On the inequalities of dying – and passing

Death is, supposedly, the ultimate equalizer: we all die. Yet when and how we die, and the social consequences of our deaths, remain deeply inequitable. Does insisting on abandoning our metaphors for death risk obscuring these sociological truths?

Metaphors such as ‘going over’ or ‘passing on’ suffuse everyday talk. A Marie Curie survey identified 50 euphemisms in English, ranging from the well known (popped their clogs, pushing up the daisies) to the more specific (pulled his last pint, doing the final moonwalk). From time to time, a social media outpouring advocates abandoning these terms in sociological and clinical discourse, and using plain speaking in relation to death and dying. There are certainly compelling grounds for doing so.  As the Marie Curie survey suggested, other terms are not universally understood, and can cause confusion for patients and relatives in clinical care.

Abandoning metaphors, it is argued, can also help redress taboos around death. Sociologists have long debated whether such taboos have grown because of the privatization and sequestration of death and dying in contemporary societies: whether, for instance, squeamishness in some communities arises from lack of familiarity with the dead body, as processes such as dying, laying out, and mourning are less likely to happen in the home.  Yet, the use of metaphors to describe death and dying is hardly new. Fabien Horn’s linguistic study of Homer’s Iliad found that the Greek verb ‘to die’ was never used in battle scenes to describe a death; instead, Homer used language of darkness, departure or sleep.  As Horn concludes, metaphors are essential for speaking about abstract or phenomenologically inaccessible experiences, not ‘merely stylistic embellishment but a fundamental process of cognition by which we can think, speak and make sense of our environment and our existence’.

Finally, echoing Susan Sontag’s argument in relation to cancer, that ‘illness is not a metaphor’, the advocates of plain speaking suggest that the symbolism surrounding disease and death is unhelpful, obscuring the realities of suffering and illness. Yet, as Scheper-Hughs and Lock note in their critique of Sontag, it is not only impossible to strip illness from its symbolism, but also dehumanizing and deeply un-sociological. For illness – like death – is not only a biological state, but a social state.  Insisting on scientific language obscures social realities.

The evidence of the social shaping of death is overwhelming, and nowhere more obvious than for the inequalities that characterise every part of the process. Your chance of a later age of death is higher if you are lucky enough to live in a rich and socially equitable country, or were born to wealthier or more socially advantaged parents.  Despite the advent of protocols and advances in health care, your chance of being resuscitated in hospital remains influenced by your social worth, as  Stefan Timmermans found, in observing care of ‘socially but not yet officially dead’ patients, some thirty years after David Sudnow’s 1967 classic Passing On, which documented the ‘social rationing’ of resuscitation.  Inequalities continue in memoriam: those with written obituaries in the media, who become part of a collective memory, are from the elite; the length of an obituary relates to socioeconomic status; the more socially advantaged leave marked headstones, and the most advantaged, statues, named buildings and other material echoes.

Yet to insist we speak only of death orients our attention to the biological process, prioritising not just a medicalised frame, but also an individualised one, focused predominantly on the single human body as if the end of that were the end of a social life.

Arguing for sociologists in minority worlds to adopt a more relational approach to bereavement studies, Jane Ribbens McCarthy and colleagues suggest that a bias from largely affluent, White population research has hidden the fact that all deaths are relational.  That is, they impact on families and social networks long after the ‘biological’ death.  The biologically dead continue to live and have agency – explicitly through wills and bequests; variably in the biographies and memories of kin and colleagues; and more or less publicly in the artefacts and memorials they leave behind.  Yet Ribbens McCarthy and colleagues argue that research on grief and bereavement in sociology remains largely wedded to an individualised model, ignoring the ways in which this ongoing life is rooted in relations, and changes relations.

To restrict discourse to ‘death’, and not the myriad other ways we can describe the altered states of our kin, friends and others who have passed on, but are still present, underplays this relationality.  It also underplays the ways in which the social, more broadly, shapes the processes through which the non-living do or do not endure in our collective memories.

In clinical care, carefully choosing the words to communicate the end of life is vital. In sociological studies, and everyday life, though, we need also to speak also of the multiple lives that continue after the death of the biological body.  Euphemisms are not necessarily ways to avoid speaking of harsh realities, but can signal changed states as well as endings, such as altered relations after passing on or over.  Plain speaking has its uses, but so too does metaphor.