On Death without Dignity

The Human Impact of Technological Dying

David Moller, David Wendell Moller

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9780415783835
  9780895030672
• Edition: 1
• eBook ISBN:
  9781351842556
• Topic: Social Sciences
• Subtopic: Mental Health in Psychology
• Index: Social Sciences

Candidly written, ""On Death Without Dignity: The Human Impact of Technological Dying"", attempts to re-humanize the inevitable biological occurrence called dying. It is Moller's view that through the advancement of medicalized technology, has come the demise of the contemporary dying process. The oncological death is reflected as failure in the part of modern medicine, the physician, and the hospital; yet the patient experiences alienation, stigma, helplessness, and normlessness. Yet as a culture the current societal approach to the dying-silent avoidance-only adds to this alienation. Society has failed to provide the necessary rules for this universal, social, and biological event.

CHAPTER
1

Technology, Meaning and Death

How the tumor was spreading! Seen through the eyes of a complete stranger it would be frightening enough, but seen through his own …! No, this thing could not be real. No one else around him had anything like it. In all his forty-five years Pavel Nikolayevich had never seen such a deformity … [1, p. 18]

“If only it would stop growing!” said Pavel Nikolayevich, as though begging it to stop. His voice was tearful. “If only it would stop! If it goes on growing like this for another week, Goodness only knows. …” No, he couldn’t say it, he couldn’t gaze into the black abyss. How miserable he felt—it was all touch-and-go. “The next injection’s tomorrow, then one on Wednesday. But what if it doesn’t do any good? What shall I do?” [1, p. 176]

Alexander Solzhenitsyn

Science and technology assume a panacea-like character; given only time, the fantasy is that all problems will capitulate to it. Man is really a Promethean and there is presumably nothing he cannot accomplish [2, pp. 260–261].

Alvin Gouldner

As one surveys the values, institutions, and people of America, it is not difficult to see the centrality of science and technology to the economic and social forces of society. In many ways the combined scientific and technological efforts of the private and public sector are so vast that they are beyond the comprehension of ordinary citizens. Yet, technology has become so consistently and deeply a part of everyday life that American people have fallen rather blindly in love with it [3, p. 34], albeit if in a take-it-for-granted way. As Edward Shils observes, Americans have fully committed themselves to a scientific way of life even without concrete guarantees and evidence that science improves upon the quality of life:

… readiness to support science rests in part on the belief that science contributes to the material well-being of society. … At present, the evidence that fundamental scientific research contributes to material well-being is very uneven and not by any means vigorously conclusive. The conclusion is accepted because there is a mood to accept it…. But it is largely a matter of faith … and derived from a profound and diffuse “will to believe” in the efficacy of science [4, p. 3].

This faith in science reflects an underlying attitude of the American people; a sensibility which inherently values science and its ways of life. Consistent with the conviction that science improves the livability of life is the belief that technological by-products of scientific activity make life more meaningful and facilitate the improvement of personal and social problems [5, Chapters 2, 3, 4, 5]. While it may be overstating the current course of affairs to suggest, as Ellul [6] and others have, that America is exclusively dominated by technical forces, it is not pressing too far to note that recent decades of American life have given rise to a sustained and national commitment to a scientific and technological orientation.

Some scholars would have us believe that technology is ethically neutral, that is to say, that once having been created, it does not possess self-sustaining life or momentum of its own but rather is used for purposes good or bad by humanity. While I do not necessarily disagree with these utopian scholars who see technology as a tool in the hands of humanity, there is mounting evidence that the presence of the tool has an inevitable and significant impact on the tool holder. In addition, the philosophy which surrounds and has been internalized by the tool holder, a philosophy which promotes the value of tools in particular and the process of tool making in general, has an intractable value-relevant impact on the men and women who use the products of science and technology in their daily lives. Thus, while humanity may not be inescapably imprisoned by technological forces, the role of technology in modern society is so pervasive that individuals cannot avoid being influenced and directed by the social forces which associate with technology and its development.

The work of Gouldner is seminal in addressing this issue of the impact of technology on the social conditions of human life. In The Dialectic of Ideology and Technology, Gouldner discusses the transformation of traditional, ritual-based, religious society into systems of thought and activity which are more secular:

The rise and development of modern ideologies was shaped by the rise of modern science, by the growing prestige of technology and new modes of production, and by the development of publics whose favorable judgment of modern science was rooted in the decline of older authority-referencing discourse. Science became the prestigious and focally visible paradigm of the new mode of discourse; it was this mode of discourse, which diffuses the seen-but-unnoticed set of background assumptions, on which science itself was tacitly grounded [2, p. 7].

The connection between science and technology and value-laden ideology is carefully unveiled by Gouldner’s analysis. The inescapable paradox of science, and even of the social sciences, with their pretense to value-neutrality, is that it embraces the values of rationality and efficiency in its quest for objectivity. Thus, as society modernized, that is to say moved toward the grounding of action in rational and secular thought, traditional world views of myth, religion, and metaphysics were systematically devalued. New legitimations appeared in the mantle of science, and were affirmed by the modernizing citizenry. In this way, from its origin, science is not value-free but is carried out within a framework that values the scientific mode of living. Science and technology have become a dominant, value based ideology of society with which, in one way or another, humanity has to come to terms.

In an important way, the American scientific and technological orientation affects the symbols and the values to and through which people relate to society and society “relates” to people. For example, as the power of traditional systems of authority declined and was supplanted by the growth of rationalization of thought, one of the primary underlying catalysts of the growth of the rational orientation was the development of the technology of printing. As printing became more and more widespread, explanations for human and social living were no longer exclusively linked to sacred and unquestionable definitions of the world. The idea of rational discourse, the intellectual clash between competing and often contradicting interpretations of reality, became increasingly relevant for society. But the age of rationality presumed literacy and hence elicited the development, spread, and organization of printing. This, in turn, produced a growing supply of pamphlets, newsletters, newspapers, books, and journals that were partly a response to and partly a source of growing literacy [2, p. 40].

The relevant point is twofold: 1) the revolution of printing technology was grounded in a culture of growing scientism, and; 2) the technology of printing had an important impact on shaping the social character structure of human personality. The following discussion illustrates one of the major consequences of this technological-social change for human personality.

Prior to printing, human communication primarily occurred in a social context among human aggregates: people talking face to face with others. Communication was inherently a collectivizing social phenomenon. However, the printed word began another tradition, one of the isolation of human communication. As Neil Postman comments, with the printed book came the isolated reader and his private eye. In this sense, reading and printing technology represented a conspiracy against human community and social presence [7, p. 27]. Indeed, as Gouldner suggests, printing does allow for separation of talk from the talker [2, p. 41], but more importantly allows for a single individual to speak to large numbers of distinct and unrelated individuals in the absence of a shared social context. Additionally, the more contemporary development of electronic media technology (radio, television) has made the separation of physical proximity and social interaction-communication all the more widespread and accessible [8, pp. 116–118].

Thus, printing technology initiated the mass media movement which introduced into society the social categories of public and mass society. But the irony of this is that the existence of a public requires people to be treated as private persons [2, p. 98]. In the framework I have briefly delineated here, one can see how the modernization of society has entailed the transformation of once isolated individuals into a public while simultaneously keeping the public isolated individuals. The massifìcation of modern-technical society then was predicated on the privatization of the individual and the technological revolution of European society inherently gave rise to the burgeoning of individualism [9].

I have selectively sketched the association between technology and individualism in the modem society to stress that the progress of modern civilization itself was and is largely defined by these social forces. Indeed, the technological foundation of society in large part facilitates the excessive individualism, detached egoism, and absence of shared concerns which characterize our age [10, 11]. It is also these social forces of technology and individualism, inherent to the modern American way of life, which are pre-eminent factors in shaping and defining the experience of dying and death for modern individuals.

MEANING OF DEATH OR DEATH OF MEANING

The scientific orientation of American society is closely linked with the value of materialism. In other words, science has merged with technology and technology has become science-based [12]. The core motivational ideology of society lies within this framework of the fusion of science and technology. But yet, the scientific and technological orientation is a dominant force in society, not just in an ethereal-ideological way, but as part of a concrete, pragmatic program of social progress and personal betterment. The technological consciousness of modern American society sees science and technology as a utopian absolute, integrating good intentions with unlimited possibilities, in the pursuit of the elimination of social evils [2, Chapter 12; 5, Chapter 2]. However, the technocratic consciousness becomes meaningfully relevant to the everyday life of ordinary citizens through the value of materialism, and the loyalty of ordinary citizens is cemented to the technocratic system through technologically based gratifications, that is to say, “consumerism” [2, p. 262].

The degree to which the technocratic way of life is adopted by society and its people, the definition of personal and social worth becomes characterized by the equation, I AM = WHAT I HAVE AND WHAT I CONSUME [13, p. 15]. More importantly, within a framework where the value of life is defined through possessions and materialism, death and dying represent penultimate threats to the utopian vision of the technocratic world view. Dying and death threaten to deprive one of security, of identity, of those qualities which provide modern individuals with a sense of self-importance and social status. Thus, as long as the technocratic way of life and definition of reality prevail, dying and death must be feared. Erich Fromm effectively articulates the point:

There is only one way–taught by the Budda, by Jesus, by the Stoics, by Master Eckhart–to truly overcome the fear of dying, and that way is by not hanging onto life, not experiencing life as a possession. … The fear, then, is not of dying, but of losing WHAT I HAVE: The fear of losing my body, my ego, my possessions, and my identity; the fear of facing the abyss of nonidentity of “being lost.” To the extent that we live in the having mode, we must fear dying [13, p. 112].

Dying is intolerable to the technocratic consciousness since it blemishes the technical ideals of omnipotence and abundance, with scarcity and vulnerability. Dying points out the weaknesses of the technological and scientific lifestyle. Literally dying, especially from cancer, means encroaching helplessness, physical deterioration, alienation, emotional turbulence, and of course, makes the pursuit of materialism empty and moot. The major societal response to the intolerable social evil of dying is technological intervention. As we shall see in subsequent chapters, it is the technological orientation of society in general and of the profession of medicine in particular which is unable to provide for legitimation, purpose, and meaning to the dying experience. Consequently, an antagonistic relationship between technocratic consciousness and dying is spawned and the ultimate goal of the technological management of dying becomes the defeat of death.

I do not mean to imply that the technocratic coordination of society and the technical management of death have marched forward without resistance. In recent decades the counter-cultural movement of the sixties and the invasion of the theme of ‘hi-touch’ in the seventies and eighties has sought to bring something seemingly non-technical to the technological orientation of modern social living. Indeed, one response to the growth of the technical system was the emergence of a highly individualized, personal value system to compensate for the impersonal nature of technology. The result was the new self-help or personal growth movement [14, p. 36]. As we have already seen, individualism is historically consistent and compatible with the technological framework of modem civilization. It is therefore logical that resistance to an increasingly technocratic style of living would assume the character of individual self-expression and development. It is in this way that the ‘hi-touch’ movement pursues qualities that reflect the non-technical and non-mechanical side of life but are also harmonious with the broader values and framework of technological society.

The human potential movement is not representative of a fundamental change in the sensibilities of the American culture and its people. This is precisely why the self-growth movement is accepted and even enhanced by the technocratic consciousness. The nature of self-expression and growth, in the contemporary social setting, is consistent with the HAVING ORIENTATION of the broader technocratic society. The self in the human potential movement is o...

Table of contents

• Cover
• Title Page
• Copyright Page
• Dedication
• Preface and Acknowledgements
• Introductory Précis
• Table of Contents
• Introduction
• Chapter 1 Technology, Meaning, and Death
• Chapter 2 Death and Denial in Modern America
• Chapter 3 Technological Medicine, The Technocratic Physician and Human Dying
• Chapter 4 Individualism, Fellowship, and Dying
• Chapter 5 Modern Dying and Social Organization of the Hospital
• Chapter 6 The Stigma of Dying
• Chapter 7 Approaching Omega: The Roller Coaster of Dying
• Chapter 8 A Concluding Statement on Technology and the Social Isolation o f Dying
• A Methodological Note
• Index