The culture of dying throughout the past century

As we approach the end of Dying Matters Awareness Week 2025, I’d like to take a little look at how time has influenced the culture of dying. Some of this will be an echo of a TED talk that the inimitable Kathryn Mannix gave several years ago (I’d highly recommend watching her stuff if you haven’t already).

(In this blog post, I’m generally talking about the ‘normal’ dying process. It’s important to note that, whilst patterns can be drawn, every death is unique and deserves to be treated as such. I’m not very well versed in sudden deaths (i.e. through traumatic injury etc), so I’m steering clear of them in this post.)

I want you to imagine that you’ve been flung 100 years in the past, to 1920s Britain. The NHS is still around 30 or so years away; Dame Cicely Saunders wouldn’t reach her teenage years until the 1930s; and many of the world’s economies were having a post-war boom.

Where do you think most dying would have taken place? There wasn’t a huge amount that contemporary medicine could offer at the time; we didn’t have anything close to the grasp of pain management that we have today. And even if we did, because of the NHS, it would’ve been unattainable for many.

At this stage in time, most dying took place at home. People would be supported in their own homes by family and friends, often without professional intervention. Now, whilst this is obviously unimaginable by today’s standards, it did have one curious silver lining; most people had a first-hand experience with death. Most people knew what the signs were that someone was entering into their final days and hours. Death was very much a commonplace conversation topic, and we didn’t have as much anxiety around talking about it.

Now, I’d like you to imagine you’ve been flung 60 years forward, to the 1980s. The NHS is celebrating its 40th anniversary this decade; St Christopher’s Hospice will be celebrating its 20th anniversary; Dame Cicely Saunders will receive the Order of Merit at the end of the decade; and palliative care is well and truly its own clinical speciality.

I ask again; where do you think most dying would have taken place? Given the huge technological and clinical break-throughs, and our better understanding of pain management, and our increased end-of-life specialist workforce.

Most dying now took place in hospitals and hospices. The advancements in care standards were astronomical, and we now had the means to provide state-of-the-art support to people in the final days and hours.

But the silver lining of the 1920s was largely gone. Death had become a ‘behind-closed-doors’ thing: a taboo; something to fear. Our familiarity with it disappeared gradually…and the one thing humans generally feel towards what they don’t understand is fear. We forgot how to spot signs that someone was in the normal dying process. The sound of their breathing became distressing, because we forgot how to prepare for it. The more that death became remote, the fewer opportunities there were to talk openly about it. I now hear from people who say they want to talk about death with their loved ones, but are shut down instantly. And it’s such a difficult line to walk, because just as much as I think we should all have the confidence to be able to talk about death openly, I don’t think any single one of us should be compelled to do so.

 So, should we just accept that our current culture is one where death and dying are not talked about? I don’t believe so. I believe that campaigns such as Dying Matters can help to put together safe spaces for people to talk whenever they’re ready to do so. But I really do believe that we should all be confident in our abilities to talk about death and dying; and I really cannot understate the importance of doing so. Just last July, Compassion in Dying released its Rethinking the UK’s approach to dying report, which showed that ‘one in four people say the last close friend or family member they know who died received medical treatment they would not have wanted’. By talking about death and dying, we can help make sure that we don’t become part of that statistic in the future.

Throughout May, I’m holding some free online or face-to-face chat sessions through Teign Angels, where you can come and ask anything you like about advance care planning. Whether it’s talking about the end of life, or something else that’s on your mind, why not come along for a little chat all about it?