Vol. 54, No. 9, October 2009 From the Director 'Death Panel' Rhetoric Sets Us Back

Elizabeth J. Clark, Ph.D., ACSW, MPHFrom the Director

I taught my first academic course when I was a second-year graduate student in social work. Its title was simply Death and Dying.

It was during that time that I came across "pornography of death," a concept as relevant today as it was then. The term was coined in 1955 by British social anthropologist Geoffrey Gorer, who studied the social mores of Americans. Gorer felt that death had replaced sex as the most taboo topic for our society. Pornography of death can loosely be defined as death divorced from its natural emotion of grief.

America is described by experts as a death-avoiding society — but only when we are talking about the actual physical death of a loved one. Out of touch with death as a natural phenomenon, we have become fascinated with death in many other forms. Every day we are surrounded by death imagery, and we use death to sell things such as newspapers, magazines, movies and video games.

In the past few months, death also has been used to sell a political viewpoint in the health care reform debate. This happened when the term "death panels" entered our everyday lexicon.

The very words "death panels" elicited our deepest fears — not only the fear that we will all die, but that we may have no control over our death. At a press conference, former Alaska Gov. Sarah Palin used her own son, who has special needs, as an example of the individuals at risk and then linked in others who might have physical or emotional disabilities or who were approaching advanced age. She claimed that life and death decisions would be based on one's value to society.

Palin's remarks were couched as a response to a section in a health care reform bill that would allocate dollars to pay physicians for counseling individuals who requested advice about advance care directives. Nowhere in the bill is end-of-life counseling required. That didn't matter. Most people will never read the bill. But Palin is good media fodder, and her words got repeated so many times that they began to be treated as fact.

Geoffrey Gorer could have predicted the response of the American public. The idea of thinking about or talking directly about dying — about our own potential death — stirred our deepest fears. Fear always trumps logic, and all of a sudden, both the public and the politicians were scared to death. The outcry was such that the Senate said the amendment would be removed from their bill.

I had been excited about the fact that Medicare might now make it possible for more individuals to get good counseling about end-of-life care. I thought Americans might finally have the opportunity to talk openly about death, to return the topic to its rightful place as part of the natural order of life. Instead, our fears about death were exploited.

Did Sarah Palin misunderstand the bill provision? Did she change her mind about supporting good decision-making around end-of-life care? As governor of Alaska, she had signed a proclamation in April 2008 for National Healthcare Decisions Day, which has the goal of providing clear information about advance directives.

Each year NASW proudly participates in National Healthcare Decisions Day, and social workers in hospice, palliative care and health and aging settings have long recognized the need for better education and better conversations about advance directives.

Are conversations about end-of-life care easy? Not by a long shot. But many of the critical conversations in our lives are difficult. Are conversations about end-of-life care important? They are not only important, but essential to dying well.

Advance care directives are the best way to assure that individuals can make their own decisions and exert some control over their dying. They are the exact opposite of the supposed death panels where someone else makes the decisions and holds the control.

The approach was an ingenious use of the pornography of death. It sold newspapers and magazines. Most of all, it sold Sarah Palin. Unfortunately, it also sold out the American public.