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The Lancet Commission on the Value of Dying

Daniel Miller7 February 2020

The Comfort of People (2017)

In 2017 I published a book called The Comfort of People (2017 Cambridge:Polity Press), based on research amongst people who had received a terminal diagnosis and were being looked after by a hospice. In that book I made various recommendation for how the hospice might employ new media. More recently I was approached by a group who have been commissioned by the journal The Lancet to develop a special issue around the topic ‘The Value of Dying’. My contribution is called Dying with Smartphones. Much of the time since writing The Comfort of People has been spent in the ASSA project, so this more recent contribution reflects what I have subsequently learnt. The topic is significant, since given the rapid expansion in the usage of smartphones by older people, we might expect that in the future most people will ‘die with smartphones’.

One of the reasons new media matters to the hospice is that most people want to die in their own homes, or at least stay there as long as possible, so most hospice work involved going to, or communicating with, people at home rather than them coming to the hospice. A key finding in our current project, the Anthropology of Smartphones and Smart Ageing, is the appreciation of how much the smartphone has become what we can call ‘the Transportal Home’. On the one hand, it has become a place people live within rather than just a device they use, where they compose their thoughts and entertain themselves. On the other hand, it has huge potential in relation to loneliness and isolation since it is the portal through which we communicate with other people; very different from just watching television. So, the smartphone ‘home’ can be quite convivial. The ASSA project also reinforced the our theory of ‘polymedia’, which posits that different people feel comfortable with different forms of communication and the hospice should not assume which media suits which person. One patient might prefer WhatsApp, another might prefer communicating via webcam, and a third might prefer voice calls. Many people now first want a text that confirms if this is a good time to speak. So the sensitivity of the hospice can be expressed by following patient preferences with regard to how they communicate with people now living within this Transportal Home.

The ASSA project has also seen a huge expansion in something that was just starting during the hospice research, which is the creation of WhatsApp groups by relatives to support the patient. The team members in Brazil and Chile have observed how WhatsApp can be used by medical staff to manage patient requests and other purposes. In general, our project’s conclusion, which focuses on the free and ubiquitous apps that most people already use, rather than bespoke mHealth apps, also applies to palliative care. Each fieldsite offers additional insights. For participants in Kampala, one of the primary uses of smartphones and mobile phones is to send mobile money. These remittances would often be sent to support relatives’ health needs, such as transportation to the hospital and medical fees. Smartphones can also be helpful for people with limited literacy because of the capacity to send visual communication such as photographs.

A major facility of online communications is the space to discuss difficult and embarrassing topics. For example, in China there is widespread taboo against talking about dying. For many, social media has become the first space where people experience the possibility of talking to strangers on this subject. Working with hospice patients in the UK, I found that we need two kinds of forums. One is for those who want to discuss delicate issues around chemotherapy, but only with people who cannot know who they are. Then we need another for patients who only wish to discuss these intimate matters with people they can actually see or know.

Although the ASSA project is not based on studying people with a terminal condition, I very much hope that in the future it will provide useful pointers to the way we can improve our support for people who increasingly will be dying with smartphones.

The Burden of Caring in Japan

Laura Haapio-Kirk5 January 2018

Image (c) Laura Haapio-Kirk

A recent news story titled Dying at home rather than in hospital, elderly Japanese “go to the afterlife quietly caught my eye with its suggestion of a preference for home deaths in Japan. The location of palliative care and the relationship of a dying person to their caregivers, whether they are relatives or professionals, can reveal a great deal about an individual’s social world, as demonstrated in Miller’s recent book The Comfort of People. Upon closer inspection the article’s title proved to be misleading; Japanese cultural beliefs surrounding death and the avoidance of burdening others (Long, 2012) indicate that the situation is more complicated.

The article claims that the current shortage of hospital beds combined with the expense of professional medical care means that for many people the choice to die in hospital is taken away from them. One reason why hospital care may be preferred over family care is that over half of Japanese carers are pensioners themselves (Hurst, 2017). The Japanese term rou-rou kaigo describes the common practice of care between the elderly. Our ASSA project focuses on people between the ages of 45-70 who may be both experiencing embodied reminders of ageing, while simultaneously caring for their ageing relatives. We will study how care is mediated through technology, specifically through the smartphone, such as by maintaining self-care through mHealth apps or caring for others through connected devices.

In Japan, not wanting to be a burden in death can be understood as a final act of care towards one’s family. I am wondering whether this may help to explain people’s interest in new technologies such as smartphones. Perhaps older people are hoping that technology will give them a means to look after themselves more effectively and so be less dependent upon their families. Or perhaps, as Long’s article suggests, some people resist such technologies precisely in order to preserve what they consider to be traditional Japanese family values. By conducting my research in Japan where life expectancy is the longest in the world, I hope to deepen our understanding of the possibilities afforded by a prolonged mid-life and explore how family relationships and networks of care are affected by the simultaneous rise of the smartphone.

– Laura Haapio-Kirk

 

References

Long, S.O. J. 2012. ‘Bodies, Technologies, and Aging in Japan: Thinking About Old People and Their Silver Products’ in Cross Cultural Gerontology (2012) 27: 119. https://doi.org/10.1007/s10823-012-9164-3

Hurst D. 2017. ‘More than half of Japanese carers are pensioners’ in The Times June 28 2017. Retrived 23..11.2017 (https://www.thetimes.co.uk/article/half-of-japanese-carers-are-pensioners-themselves-n2v3glbkz)

Dying at home rather than in hospital, elderly Japanese ‘go to the afterlife quietly’ (November 20, 2017) Retrieved from https://www.reuters.com/article/us-japan-homedying/dying-at-home-rather-than-in-hospital-elderly-japanese-go-to-the-afterlife-quietly-idUSKBN1DK2LB