The US is a dying society
The people living alone in our society, the so-called singles, who are not part of the family, already represent a third of all households on a national average (Federal Statistical Office).
Figure 12: People living alone
35,256 private households
11,858 one-person households
There are of course enormous differences between rural and urban regions. Again in my hometown of Bingen, 42% of the people in the core city with a population of 20,000 already live in one-person households, in the suburbs around 38%.
In summary, here are a few remarks on the
4. Consequences of the civilization process:
According to Norbert Elias, who first reported "on the process of civilization" in 1936 and summed up "on the loneliness of the dying" in 1982 and analyzed the resulting consequences, came to the conclusion that the current process of civilization tended towards individualization and thus also towards development -Socialization becomes evident. For the dying person, this means that his parting process comes from the life that was previously integrated into the life family and with it salvaged was, is becoming more and more lonely, even in one of the institutions that have been available up to now, such as clinics, hospitals, old people's and nursing homes. Because only the number of people working there is not identical to the number of accompanying people, i.e. the people who should be available in these facilities for terminal care.
The more successful medicine has become since the sixties, the more the conscious handling of dying and thus of the dying themselves has been suppressed in this development.
The more manipulable human life has become in the past decades, the greater the expectation of the population that it will be manipulable and, ultimately, that of an illusory avoidance of dying and death.
The more "insurable" the people of our generation became, the more the thought grew here and there of being able to insure oneself in some form at least against dying and thus probably also against death (preserved corpses in the USA).
But secretly it is absolutely certain that, besides the certainty of our life, we are really only certain of the certainty of our aging and also of the certainty of our death. But if that is the case, then death should take place as quickly as possible (without saying goodbye), as painlessly as possible (without agony) and, if possible, at night in sleep (unconsciously). In the present, this is very often what the dying want when they are asked about them. But also those affected have their wishes, namely that of dying in secrecy ("in complete silence") and that of repression (just don't have to think about it, just don't have to talk about it).
All of these mechanisms of repression have (according to Elias) both an individual and a social face.
The individual content of repression is primarily shaped by formulations such as:
"Something like this won't happen to me, especially not so soon"
"And if so: everything is over with death anyway"
"This is no longer life (depending on addiction, illness, suffering and incurability) - so get rid of it as soon as possible!"
As part of his logotherapy, Viktor Frankl coined the term of suffering from life that appears meaningless. In a modification of this formulation, in our case, couldn't one also speak of a "suffering from seemingly meaningless death"? And the question here is not only permitted, but necessary to ask how we should best deal with such mechanisms of repression in the future .
The "social face" of repression also has its very specific causes:
For one thing, the traditional rituals have become suspicious and embarrassing for many people,
on the other hand, such embarrassments tend to leave you speechless and mute,
Furthermore, we have become poor in our verbal communication language,
and finally we live, as it were, in an age of "lost closeness" (Pera) and this is to be understood physically and personally.
All of this has often led to the social death often precedes physical death very consciously - and not only in our old people's homes. "They have already died while still alive"! And in our hospitals the dying situation is often given a (new) social shape with institutionalized routine. At the same time, however, the dying situation in our society is transformed into a "blank spot" on the social map. And if we are already clear about the fact that development aid is necessary in an all-encompassing sense, then our society, even in our welfare state, needs such aid in an all-encompassing sense: In care for the dying, we are actually a developing country! However, this situation can not only (but also) be changed through financial measures; Rather, it also requires the courage of each individual to allow his willingness to serve others and, in this context, to show feelings of belonging and security. If an anesthesiologist I know still says today, "He does not believe in holding hands," then one must be able to ask whether medical science has nothing or nothing to do with medical science.
And how are those affected? All of these uncertainties make people afraid of dying and shy of dealing with the dying and the grieving. For the dying person, however, there is also the fear of losing his independence through dependency, the fear of losing communication through isolation, the fear of losing his integrity through distortion, the fear of losing a pain-free life and even psychological degeneration , but also ultimately the fear of the loss of meaningful content through a seemingly meaningless death.
All of these fears cause the repressions described of a social and individual nature. Suffering from a life that appears personally to be meaningless (in dying) also has a social category (Elias):
- The being that isolates itself again in its dying apparently loses its meaning "as an associated subject in the plurality of people connected to one another";
- the togetherness in a common realization of meaning is thus definitely lost;
- a life lived meaningfully up to now apparently lacks its meaning, "since it can no longer do or be for others" and only has to die;
- the inability to achieve goals any longer makes everything more and more meaningless for the person affected by his death.
"Has the death but nothing terrible in itself "(- death is no longer experienced); dying, on the other hand, is still very much, because this is what one experiences:
- In pain and agony
- in isolation and isolation,
- in the strangeness of the place,
- in the question of "why?"
But there is also help here:
- For example in the friendship of the survivors,
- in open and honest conversation,
- in survival in a memory of others,
- in accepting dying as an integral part of life.
Now we come to the resulting ones
To open up these are the goals of the Hospice idearegardless of whether you are at home (as your final destination),
whether they are in hospices or homes (for singles, the elderly and those in need of care),
or whether it is implemented in the palliative care units of hospitals.
What should and will care for the dying in this situation?
The realization of the hospice concept basically goes back to Cicely Saunders, who opened the first hospice on European territory in London in 1967. (What is said to have already happened in hospice realizations in Poland, for example, actually corresponded to the services in our old people's and nursing homes.) Saunders wanted nothing more than to bring the dying home to the security of a hospice, after having worked as a nurse, The social worker and doctor had to learn how often people died inhumanely in the hospitals of the cosmopolitan city of London. From the very beginning, hospices were not binding end-of-life stops for them at any price, but rather "rest stops on the way" (P. Becker).
In 1971, the first German version of her book "On death and dying" under the German title "Interviews mit Sterbenden" by Elisabeth Kübler-Ross made our society aware that dying is also a part of life (for everyone) that communication with the dying is important and possible, that the companions have the right to be accompanied, and that all service to the dying also has the meaning of "being reminded of one's own future".
In the following years, Twycross and Lamerton recognized and secured the importance of freedom from pain while maintaining the consciousness of the dying person, thus creating the prerequisite for people to be able to die at home in familiar surroundings, in the security of their families and free from avoidable agony and pain .
In this context in particular it is and remains a scandal that, despite a possibly achievable freedom from pain or pain relief, up to 80% to 90% of all dying people only get about 15% to 20% "enjoyment of such security"! Basically this is nothing more than a failure to provide assistance, which must not remain.
In our Federal Republic of Germany, from 1971 onwards, the first approaches for a "different way of dealing" with dying and thus with the dying developed. It is worth remembering the first initiatives in Limburg, Aachen and Munich.
Since 1981, the first steps towards the implementation of anticipatory pain therapy have been taken, again in Limburg and in Ludwigshafen.
Since 1982, seminars for the introduction to terminal care have also been implemented from here in the former GDR for the first time.
Since 1987, active hospice helper groups have been set up in Austria, Switzerland, Luxembourg, German-speaking South Tyrol and East Belgium.
3. What does the hospice movement want now?
Perhaps, here today, the content of the hospice idea, which is always being developed, can be presented in the following way:
- To make people aware of the content of dying, death and mourning in our society and thus to remove the taboo.
- To meet the needs, expectations and hopes of the dying and grieving (and this in physical, emotional, social, spiritual and legal terms).
- To enable relatives, friends, full-time and voluntary employees in medicine, nursing, social work, pastoral care, psychology and sociology to accompany and support each other (such as through the hospice training center of the International Society for Terminal Care and Living in Bingen and through the hospice training center of Maltese in Bad Kreuznach).
- To allow dying to happen in a humane manner wherever it happens (i.e. at home, in hospices, in palliative wards, in homes, in prisons, in monasteries, etc.).
- Ultimately, no longer preventing the dying person from being brought home to the security of his or her place of life or another place of security, but rather to make it possible. (In doing so, hospices must never become mandatory, legally prescribed end stations.)
4. What has happened so far?
- In the meantime there are around 20 hospice facilities in the Federal Republic of Germany (albeit of very different forms), whereby the question must already be asked whether these are real hospices in the original sense.
- After a three-year model test by the Federal Minister for Labor and Social Affairs (BMAS), a number of palliative wards are now being planned and implemented in hospitals.
- Countless local and regional hospice initiatives have now been set up.
- This year, a state working group for hospice initiatives was established with the government in Rhineland-Palatinate (as before in North Rhine-Westphalia) and became a contact point for the preparation of political decisions.
- Has started a nationwide educational work, which should be nationwide, general and job-related.
- A federal working group of all hospice initiatives has been founded, which will act as a corresponding mouthpiece for the federal authorities.
5. What is still missing?
- In the university area on subject-related teaching content (in medicine, sociology, psychology and theology) but also at our universities of applied sciences as part of the social work / social pedagogy courses, and to a large extent still at our nursing and geriatric care schools.
- The general binding nature of anticipatory pain therapy (approval regulations) and generally valid recognition of palliative medicine in the teaching and field of medicine in general.
- A consensus between the state, churches and social institutions (Caritas, Diakonie, AWO), whereby cooperation among the federal ministries, but also with the respective state ministries, must be classified as urgently necessary.
- Uniform educational concepts (such as are currently being developed in a working group at the BMAS, for example).
- Comprehensive outpatient home care services, which are a first and essential prerequisite for all hospice work and which require unconditional cooperation with the social stations, mobile social services, local doctors, etc.
- Sufficient facilities of independent hospices and independent integrated palliative wards in our hospitals as well as a binding definition of the term hospice.
- g.) A sufficient number of volunteers and full-time employees (as well as their support by supervision).
- h.) To their legal (e.g. through a hospice law) and financial (e.g. through mixed financing) security. It is simply no longer acceptable that helpers are expelled from ministry to ministry, from office to office, from door to door, from paragraph to paragraph and, as in the past, have to beg in the future in order to get away with their selfless service To be able to keep "red numbers" free. If a hospice in Recklinghausen is still dependent on 60% of its financing through donations, then this is and will remain an untenable situation and the question of the political responsibility of such circumstances may well be allowed at this point be asked.
- i.) Because of the jointly responsible willingness to perform of some health insurances, also in the recognition and financing of psychosocial services and the associated services, they are also "health insurers" for the mental health of their members!
- k.) Some clarifications within the framework of the federal long-term care insurance, whereby the recognition of psycho-social services and their financing must finally be secured.
- l.) In the approval and support of justified model projects beyond the previous modest framework, but bound to the requirement of corresponding competence.
- m.) The willingness of families, neighborhoods and local communities to rooming-in.
Only through a cooperation of all willing and committed in thinking, speaking and To do we will succeed in realizing what has brought us together here and here and which finally needs to be set in these hours.
Ultimately, the way society deals with dying and death will only be given a different face, i.e. a human face, if:
- Terminal care in our society (and that is what we are) receives the recognition and support it deserves (and without which it will "die");
- when the dying themselves are no longer separated from the community of the living and those affected are no longer left alone in their grief;
- when we are all finally ready to let the death of others remind us of our own future and thus to make ourselves aware now of what will be and remain important in our own death.
© Friedrich Ebert Foundation | technical support | net edition fes-library | March 1999
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