Dehumanization is the process of stripping away human qualities, such as denying others their individuality and self-esteem. With the rapid increase in medical technology many basic human qualities surrounding the care of the dying have been lost. Dehumanization is like a form of self-death that now often precedes physiological death owing to the institutionalization of the dying. For millennia the process of dying and the presence of death were both close and familiar realities of everyday life. Many people died in the bed they were born in, surrounded by their family and friends. Called "tame death" by the French philosopher and death expert Philippe Ariès, it was natural, expected, and integrated into the rhythms of life. The Russian novelist Leo Tolstoy, in his epic work War and Peace (1869), comments that when a relative is sick the custom is to seek professional care for him or her, but when a loved one is dying the custom is to send the professionals away and care for the dying within the family unit. The naturalness to dying that Tolstoy describes has undergone a radical shift in the modern era.
The history of medicine was originally the art of personal caring and compassion. Since the Enlightenment, what was originally an art has become more clearly a science. In the twenty-first century the science of medicine focuses on curing disease and thus views death as a defeat. It is no longer natural or tame, but fearsome and strange. Increasingly it is the disease and not the individual being treated. The equally rapid development of medical technology has blurred the border between life and death. Life-sustaining machines have initiated new definitions of death, such as "brain death," into the medical lexicon. Medicine has become an increasingly technological profession. This has led to the modern phenomenon of dying when the machines are shut off or what the philosopher Ivan Illich calls "mechanical death." Illich states that mechanical and technical death have won a victory over natural death in the West.
H. Jack Geiger notes that the dehumanizing aspects of health care mainly deal with the loss or diminishment of four basic human qualities: the inherent worth in being human, the uniqueness of the individual, the freedom to act and the ability to make decisions, and the equality of status. While all people are worthy of the same care and attention from health care services, people instead receive it according to their social and economic status. Basic human services and all aspects of the health care are distributed unequally throughout society depending on economic and political power and status. This implicit loss of human worth is especially dehumanizing for the poor and marginalized in society.
The medicalization of the dying process, enhanced by increasing technology, has resulted in increased isolation and dehumanization of the dying. People are surrounded by machines in intensive care units rather than by their families at home, and often people are treated as objects without feeling. The scholar Jan Howard notes this often occurs with acute care patients who are seen not as unique individuals but as extensions of the life-sustaining machines they are attached to at the end of their lives. Dehumanization of the dying acts to lessen the impact of death for survivors in a death-denying culture.
These trends are reinforced by advances in technology and by larger and more impersonal systems of health care that have developed. What has become known as the "tyranny of technology" has forced those involved in health care to become more technologically sophisticated. This in turn has lead to an increased sense of professionalism and specialization within all aspects of medicine. Such professionalism has been characterized by a growing detachment from the unique concerns of individual patients and a loss of personal relationship to them. Physicians and other health care workers now react less as individuals in relationship to other individuals and more as representatives of their professions and their health care organizations. This results in a loss of autonomy and decision-making ability on the part of the patients and sometimes of their families as well. The policies and procedures of insurance companies and health maintenance organizations (HMOs) determine many critical health issues facing people in the twenty-first century. This loss of freedom is yet another dehumanizing effect of modern technology.
The advances in the scientific and technical aspects of medicine have increasingly made people dependent on strangers for the most crucial and intimate moments of their lives. Health care professionals and health care organizations have become more impersonal and bureaucratic. There is an obvious inequality of status between those in need of medical care and those whose profession it is to respond to that need. This inequality coupled with the impersonal quality of care they are offered leads to mistrust and a feeling of dehumanization.
The rise of hospice organizations, holistic medicine curricula in medical schools, and in-service programs in hospitals has attempted to address these dehumanizing aspects of modern medicine. Dying is one of the most personal and intimate times in a person's life. At that time, more than any other perhaps, people need their inherent worth valued, their uniqueness affirmed, and their ability to make decisions honored by those who care for them.
Ariès, Philippe. Western Attitudes toward Death: From the Middle Ages to the Present, translated by Patricia M. Ranum. Baltimore: Johns Hopkins University Press, 1974.
Illich, Ivan. Medical Nemesis. London: Calder and Boyars, 1975.
Geiger, H. Jack. "The Causes of Dehumanization in Health Care and Prospects for Humanization." In Jan Howard and Anselm Strauss eds., Humanizing Health Care. New York: John Wiley and Sons, 1975.
Howard, Jan. "Humanization and Dehumanization of Health Care: A Conceptual View." In Jan Howard and Anselm Strauss eds., Humanizing Health Care. New York: John Wiley and Sons, 1975.
Tolstoy, Leo. War and Peace. 1869. Reprint, New York: E. P. Dutton, 1911.
Van Zyl, Liezl. Death and Compassion. Burlington, VT: Ashgate, 2000.
THOMAS B. WEST