The hospitalisation of death: should more people die at home?

Dying at home or in an institution

“…The proportion of hospital deaths is indisputably higher in urban areas than in rural or slightly urbanized areas. This is in line with previous findings [6,13]. Next to the influence of the degree of urbanization of the municipality of residence there seem to be modest regional differences (depending on the province of residence) in the probability of a home death.…”

“…Interest in research about place of death often ensues from beliefs [3,[6][7][8] and proof [6,[9][10][11] of better overall end-of-life care for patients dying at home as well as better support for their next of kin. Some authors, however, dispute the a priori superiority of home death.…”

The Social Construction of Death

“…For instance, the hegemonic discourse of a good death as defined in terms of control, autonomy, dignity, awareness, and heroism (see Chapter 1 by Van Brussel in this book) is often explicitly used as a justification for an interest in the place of death (Seale and van der Geest, 2004;Payne et al, 1996;Steinhauser et al, 2000). Emerging medical-revivalist death discourses challenging the medicalised, rationalised and institutionalised death inspire this interest, particularly in home death which is seen as more natural, enabling people to have more control over their quality of life and providing more psychological comfort (Bowling, 1983;Gallo et al, 2001;Wilson et al, 2002;Higginson et al, 1998;Brown and Colton, 2001;Yun et al, 2006). Changes over time in the place of death are also understood within the context of changing discourses around dying control and the good death (Wilson et al, 2002).…”

Dying alone

“…A typical example of such an argument is seen in Bowling's (1983) call for more people to die at home (because 'home deaths are more natural'), linking this to Illich's critique of medicalisation and describing hospitals as 'anxiety provoking' environments where staff 'withdraw' from dying patients. She singles out the danger that in hospitals people will die 'alone with no relatives or friends with them' as opposed to deaths at home which make the dying person 'feel tnore wanted (because) not rejected by the family and/or community'.…”