Chages and Chalenges

Abstract:

Understanding what constitutes quality end-of-life care from the perspective of the patient, their family, and health care professionals has been a priority for many researchers in the past few decades. The aim of this paper is to determine the perception of the „good death” meanings, by reviewing changing patterns of the quality of death statement in the traditional Romanian community and nowadays, paying particular attention to differences between the past and the present. For the past, the investigation of the ethnographic material,narrative folklore and ecclesiastical art has disclosed that we may ‘categorise’ good death as having a social, a psychological and a spiritual character, a time and a spatial aspect. Nowadays, we often talk about the quality of dying in the context of palliative care system. But the determination of death quality is limited to medical, philosophical, legal and ethical issues and this is seen in the articulation of a „good enough death”. Nevertheless, the care accorded to dying patients is organised in a scientific and reductive way, by a process that seeks to categorise by comparison and similarity. Medical responses to symptom management appear, in this context, rather to offer a routinised response to the uncertainty of dying than a psychological, social, and spiritual counselling needed to help facilitate a good death. A lack of control and a lack of language to talk about making death good is evident not just in the palliative care community, but in the broader Western society, that is also analised in this study.

Keywords: good death, traditional community, ethics, palliative care, terminal patient.

Introduction

The influencing aspect of consciousness of death is active over the entire life span and is not restricted to the sick or aged. The meaning of death is multidimensional and varies not only between individuals but within the same person . Dying and death have psychological, spiritual and social features and are not merely biological events.

What do we mean when we say that someone had a good death? Talking about a person’s death focuses upon its perceived „goodness” or „natualness”. The aim of this study is to focus attention on the values of the human person, considered under the changes of the contemporary process of globalization. Paradoxically, continuous qualitative increase of the quality of life cause more and more fragmentation in the human being’s understanding of himself/herself and his/her own cultural and social environment. Within this perspective we identify new challenges addressed to the present role of the humanities, medicine and technology, which entail a diagnosis of classical, modern and postmodern models of thinkings related to the problems of good death. In Romanian area, the Thanatos continues to be dominated by archetypal symbols, superstitions and rites, in a dramatic confrontation between archaic and modern mentality. Finally, the study will provide the special opportunity to discuss of the extent to which medical and scientific measures erode traditional religious consolations for the problems involved in dying and bereavement ,

Romanian folk tradition of death pending

”Death itself can not be than an indifferent reality (Moartea în sine nu poate fi decât o realitate indiferentă), just the way we look at and understand it is unable to give it some sense, negative or positive” . In the world of the Romanian village, the people reacted to death as something to fear but in some respects also as something to be welcomed.

In the collective mind, the fate of man is guided from above de sus, by the supreme court, not in the sense of a protestant predestination, but of a divine prescience. The belief that all attempts are from God and are the natural consequence of a violation of moral precepts is often expressed as ”the Lord”s rebuke" and used as a mean of understanding the unpleasant events. Death, event of the last human route, occurs under the sign of this divine acceptance. As a result, the Romanian peasant preparation for death can take on a rigorously character of self-examination, repentance and a final submission to the will of God.

The stigma of sudden death, horrifying in the West during the Middle Ages did not decisively influence the Romanian mentality, which feels no need to explain or report it to the dichotomous scheme good death / bad death . In medieval concept, a dignified death should offer respite and warning. Accepting unavoidable aging or suffering may be an opportunity for spiritual growth through humble submission . This kind of premonition was perceived as positive and natural. Unnatural was the sudden disappearance (mors repentina), that would deprive the man of the rites of passage.

In various parties of the country, pleople believe that the man who long struggled to death se chinuie îndelung până moare committed serious sins or he was cursed by or cursed himself. A violent or painfull death indicates some fault and is seen as punishment. Instead, the good death is always serene and, if it happens to still have a long struggle, it is because of sins of any relatives. From Christian perspective, these categorizations are unsubstantiated neîntemeiate or even false, because the judgments on others never belong to people, but is the power of God.

An extraordinary world is revealed in the ethnographic account of traditional mortuary practices. The traditions, situated at the confluence of religious point of view on death and of the folkloric ones, are relatively more ”folkloric”, althought the ideas descend from religious area. Our approach would be incomplete without an analysis that is based on popular piety and the role that Christian tradition has had in shaping the collective mind.

"The key to mental preparation for death – notes I. Ghinoiu – is the three legacy systems: biological (children birth), material (fortune left behind) and spiritual (cultural). Of these, the most valuable heritage that one can leave is the extending of his genealogy by children, grandchildren and great grandchildren” . Perpetuation of genealogical lineage was tantamount to the defeat of death. In the wallachian iconography we can find the scenes of Samson' fight with the lion and the motive of the stork (a symbol al life regeneration), interpreted by A. Paleolog as defeats of death: ”The exterior painting of the monuments of Wallachia proposes a comprehensive program of philosophizing, not so much on the precariousness of existence, but on the theme of life and hope value” .