The Canon: The Dying Process: Patients' Experiences of Palliative Care by Julia Lawton

November 18, 2010

I was a master's student in sociology when I first read Julia Lawton's powerful account of her ethnographic study of a hospice. In The Dying Process, she detailed her observations of residents' experiences of dying, painting vivid descriptions that contrasted sharply with the romanticised idea of the peaceful and controlled "good death" aided by palliative care. In her account, residents fought against death and were sedated, isolated both physically in side rooms and socially as their troubled families ceased to visit, all while their bodies continued to deteriorate in sometimes very distressing ways.

At the time of its publication in 2000, The Dying Process received a mixed response. It was regarded by some as "lifting the lid" on what can happen in hospices, and encouraged those working in palliative care to talk openly about, and question, their everyday practice. But it was seen by others as a damning indictment of the palliative care movement, and as a result was heavily criticised by both academics and practitioners. Certainly it remains one of the most disturbing texts on palliative care, albeit not because Lawton sought to sit in judgement on it, but because of her extensive documentation of some of the less well known (and arguably sometimes necessary) ethically challenging practices used in the hospice environment.

It was not just the topic of this book that made it so influential, however. A personal, candid and well-written text, The Dying Process showed how academia is not just about generating cerebral argument. Lawton told of the body's potential for disintegration, of the smells and sounds that can accompany its decline, and of the hospice residents' often heartbreaking responses to their own failing bodies. She provided poignant accounts of the kindness of hospice workers alongside the social death that can accompany dying, as those once closest to the patient struggle to know how to converse, how to sit alongside, and ultimately how to visit - to the point where they ceased to do so.

Only a decade old, Lawton's book remains an important insight into the not-often-seen world of the hospice. It shed light on the social needs of hospice users, and much healthcare policy developed in the intervening years since the book's publication has focused on this area. For some, the criticism Lawton's work attracted was justified, but many others saw it as a salutary example of the power of academia to inspire change, and an illustration of the impact of good qualitative research.

The Dying Process demonstrated that a scholarly text does not need to be impersonal or difficult to read, and that the ability to reach out to an audience is central to what the academy produces. To me as a relatively young sociology student, witnessing an academic creating material that was theoretically and intellectually stimulating, while also moving and genuinely interesting, was inspiring. In this book, Lawton showed, to great effect, how evocative scholarly ideas can be.

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Reader's comments (1)

Agree absolutely. I recommend this book to my students as a fine example of how a PhD thesis (which is what it's based on) can be rivetting reading and yet theoretically well developed. Many in the Hospice Community didn't like it because it showed that however good palliative care can be, there are times when even it isn't enough at the end of some lives.


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