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In this article our focus is upon the dying process itself rather than the point at which we will all be on our own at death, being dead or nearly so. However even then, death is a solitary experience, perceived as the unique construction of an individual's perceptions, history, context, and location.
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Ultimately everyone “dies alone” since we go through that door by ourselves, unless we lose life during a mass event such as a natural disaster, pandemic, or war. Can heroism also be applied to health care staff in protecting the family from risk of infection, or the families who permitted their loved one to die alone in hospital to protect staff from risk of Covid-19 from their (the family's) presence?Ĭonceptual clarity and drawing key distinctions between dying alone and lonely dying is the first objective of our paper. Heroism is often nominated for those who use their death to identify and use battle or struggle metaphors to describe their narrative of resistance ( Nelson-Becker, 2006 Seale, 2004). An accompanied death at the end of a long life or a death given for the welfare of others is a good death, a heroic death. For older people, until the pandemic of 2020, dying alone was often a result of living alone ( Population Reference Bureau, 2019), and this may carry overtones that signal character flaws leading to reclusiveness or a solitary nature, cognitive impairment, or self-neglect.ĭying alone can be no acceptable choice for death in the public view the historical image of a good death where one can exercise final control to die at home accompanied by friends or family continues in contemporary times. A sense of unease may be due to the assumption that lonely dying represents social distance, and living or dying in a state of social distance is not consistent with cultural norms. We who observe it in-person or via media are also disturbed.ĭying alone can encompass various ideas: dying with no one present, dying with medical staff in an Intensive Care Unit (ICU) but no family present, or dying with people nearby who fail to include the dying person or be attentive to him/her in some key way, or who fail to notice the moment of death. People who die alone are imagined to have a disturbing death. Loneliness tends to be assessed as a problem, and lonely dying or dying alone is viewed even more fundamentally as a failure by society to acknowledge and provide for duty of care ( Leontiev, 2019). In the loneliness literature, being alone is often equated with being lonely ( Ettema, Derkson, & van Leeuwen, 2010).
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Loneliness at death is one facet of potential suffering and pain that invites such attention. Such pain forces us to look directly at the many inadequacies of modern healthcare to successfully assess and treat this often-intractable force. Indirect or vicarious pain endured along with patients, service users, family or significant others whose suffering is in view affects health and social care professionals deeply and elicits its own emotional burden. Pain of any kind including the pain of loneliness and the pain of witnessing the suffering of others deserves to be addressed. A common moral perspective held by health and social care professionals as well as the public is that suffering should be short. What constitutes a good death and what is considered a bad death has been a concern of many end-of-life, health, and gerontological researchers ( Cipolletta & Oprandi, 2014 Ko, Kwak, & Nelson-Becker, 2015 Meier et al., 2016 Seale & van der Geest, 2004). It is essential for individuals to find their own still point of acceptance within competing societal narratives of privileging the self in dying alone and the value of social connection. Recommendations include inclusion of accompaniment/nonaccompaniment at death as part of advance care planning and mitigation if this condition occurs. Cultural and societal responses to lonely dying are important in easing the emotional burden of dying alone, helping individuals prepare for this possibility and better integrating death with the life course. Because of limited discussions and preparation, these deaths may lead to disenfranchised grief for the mourners. This is an invisible constraint of modern healthcare. Few people have discussed their wishes about their preferences in dying and whether and how they want to be accompanied at their death, if possible. We seldom address our civic obligations to each other. Contemporary dying involves conditions for which we are unprepared as a society.