID-19 pandemic has thrown the question of a ‘good or bad death’ into sharp relief as countries across the globe have grappled with multiple peaks of cases and mortality; and communities mourn those lost. In the UK, these challenges have included the fact that mortality has adversely affected minority communities. Corpse disposal and social distancing guidelines do not allow a process of mourning in which families and communities can be involved in the dying process. This study aimed to examine the main concerns of faith and non-faith communities across the UK in relation to death in the context of the COVID-19 pandemic. The research team used rapid ethnographic methods to examine the adaptations to the dying process prior to hospital admission, during admission, during the disposal and release of the body, during funerals and mourning. The study revealed that communities were experiencing collective loss, were making necessary adaptations to rituals that surrounded death, dying and mourning and would benefit from clear and compassionate communication and consultation with authorities.

From Normal to Viral Body: Death Rituals During Ordinary and Extraordinary Covidian Times in Pakistan

Death is far from being simply a physiologic event; it is a complex phenomenon with sociocultural and politicoeconomic aspects. During extraordinary times such as the 2020 coronavirus pandemic, death becomes a contested site. I argue that the Pakistani government's dealings with the bodies of people who die from COVID-19 have shifted the meaning of a normal dead body to a viral body that poses particular challenges to cultures and people, including the government. This article is both autoethnographic and ethnographic. It concurrently draws on my observations and participation in death rituals in a Pakistani village in Sindh province as a member of that society, and on a recent experience that I faced after the death of a gentle lady of my acquaintance due to COVID-19. I also build on my previous long-term ethnographic research in Pakistan and my ongoing research on COVID-19 in that country. I discuss the death rituals and ceremonies performed during "ordinary" situations as background information; and the changes in these rituals that have resulted from the coronavirus pandemic. My data demonstrate significant differences between usual and customary death rituals and those performed during Covidian times by government mandate, which have severely and negatively affected people's mental health. I show the government's "symbolic ownership" of the viral body, in that the government can control how people deal with their viral dead.

Ambiguous Loss and Embodied Grief Related to Mexican Migrant Disappearances

Since the 1990s, thousands of Latin Americans have died or disappeared along the US-Mexico border, following the funneling of migration through remote desert regions. The families of missing migrants face long-term "ambiguous loss," a lived experience in which a loved one is physically absent but psychologically present. Mexican relatives of the missing in Arizona and Sonora report that these losses produce deep emotional suffering along a timeline - worrying about the crossing, learning of the disappearance, beginning to search, and finally, coping with the long-term impacts of unknowing. Close relatives experience embodied health effects including headaches, insomnia, anxiety, depression, and chronic disease.