Background and objectives

This paper explores current concerns and practice related to older people dying alone in Intensive Care Units, care homes, and at home through media discussions during the Covid-19 pandemic and before. It addresses the historically-situated concept of a good death and a bad death and suggests why dying alone, whether completely alone or without significant others physically present, may be considered a bad death.

Methods

As evidence for collective fears about dying alone, we explored the treatment of these deaths in media using headline examples from the US New York Times and the English Guardian newspaper from the 19th century through Sept. 2020.

Results

A search of the New York Times located 39 articles with either lonely dying or lonely death in the headline. The Guardian had 25 articles with use of the term, but unlike the New York Times, no obituaries were included. Although the deaths profiled were deemed unusual, deaths by suicide were only minimally classed as dying alone. The condition of dying alone is represented as a stigmatised death. Themes addressed: 1) dying alone is a nonnormative event; 2) this death matters; and 3) where people die alone, societies should honour the death and learn from it.

Discussion and implications

Contemporary dying involves conditions for which we are unprepared as a society. We seldom address our civic obligations to each other. 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. This is an invisible constraint of modern healthcare. Because of limited discussions and preparation, these deaths may lead to disenfranchised grief for the mourners. 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. Recommendations include inclusion of accompaniment/nonaccompaniment at death as part of advance care planning and mitigation if this condition occurs. 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.

中文翻译：

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孤独地死去和孤独地死去：媒体话语和流行病状况

背景和目标

本文通过 Covid-19 大流行期间及之前的媒体讨论，探讨了与老年人在重症监护室、疗养院和家中独自死亡有关的当前担忧和实践。它解决了历史上的好死和坏死的概念，并提出了为什么独自死去，无论是完全孤独还是没有重要的人在场，都可能被认为是坏死。

方法

作为对孤独死亡的集体恐惧的证据，我们使用美国纽约时报和英国卫报从 19 世纪到 2020 年 9 月的标题示例探讨了媒体对这些死亡的处理。

结果

对《纽约时报》的一次搜索发现了 39 篇标题为孤独死或孤独死的文章。《卫报》有 25 篇文章使用了这个词，但与《纽约时报》不同的是，没有包括讣告。尽管描述的死亡被认为是不寻常的，但自杀死亡只是最低限度地归类为单独死亡。单独死亡的情况被描述为被污名化的死亡。讨论的主题： 1) 独自死亡是非规范事件；2) 这个死亡很重要；3) 在人们孤独地死去的地方，社会应该尊重死亡并从中吸取教训。

讨论和影响

当代死亡涉及我们作为一个社会没有准备好的条件。我们很少解决我们对彼此的公民义务。很少有人讨论过他们对死亡的偏好以及他们是否希望以及如何在可能的情况下被陪伴的愿望。这是现代医疗保健的无形约束。由于讨论和准备有限，这些死亡可能会导致哀悼者被剥夺权利的悲痛。对孤独死亡的文化和社会反应对于减轻孤独死亡的情感负担、帮助个人为这种可能性做好准备以及更好地将死亡与生命过程相结合非常重要。建议包括将死亡时的陪伴/非陪伴作为预先护理计划的一部分，如果发生这种情况，则可以缓解。