The history of natural death is the history of medicalisation of the struggle against death. Ivan Illich, 1976

I’ve used these quotes from Ivan Illich’s “Limits to Medicine” (1976) to illustrate his argument of how death has been steadily medicalised, reaching its apotheosis perhaps with people dying of Covid-19 surrounded by gowned and masked nurses and able to communicate with those they love only electronically.

[In the Middle Ages] The imminence of death was an exquisite and constant reminder of the fragility and tenderness of life.

[At the end of the 15^th century] From a lifelong encounter [a dance], death has turned into the event of a moment.

Once death had become such a natural force, people wanted to master it by learning the art or the skill of dying…[The Ars Moriendi ] was a ‘how-to’ book in the modern sense, a complete guide to the business of dying, a method to be learned while one was in good health and to be kept at one’s fingertips for use in that inescapable hour.

After the Reformation, death became and remained macabre.

[In the 15^th and 16^th centuries] The question whether medicine ever could “prolong” life was heatedly disputed in the medical schools of Palermo, Fez, and even Paris. Many Arab and Jewish doctors denied this power outright, and declared such an attempt to interfere with the natural order to be blasphemous.

Paracelsus (1493-1541) wrote: “Nature knows the boundaries of her course. According to her own appointed term, she confers upon each of her creatures its proper life span, so that its energies are consumed during the time that elapses between the moment of its birth and its predestined end…A man’s death is nothing but the end of his daily work, an expiration of air, the consummation of his innate balsamic self-curing power, the extinction of the light of nature, and a great separation of the three: body, soul, and spirit. Death is a return to the womb.”

Frances Bacon (1561-1626) was the first to suggest that physicians might prolong life. He divided medicine into three offices: “First the preservation of health, second, the cure of disease, and third, the prolongation of life…[the] third part of medicine, regarding the prolongation of life: this is a new part, and deficient, although the most noble of all.”

[ By the 18^th century] a new type of rich man refused to die in retirement and insisted on being carried away by death from natural exhaustion while still on the job. He refused to accept death unless he was in good health in an active old age.

[By the beginning of the 19^th century] To die while courting one’s grandson’s mistress became the symbol of a desirable end.

[By the 20^th century] Death had paled into a metaphorical figure, and killer diseases had taken his place.

The hope of doctors to control the outcome of specific diseases gave rise to the myth that they had power over death. The new powers attributed to the profession gave rise to the new status of the clinician.

While “timely” death had originated in the emerging class of consciousness of the bourgeois, “clinical” death originated in the emerging professional consciousness of the new, scientifically trained doctor,

In our century [the 20^th] a valetudinarian’s death while undergoing treatment by clinically trained doctors came to be perceived, for the first time, as a civil right.

The right to a natural death was formulated as a claim to equal consumption of medical services, rather than as a freedom from the evils of industrial work or as a new liberty and power for self-care.

When the doctor contrived to step between humanity and death, the latter lost the immediacy and intimacy gained four hundred years earlier. Death that had lost face and shape had lost its dignity.

We cannot understand the deeply rooted structure of our social organisation unless we see it as a multifaceted exorcism of all forms of evil death. Our major institutions constitute a gigantic defense programme waging war on behalf of “humanity” against death-dealing agencies and classes. This is total war.

The myth of progress of all people towards the same kind of death diminishes the feeling of guilt on the part of the “haves” by transforming the ugly deaths the “have-nots” die into the result of present underdevelopment, which ought to be remedied by further expansion of medical institutions.

The expectation of medicalised death hooks the rich on unlimited insurance payments and lures the poor into a gilded death-trap.

Thanks to the medicalisation of death, health care has become a monolithic world religion.

“Natural death” is now the point at which the human organism refuses any further input of treatment.

Dying has become the ultimate form of consumer resistance.

Health, or the power to cope, has been expropriated down to the last breath, technical death has won a victory over dying. Mechanical death has conquered and destroyed all other deaths.

A society’s image of death reveals the level of independence of its people, their personal relatedness, self-reliance, and aliveness.

The white man’s image of death has spread with medical civilisation and has been a major force in colonialisation.