Medicine
The medicalization of death
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Ainhoa Pérez
Alumni
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MPH, MSc.
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Some articles, such as Lancet Commission on the Value of Death, discuss how the medicalization of death has led to more solitary, impersonal deaths that are disconnected from the community fabric. In this review, we reflect on the process of medicalization in the final stages of life.
Defining death may seem obvious to us; however, far from being an obvious fact, it is one of the most complex questions to answer, leading to complex ontological questions that humanity has been reflecting on for thousands of years. Death is not a one-dimensional event, but a process with multiple layers of causality and meaning. Thus, the ontological question of human consciousness is actually more defining of life and death than the material and bodily element, and with it the vital, cultural, family, personal, spiritual, etc. experience. Thus, the experience of death necessarily implies taking a position on identity, autonomy, dignity, and the value of life.
The institutionalization and automation of medicine in society suppresses other forms of perception, decision-making, and accompaniment of the end-of-life process. Death is thus expropriated and technified, surrounded by monitors and invasive interventions in hospitals. The default policies translate into intervening with everything available, often when there are no reasonable expectations of benefit, even against the wishes of the patient and their family (Nix et al., 2025). At other times, it is the family that pursues such interventionism against all reasonable expectations. This shows the relentless structural reproduction of consciousness: the psyche of doctors and patients is structured in the same way, both reproducing the same technified cognitive and axiological scheme, which produces the framework of meaning of the value of life and death. With its technification and administrative procedures, death comes to be treated simply as a medical event, and is signified as something to be postponed using medical means (Sallnow et al., 2022). This has led to more lonely, impersonal, and disconnected deaths at the experiential, family, community, and cultural levels (Lancet Commission on the Value of Death). Additionally, in diseases such as cancer and in frail patients, aggressive care often increases suffering without proportionally improving survival. Economic incentives, a medicalizing culture, and the social expectations produced by this system fuel this practice, displacing objectives centered on respect for ethical and cultural values and the person's own life process.
This very claim to protocolization implies a one-dimensional, medicalized view of the experience of death. Thus, it is legitimate to ask who decides which practices are appropriate for the end of life, which resources are given access to, and which resources are denied. The fact that a person can decide to undergo a non-interventionist process of death is viewed with suspicion in the medical community. Despite this, community initiatives have emerged that seek to recover the relational and spiritual dimension of dying, offering emotional support, rituality, and continuity of meaning, questioning the medicalization of the end of life (Donley-Fannin, 2024). The goal is not to exclude clinical intervention, but to rebalance it, restoring the family, cultural, and spiritual dimensions of dying. Emphasis should be placed on the cultural, social, and personal expropriation of the meaning of the end of life that medicine has produced. With this, there is a need to include the patient's wishes and beliefs in determining the moment of death (Irfan et al., 2025). The integration of spirituality as a determinant of health remains a pending issue in most systems (Long et al., 2024).
Administrative frameworks define the legitimized and standardized ways of dying. Far from being neutral, this regulation is the product of political and economic choices that suppress values and practices associated with the end of life in order to impose an invasive and one-dimensional view of it. In qualitative studies, people have been asked about the meaning of a "good death." Its meaning varies according to institutional, medical, social, cultural, and spiritual frameworks. For some people, a good death means dying at home and in peace. In a comparative analysis of contemporary discourses on the end of life, Coret and Martimianakis (2023) identified thirteen different ways of describing a "good death." Some prioritize autonomy, control, or the absence of pain; others prioritize spiritual preparation or emotional support. However, death is increasingly seen simply as the result of exhausting all available technical and care resources. These differences are not minor: they reveal radically different individual and family sensibilities and shape political and clinical decisions (Zaman, 2025).
In countries such as India and Japan, spiritual preparation and community rituals remain central, while spiritual care is scarce, poorly adapted, and uneven, especially in the West (Ortega-Gal
MEDICALIZATION OF DEATH
The introduction of techniques such as cardiopulmonary resuscitation, ventilatory support, etc., has prolonged the final stages of life. This change shifted the setting of death to the hospital and gave medical personnel control over the process and meaning of this final stage of life, thereby suppressing the experience and lived reality of the person themselves, stripping away the individual, family, cultural, and spiritual meaning of the end-of-life experience, and turning it into a purely technical and hospital-based act that suppresses other levels of experience, lived reality, and decision-making.Defining death may seem obvious to us; however, far from being an obvious fact, it is one of the most complex questions to answer, leading to complex ontological questions that humanity has been reflecting on for thousands of years. Death is not a one-dimensional event, but a process with multiple layers of causality and meaning. Thus, the ontological question of human consciousness is actually more defining of life and death than the material and bodily element, and with it the vital, cultural, family, personal, spiritual, etc. experience. Thus, the experience of death necessarily implies taking a position on identity, autonomy, dignity, and the value of life.
The institutionalization and automation of medicine in society suppresses other forms of perception, decision-making, and accompaniment of the end-of-life process. Death is thus expropriated and technified, surrounded by monitors and invasive interventions in hospitals. The default policies translate into intervening with everything available, often when there are no reasonable expectations of benefit, even against the wishes of the patient and their family (Nix et al., 2025). At other times, it is the family that pursues such interventionism against all reasonable expectations. This shows the relentless structural reproduction of consciousness: the psyche of doctors and patients is structured in the same way, both reproducing the same technified cognitive and axiological scheme, which produces the framework of meaning of the value of life and death. With its technification and administrative procedures, death comes to be treated simply as a medical event, and is signified as something to be postponed using medical means (Sallnow et al., 2022). This has led to more lonely, impersonal, and disconnected deaths at the experiential, family, community, and cultural levels (Lancet Commission on the Value of Death). Additionally, in diseases such as cancer and in frail patients, aggressive care often increases suffering without proportionally improving survival. Economic incentives, a medicalizing culture, and the social expectations produced by this system fuel this practice, displacing objectives centered on respect for ethical and cultural values and the person's own life process.
DEATH AS A PROCESS OF INSTITUTIONALIZATION
The end of life has become a highly administrative act (Thumma et al., 2024). Death has been transformed into an institutionalized process, that is, one regulated by institutions. Public policies, medical criteria, and legal regulations define what counts as death and under what conditions it is recognized. Although death is usually assumed to be the cessation of vital functions, even within medicine there are still disagreements: is death the loss of brain activity, cardiopulmonary arrest, or the irreversible interruption of organic integration? (Nowak, 2025). The coexistence of definitions generates a "multiplicity of deaths" activated according to the context: clinical, legal, or symbolic (Irfan et al., 2025). Thus, the law oscillates between models such as the Uniform Determination of Death Act in the United States (a law that defines death as the irreversible cessation of cardiopulmonary function or all brain activity, including brain stem functions) and the British common law approach that requires case-by-case decisions (Schuklenk, 2024; Thumma, Weeks & Farahany, 2024). This variability generates differences both in the validation of neurological death and in the legal moment for withdrawing life support. Some advocates of brain death argue that this criterion allows respect for life to be reconciled with the viability of transplants. Others reject it as insufficient and risky, especially when the body maintains functions thanks to life support (Nowak, 2025).This very claim to protocolization implies a one-dimensional, medicalized view of the experience of death. Thus, it is legitimate to ask who decides which practices are appropriate for the end of life, which resources are given access to, and which resources are denied. The fact that a person can decide to undergo a non-interventionist process of death is viewed with suspicion in the medical community. Despite this, community initiatives have emerged that seek to recover the relational and spiritual dimension of dying, offering emotional support, rituality, and continuity of meaning, questioning the medicalization of the end of life (Donley-Fannin, 2024). The goal is not to exclude clinical intervention, but to rebalance it, restoring the family, cultural, and spiritual dimensions of dying. Emphasis should be placed on the cultural, social, and personal expropriation of the meaning of the end of life that medicine has produced. With this, there is a need to include the patient's wishes and beliefs in determining the moment of death (Irfan et al., 2025). The integration of spirituality as a determinant of health remains a pending issue in most systems (Long et al., 2024).
Administrative frameworks define the legitimized and standardized ways of dying. Far from being neutral, this regulation is the product of political and economic choices that suppress values and practices associated with the end of life in order to impose an invasive and one-dimensional view of it. In qualitative studies, people have been asked about the meaning of a "good death." Its meaning varies according to institutional, medical, social, cultural, and spiritual frameworks. For some people, a good death means dying at home and in peace. In a comparative analysis of contemporary discourses on the end of life, Coret and Martimianakis (2023) identified thirteen different ways of describing a "good death." Some prioritize autonomy, control, or the absence of pain; others prioritize spiritual preparation or emotional support. However, death is increasingly seen simply as the result of exhausting all available technical and care resources. These differences are not minor: they reveal radically different individual and family sensibilities and shape political and clinical decisions (Zaman, 2025).
In countries such as India and Japan, spiritual preparation and community rituals remain central, while spiritual care is scarce, poorly adapted, and uneven, especially in the West (Ortega-Gal
References:
Aas, S. (2024). What We Argue About When We Argue About Death. The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 49(4), 399-413. https://doi.org/10.1093/jmp/jhae016
Akdeniz, M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations at the end-of-life care. SAGE Open Medicine, 9, 20503121211000918. https://doi.org/10.1177/20503121211000918
Coret, M., & Martimianakis, M. A. (Tina). (2023). Conceptualizations of "good death" and their relationship to technology: A scoping review and discourse analysis. Health Science Reports, 6(7), e1374. https://doi.org/10.1002/hsr2.1374
Donley, S., & Fannin, C. (2024). "Death Bouncers" and "Spiritual Guides": How End-of-Life Doulas Provide, Frame, and Navigate Spirituality and Spiritual Care. OMEGA - Journal of Death and Dying, 00302228241274969. https://doi.org/10.1177/00302228241274969
Escohotado, A. (1998). Historia general de las drogas. Espasa-Calpe
Irfan, B., Padela, A., & Sirvent, R. (2025). Accepting the Multiplicity of Definitions of Death. The American Journal of Bioethics, 25(9), 22-25. https://doi.org/10.1080/15265161.2025.2529950
Long, K. N. G., Symons, X., VanderWeele, T. J., Balboni, T. A., Rosmarin, D. H., Puchalski, C., Cutts, T., Gunderson, G. R., Idler, E., Oman, D., Balboni, M. J., Tuach, L. S., & Koh, H. K. (2024). Spirituality As A Determinant Of Health: Emerging Policies, Practices, And Systems: Article examines spirituality as a social determinant of health. Health Affairs, 43(6), 783-790. https://doi.org/10.1377/hlthaff.2023.01643
Martineau, I., Hamrouni, N., & Hébert, J. (2024). From ontological to relational: A scoping review of conceptions of dignity invoked in deliberations on medically assisted death. BMC Medical Ethics, 25(1), 96. https://doi.org/10.1186/s12910-024-01095-z
Nix, H. P., Sergeant, M., & Shetty, N. (2025). Policy nudges toward medicalizing death and their impact on planetary health. Healthcare Management Forum, 08404704251348813. https://doi.org/10.1177/08404704251348813
Nowak, P. G. (2025). When does life end? Consensus and controversy in defining death. Monash Bioethics Review. https://doi.org/10.1007/s40592-025-00262-1
Ortega-Galán, Á. M., Cabrera-Troya, J., Ibáñez-Masero, O., Carmona-Rega, M. I., & Ruiz-Fernández, M. D. (2020). Spiritual Dimension at the End of Life: A Phenomenological Study from the Caregiver's Perspective. Journal of Religion and Health, 59(3), 1510-1523. https://doi.org/10.1007/s10943-019-00896-6
Prado, E., Marcon, S., Kalinke, L., Da Silva, M., Barreto, M., Takemoto, A., Birolim, M., & Laranjeira, C. (2022). Meanings and Experiences of End-of-Life Patients and Their Family Caregivers in Hospital-to-Home Transitions: A Constructivist Grounded Theory Study. International Journal of Environmental Research and Public Health, 19(20), 12987. https://doi.org/10.3390/ijerph192012987
Rodríguez Reséndiz, H., & Rodríguez Reséndiz, J. (2024). Digital Resurrection: Challenging the Boundary between Life and Death with Artificial Intelligence. Philosophies, 9(3), 71. https://doi.org/10.3390/philosophies9030071
Sallnow, L., Smith, R., Ahmedzai, S. H., Bhadelia, A., Chamberlain, C., Cong, Y., Doble, B., Dullie, L., Durie, R., Finkelstein, E. A., Guglani, S., Hodson, M., Husebø, B. S., Kellehear, A., Kitzinger, C., Knaul, F. M., Murray, S. A., Neuberger, J., O'Mahony, S., ... Wyatt, K. (2022). Report of the Lancet Commission on the Value of Death: Bringing death back into life. The Lancet, 399(10327), 837-884. https://doi.org/10.1016/S0140-6736(21)02314-X
Schuklenk, U. (2024). Time to rethink assisted dying? Bioethics, 38(4), 273-274. https://doi.org/10.1111/bioe.13286
Smith, D. G. (2024). Proposing a new history of grief's medicalisation: A critical discourse analysis. Sociology of Health & Illness, 46(7), 1306-1326. https://doi.org/10.1111/1467-9566.13770
Thumma, S. A., Weeks, E., & Farahany, N. A. (2024a). By Statute or by Common Law? The Legal Determination of Death. The American Journal of Bioethics, 24(1), 1-2. https://doi.org/10.1080/15265161.2024.2291988
Thumma, S. A., Weeks, E., & Farahany, N. A. (2024b). By Statute or by Common Law? The Legal Determination of Death. The American Journal of Bioethics, 24(1), 1-2. https://doi.org/10.1080/15265161.2024.2291988
Zaman, S. (2025). Cultural assumptions and the good death: Rethinking global frameworks. Medical Humanities, 51(2), 296-300. https://doi.org/10.1136/medhum-2024-013062
* The news published on studies do not represent an official position of ICNS, nor a clinical recommendation.
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