The readiness is all: ways people anticipate dying in the U.K.

Lead Research Organisation: University of Sheffield
Department Name: Sociological Studies

Abstract

My research analyses the ways in which people seek rights and recognition in anticipation of their death. People in the U.K. now live longer than ever before but often in a fragile state of health which affects the ways in which they anticipate their death. While a number of authors have discussed the different ways in which people in the U.K. approach dying (Kellehear 2007, Seale 1998, Walter 1994 etc.), none have so far used anthropological methods to compare different public arenas (geographical, legal, discursive) where this anticipation of death occurs, or indeed, related it to broader theoretical approaches to witnessing (Agamben 1999; Felman and Laub 1992) and recognition (Honneth 1995; Taylor 1992). The public arenas that my research focuses on are: the 'right-to-die' debate (and the vociferous 'pro' and 'anti' campaigners who sustain the debate); the laws which regulate people's 'death decisions'; and a hospice day centre.

The theoretical contribution of this research shows that all three social processes (law, activism and art) purport to offer a form of public recognition of an individual's personhood in their approach to death, in defiance of the well documented public taboo on death in the U.K (Aries 1975, Elias 1985, Gorer 1965). The overwhelming desire of many of my research participants was to gain recognition for the particularity of their deaths; which involved opening up their life to public scrutiny, whether from fellow day-centre patients or from five judges in the House of Lords. Making public claims for recognition-in-dying contained many risks, not least creating unrealistic expectations of what can be recognised. I outline a number of occasions when recognition fails precisely because some aspects of our lives (and deaths) are just too private, too emotional, and too uncertain to be publicly recognised in the way that people might wish them to be.

In addition to these theoretical contributions, my research highlights the vital methodological contribution which ethnographic work can make to controversial and highly divisive debates in bioethics and law - in my case, the 'right-to-die' debate.

In summary, this research pursues four objectives:

First, to offer an analytical and empirical investigation of how different groups anticipate dying by trying to shore up their personhood through attachment to different external forms (law, activism and art).

Second, to shed light on the beliefs and motivations of people who want to legalise a form of medically hastened death in the U.K. and in particular those who are intending to travel to Dignitas in Switzerland for help to die.

Third, to advance inter-disciplinary discussion of end-of-life issues through positioning myself at the nexus of different sub-disciplines (death studies, social gerontology, medical anthropology, socio-legal studies, bio-ethics).

Fourth, to feed back the results of my original and timely research to policy-makers, stakeholders and healthcare practitioners working on end-of-life issues.

I will be based in the Department of Sociological Studies (Sheffield University) under the guidance of Dr. Lorna Warren with whom I currently work on the E.S.R.C funded Representing Self: Representing Ageing project (New Dynamics of Ageing programme).
Additional support will come from Professor Jane Seymour at the Sue Ryder Care Centre for Palliative and End of Life Studies at Nottingham University. I will conduct limited additional research in the U.K. in order to be gain further insights which will enrich the journal articles I intend to write. I will publish 5 articles, deliver papers at conferences (one international), and network extensively among end of life researchers based at the University of Nottingham (where I will be affiliated); the Department of Nursing at the University of Sheffield; and the Centre for Death and Society at the University of Bath.
 
Description This research grant has enabled dissemination of the key findings from my PhD through academic publications, conference presentations, and talks to healthcare professionals. These findings centre on the certainty which an assisted suicide offers people with uncertain end of life trajectories, and the responsibility which doctors are required to assume when facilitating a person's suicide. I also conducted interviews with members of an organisation called the Society for Old Age Rational Suicide. These interviews highlighted that news stories about the poor treatment some older people have received in hospital (e.g. mid-staffordshire) exacerbate older people's fears about what will happen to them when they are at the end of their life. The research also highlighted that some older people do not consider going to Switzerland for an assisted suicide an option for them, preferring to take matters into their own hands at home and finding support amongst their peers for such actions.
Exploitation Route - Findings will feed into research being undertaken by Prof Celia Kitzinger at York University into the views of relatives of people who have had an assisted suicide in Switzerland.
- Findings are feeding into international debates about assisted dying. My work has been cited by Canadian scholars researching the 'medical-aid-in-dying' legislation in Canada, American scholars researching 'medical-aid-in-dying' legislation and I was invited to write an abridged version of my Medical Anthropology article for a Norwegian palliative care journal.
- Findings fed into a philosophy workshop (Glasgow, March 2017) on Suffering and Autonomy at the End of Life which will ultimately feed into policy recommendations to the Scottish Government.
- Published findings will feed into debates on the Assisted Dying (England) Bill and the Assisted Suicide (Scotland) Bill.
- Healthcare practitioners who have listened to my talks might reflect differently on the issue and any requests for hastened death they might encounter in their professional practice.
Sectors Education,Healthcare,Government, Democracy and Justice

URL https://www.gla.ac.uk/research/az/endoflifestudies/
 
Description Findings have been disseminated to a number of different audiences. In presenting talks at academic conferences (BSA Medical Sociology; Centre for Death & Society Bath) and departmental seminars (Sheffield and the University of the West of Scotland) the findings prompted lively discussion and led to further requests from attendees for information e.g. from the Medical Director of a hospice currently doing research with Prof Daniel Miller on a similar project. I was also asked and agreed to contribute to an edited collection on Death & Social Policy published by Palgrave Macmillan in 2016. I presented on assisted suicide at a hospice which again led to passionate discussion. The information I presented was new to many healthcare professionals attending, although many had their own experience of requests for hastened death. Some commented that my talk had made them think about the issue differently and that they would read the news reports about assisted suicide in a new light as a consequence. The Medical Director of the hospice suggested my findings/analysis was important and should be published so it could influence the debate. I have since published this paper in Medical Anthropology and it has been viewed over 8000 times and is the journal's 'most read' articles. Presenting about the effects of arts initiatives at two hospice also prompted lively debate and requests for copies of book chapters. I was contacted by an artist at the Royal College of Art, London to participate in a 'Suicide Walk' to raise awareness of different aspects of suicide and end of life. Members of the public attended the event, along with other researchers (e.g. Izra Black, UCL who looks at assisted suicide from a legal perspective). This walk was filmed and subsequently footage made available on a dedicated website (http://suicidewalk.org) and during an art installation at an RCA exhibition of the suicide walk.
Sector Healthcare
Impact Types Societal

 
Description UK Parliament POSTNOTE -
Geographic Reach National 
Policy Influence Type Contribution to a national consultation/review
URL https://researchbriefings.files.parliament.uk/documents/POST-PB-0047/POST-PB-0047.pdf
 
Description Departmental Seminar (Centre for the Study of Law in Society, Sheffield Univesrity) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact The talk was attended primarily by law postgraduates and academic staff which resulted in stimulating interdisciplinary discussion between sociology and law.

No notable impacts, although some of those attending said their views had been challenged.
Year(s) Of Engagement Activity 2014
 
Description Departmental Seminar (Sociological Studies, Sheffield University) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Talk attracted a large number of attendees in comparison with other seminars that semester. The talk prompted a number of questions and prompted discussion amongst attendees.

One academic in the audience, Dr Liam Foster, approached me after the talk to ask if I would like to contribute to an edited collection on Death and Social Policy. This edited volume will be published by Policy Press in 2015 and my chapter will be about the 'right-to-die' debate in the UK and internationally.
Year(s) Of Engagement Activity 2013
 
Description Letter published in The Daily Telegraph 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Newspaper letters pages are a well read section of national newspapers and the Daily Telegraph is read internationally. The letter I wrote in response to the coverage of the Tony Nicholson legal case was published and continues to be available online.

No know impacts
Year(s) Of Engagement Activity 2013
URL http://www.telegraph.co.uk/comment/letters/10526174/Poorer-than-your-parents-Baby-boomers-have-worke...
 
Description Suicide Walk (Royal College of Art) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact A walk along the Sussex downs discussing different aspects of suicide. Informal discussion with other walkers and interludes of formal presentations about my research. The activity was filmed and subsequently uploaded to a dedicated website. Clips of the footage also shown at RCA exhibition.

No known impacts
Year(s) Of Engagement Activity 2013
URL http://www.suicidewalk.org
 
Description hospice talk (Bradford) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Health professionals
Results and Impact Talk was well attended (beyond expectations) with people standing at the back due to a lack of seats. Some of the palliative care faculty from Bradford University also attended. The post-talk discussion lasted for 40 minutes and involved some passionate views being expressed.

After my talk, the Medical Director suggested I publish my findings in the journal Palliative Medicine as she thought others in the discipline should benefit from reading my findings.
Year(s) Of Engagement Activity 2014
 
Description hospice talk (Greenwich & Bexley Cottage Hospice) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Health professionals
Results and Impact talk prompted questions and discussion.

The hospice Chief Executive was very interested in the findings and requested an electronic copy of the book chapter for circulation to staff and volunteers who could not make it on the day.
Year(s) Of Engagement Activity 2014
 
Description hospice talk (Harrogate) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Health professionals
Results and Impact talk prompted questions and reflection.

The hospice Chaplain was particularly interested in the research and asked for a copy of the book chapter on which the talk was based.
Year(s) Of Engagement Activity 2012