Sociology of Health & Illness Vol. 26 No. 1 2004 ISSN 0141–9889, pp.

110–122
Catherine
Original
Review
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Review article: the sociology of dying, death and

bereavement
Catherine Exley
Nuffield Community Care Studies Unit, Department of Health Sciences,
University of Leicester

Cobb, M. The Dying Soul: Spiritual Care at the End of Life. Buckingham:
Open University Press, 2001 £16.99 (pbk) vii + 145pp
Currer, C. Responding to Grief: Dying, Bereavement and Social Care.
Basingstoke, Hampshire: Palgrave, 2001 £14.50 (pbk) v + 181pp
Field, D., Clark, D., Corner, J. and Davis, C. (eds) Researching Palliative
Care. Buckingham: Open University Press, 2001 £22.50 (pbk) vii + 198pp
Hockey, J., Katz, J. and Small, N. (eds) Grief, Mourning and Death Ritual.
Buckingham: Open University Press, 2001 £19.99 (pbk) vii + 286pp
McNamara, B. Fragile Lives: Death, Dying and Care. Buckingham: Open
University Press, 2001 £17.99 (pbk) v + 165pp
Seymour, J. Critical Moments – Death and Dying in Intensive Care.
Buckingham: Open University Press, 2001 £17.99 (pbk) xiii + 185pp.

Introduction

The sociological study of dying, death and bereavement is a relatively recent

field of research interest. In 1958, Faunce and Fulton wrote a paper entitled
‘the sociology of death: a neglected area of research’, their argument being
that the lack of sociological research in this area was probably attributable
to a wider reluctance within society to contemplate dying and death. How-
ever, despite Walter’s (1993) claim that (with the exception of medical soci-
ology) British sociologists had been notably quiet in this topic, it would
seem from the research literature that the number of sociologists researching
in the area of dying, death and bereavement has increased significantly,
particularly in the last 10 to 15 years.
The aim of this review is to outline the work that sociologists have con-
ducted with regard to dying, death and bereavement. Within this discussion,
I locate and review the six books listed above, ending by reflecting on what
sociological research related to dying, death and bereavement might explore
in the future. Reviewing the work of sociologists in this field is no small task
© Blackwell Publishing Ltd/Editorial Board 2003. Published by Blackwell Publishing, 9600 Garsington
Road, Oxford, OX4 2DQ, UK and 350 Main Street, Malden MA 02148, USA
 Review article: the sociology of dying, death and bereavement 111

given the diversity of research that has been, and continues to be, conducted.
Indeed, it is testament to the wealth of material published by social scientists
that I have such a broad range of books to review. The six books cover
topics that include the experiences of dying and death in the high-tech world
of Intensive Therapy Units (ITUs), a reflection on the difficulties of provid-
ing ‘spiritual’ care, and an edited collection introducing the research meth-
ods used within palliative care research. Given the burgeoning amount of
research related to dying, death and bereavement which has developed in
recent years, in this review I focus primarily on the work which has been
conducted within Britain, referring only briefly to some work undertaken in
the US. Before, however, considering specific examples of the work of soci-
ologists in this field, I think it is important to look, albeit briefly, at how we
as a society and as individuals manage dying and death, an area to which
sociologists have made active contributions.
There has been much academic debate (see Kellehear 1984, Walter 1991,
Seale 1998) about the extent to which dying and death remain ‘taboo’ in
Anglophone societies. This is not a debate I can possibly do justice to in the
space of this review, but it is important to note that experiences and under-
standings of dying, death and bereavement in modern society are contradict-
ory. In a world full of instant mass media which can be ‘beamed’ to our
homes ‘live’: dying, death and the experiences of grief are all too common
images on our television screens, in newspapers and on websites; to this extent
death is ever-present in our lives. This, however, is the death and suffering
of ‘others’ to be watched and observed, but something we often find difficult
to relate to on a personal and individual level. As a society we value youth,
health and fitness (Featherstone 1982). Dying and death is something asso-
ciated with older age – those who may be regarded as having little economic
or social value to society and its continuing function (Glaser 1966, Turner
1995). At a societal level, dying and death are managed very well, generally
having little or no impact on its smooth and productive running. However,
it remains the case that many of us as individuals ‘remain characteristically
uncomfortable with the facts of mortality’ (Mellor and Shilling 1993: 423).
At an individual level we are able to discuss dying and death in the
abstract, that is, as an event we know we will encounter at some unknown
point in the future. But, when confronted with the realities of these phenom-
ena many of us are less able to talk openly. Anyone who has experienced
bereavement, or has been close to someone who was dying, will be able to
recount stories of when people were ‘uncomfortable’ or ‘did not know what
to say’. At an individual level death has become increasingly institutional-
ised: the majority of us will die in a hospital or long-term care institution
attended to by professional strangers. Increased life expectancy means that
the ‘private’ face of death is something many of us will not encounter at a
personal level until mid-adulthood, and when we do, we may face an uncer-
tain time in terms of grieving and mourning procedures, as more traditional
rites and practices have been eroded in our increasingly secularised society. So,
© Blackwell Publishing Ltd/Editorial Board 2004
112 Catherine Exley

as Walter (1991) argues, dying and death do not threaten society, which
deals with it very well by prizing their antitheses: youth, health, vitality.
Those, however, who are dying and who are bereaved consequently become
‘uniquely isolated, lepers even, because they highlight the Achilles heel of
the modern individual’ (Walter 1991: 306).
It is difficult to quantify the impact sociologists working in any given field
have on those practising within it. However, if one accepts the presence (or
absence) of such work in the literature directed towards healthcare pro-
fessionals as being indicative of such success (or failure), a review of any
back copies of specialist palliative care journals will identify a number of
sociologists writing for practitioner audiences. More recently within the
British Medical Journal, both Clark (2002) and Walter (2003) have written
sociologically informed articles about the management of dying and death
in our society. Indeed, it is true to say that much of the research conducted
by sociologists in this area is conducted as part of multi-disciplinary teams,
and serves as a good example of how it is possible to produce theoretically
robust work based on empirical research which is relevant for healthcare
planning and delivery. Sociologically informed work is regularly presented
at palliative care conferences and the bi-annual international conference on
Death, Dying and Disposal. Within Britain there is an active group of aca-
demic researchers who meet annually at the Social Aspects of Death, Dying
and Bereavement Symposium. This group first met in 1990 at the University
of Leicester, attracting sociologists and those from other academic dis-
ciplines and healthcare practitioners alike, and has generated three edited
collections (Clark 1993, Field et al. 1997, Hockey et al. 2001). In addition,
to these publications, there is now a well-established and highly-regarded
series of texts published as part of the Facing Death series edited by David
Clark (four books from this series are included in this review). In addition,
in 1996 the journal Mortality was first published addressing issues related to
dying, death, bereavement and memorial. Both Facing Death and Mortality
are multidisciplinary in scope, but their establishment and continuing suc-
cess was led by sociologists – David Clark, David Field, Glennys Howarth,
and Peter Jupp – researching within this area.

Sociology and dying and death

The work of sociologists in the study of dying, death and bereavement dates
back to the 1960s in the United States, when the first (and still influential)
empirical observational studies looking at the care of people who were dying
were conducted within hospitals (Glaser and Strauss 1965, 1968, Sudnow
1967, Strauss 1970). Such research fundamentally changed the way people
thought about the management of dying and death, and brought into sharp
relief the experiences of those who were dying within a hospital environ-
ment. Work in Britain has also explored the management of dying and death
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 Review article: the sociology of dying, death and bereavement 113

within both the acute hospital setting and hospice settings (e.g. Field 1989,
Seale 1989, May 1992). Such work has sought to challenge some of the
taken-for-granted assumptions of palliative care, which at times has been
uncomfortable for services and healthcare practitioners alike, but has, at
least, opened up the debate about what palliative care can and does achieve.
James and Field (1992), for example, suggested that the provision of palliat-
ive care within hospices, far from being individualistic and holistic, and
notably different from the care delivered in hospitals, was, in fact, becoming
increasingly ‘routinised’. This was a challenging paper that caused much
reflection (and disquiet) amongst palliative care healthcare professionals.
Another example is Lawton’s (2000) seminal ethnographic study of the care
provided within an NHS hospice. This work has been particularly influ-
ential, and challenging, in terms of palliative care provision. In particular, her
graphic and moving account (Lawton 1998) of the management of leaking,
failing bodies – ‘dirty dying’ – hidden away within the hospice, had a
significant impact both for those of us researching in this area but also for
palliative care practitioners themselves. The public image of hospices facilit-
ating dignified or ‘good’ deaths was challenged as she sought to examine
what happens when people’s bodies fail them in the most socially unaccept-
able of ways, leaving them devoid of personal identity and unable to engage
any longer on any meaningful level with significant others because their
physical bodies have failed them so badly.
In her book Fragile Lives: Death, dying and care McNamara also focuses
on the care delivered to people at the end of life in Australia. Her discussion
is based on ethnographic research she conducted with healthcare profession-
als (predominantly) and dying people and their families. In this well-written
text she skilfully weaves the accounts and experiences of her respondents
with other research literature, and engages with topical debates within pal-
liative care including euthanasia and the value of the notion of the ‘good
death’. In her methodological appendix, she also provides the reader with a
personal and candid insight into how she conducted her ethnographic field-
work; written in such a way as to be accessible to those less familiar with
this kind of research. McNamara provides a particularly useful account of
the way in which cancer is viewed and responded to in modern society, and
the impact this has on those who are themselves diagnosed with a terminal
condition. The chapter on ‘the uncertain worlds of terminally ill people’
provides a poignant and well-illustrated discussion of the world of ‘stranger’
which those who are aware of their own dying find themselves inhabiting in
our society.

Terminally ill people live until they die, but their living is irretrievably
changed as they begin to live their dying ( p. 66).

Her final chapter ends with some thought-provoking debate for those deliver-
ing palliative care:
© Blackwell Publishing Ltd/Editorial Board 2004
114 Catherine Exley

Where postmodern dying finds us bereft of ways to approach death as a

collective, medicalised dying pushes the phenomenon of death away
through technology and pretence ( p. 121).

Are people being ‘enabled’ to ‘live’ to the end of their lives to the extent
that they are no longer confronting the reality of their own death? This book
is beautifully crafted and written in such a way as to be interesting to soci-
ologists, as well as to a much broader audience; it is a book which should
be read by anyone with an interest in health and illness.
Seymour’s Critical Moments – Death and Dying in Intensive Care, in
David Clark’s Facing Death series, is one of the few pieces of research con-
ducted by sociologists about dying and death which is not related to cancer
and palliative care. Like McNamara, Seymour links first-hand accounts
from her own ethnographic research with a sociologically robust discussion
of her data and their implications for practice. Her own background as an
ITU nurse raised particular ethical and personal dilemmas for her during
her research and it is to Seymour’s credit that she shares these with the reader.

In some ways I felt that I was rather an outsider: a nurse but also a
sociologist, looking in on myself acting a role within a very strange
environment ( p. 23).

It is most common for methodological discussions to be ‘hidden’ away from

view in appendices, but Seymour ensures the ethics of conducting research
in this arena are assigned ‘centre stage’. The reader is made to reflect on the
process (and costs) of conducting this research. As I read subsequent
chapters I was very much aware of the emotional and physical realities of
conducting this research, and of the sometimes problematic nature of the
notion of ‘informed consent’. In a particularly moving account, Seymour
recounts one incident of gaining ‘informed consent’ from a family whose
relative was in ITU. After being introduced as a ‘researcher from the univer-
sity’ who wanted to talk to them about their experiences in ITU, she tells
how the wife and son of the man, Jack, receiving care clearly welcomed the
opportunity to talk to someone. However:

It is sometime later that Michael [son] turns to me – almost as an aside –

and asks if I want to explain about the research I am doing, and it is only
at this point that I am able to begin to explain my research intentions to
them. Michael reads the information sheet about the study very carefully
and asks several questions, Mary [wife] on the other hand, seems already to
have decided that I can ‘do what you like dear’ . . . The problems of gaining
‘informed consent’ in such a situation are thrown into sharp focus ( p. 27).

Seymour is to be commended for ensuring that all the ‘voices’ of the actors
in these encounters at the end of life are heard throughout the book:
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 Review article: the sociology of dying, death and bereavement 115

doctors, nurses, relatives and even those of the usually muted dying person
are apparent throughout. As one who teaches future medical practitioners,
I would say that this is a book that should be read by anyone who will work
within a hospital environment and who will encounter dying and death. Not
only does this book illuminate the management of dying and death in ITU
in a sensitive and challenging way, it also tells us much about the process of
care and doctor/nurse interactions and professional/patient interaction.
A significant amount of work has been conducted on lay-carers’ retro-
spective accounts of the care received by the deceased person to gain some
insight into the experiences of care at the end of life (e.g. Field et al. 1992,
Seale and Cartwright 1994). It remains the case, however, that only a relat-
ively small amount of research has been conducted with people who are
dying themselves (e.g. Young and Cullen 1996, Exley 1999, Lawton 2000).
This lack of research may be attributable to the fact that there is sometimes
a reluctance to subject those who are dying, with all its likely associated
physical symptoms and discomfort, to research (Field et al. 1995). There are
many ethical considerations to take into account when asking those who are
close to the end of life to engage with researchers and research, and it is
imperative that people who are dying are given as much time and space as
possible when considering whether to participate in any study. Of course,
obtaining ‘informed consent’ and interviewing sentient individuals are relat-
ively easy to negotiate. However, when approaching the end of life, in the
last few days, weeks and even months, many people are likely to become
increasingly unaware of their physical surroundings. As both Lawton (2000)
and Seymour (2001) have vividly portrayed, ethnographic observational
work with very ill and/or confused or unconscious people has its own ethical
issues with regard to when, how, how often and from whom one should
obtain ‘informed consent’ to participate in a study.
Outside formalised healthcare settings ethnographic studies have also
been conducted within community settings to explore the management of
dying and death at an individual and local level, in particular to consider
how practices at the end of life have changed over time (e.g. Clark 1982,
Adams 1993). Clark’s work in particular provides an excellent ethnographic
account of how, over time, the management of dying and death in Staithes,
a small fishing village in North Yorkshire, ceased to be community centred
and managed. It provides a particularly poignant reminder of how both
dying and death have become increasingly professionalised, removed from
the private to the public spheres of hospitals and funeral directors’ chapels
of rest.

Sociology and bereavement

A significant amount of sociological work has been conducted on the

experiences of bereavement (e.g. Hockey 1990, Littlewood 1992). Both
© Blackwell Publishing Ltd/Editorial Board 2004
116 Catherine Exley

Walter (1999) and Riches and Dawson (2000) have produced books based
on empirical research and personal experiences that have made a significant
contribution to understanding how grief is experienced and managed at
both an individual and societal level. Both challenge the conventional
wisdom that, given a period of time, those who have been bereaved need to
‘move on’ and/or ‘let go’ in order to get over their loss. Riches and Dawson
have illustrated how the loss of a child has profound, long-lasting conse-
quences for one’s conceptualisation of self and other personal relations. For
any of us who have been bereaved and resisted ‘moving on’, Walter demon-
strates that maintaining meaningful bonds (and relationships) with those
who have died should not be seen as ‘pathological’ grief, but rather as part
of the reflexive construction of self-identity and relationships engaged with
on a daily basis.
Two of the books in this review are concerned with bereavement and
grief: Hockey, Katz and Small’s edited book Grief, Mourning and Death
Ritual and Currer’s Responding to Grief: Dying, Bereavement and Social Care.
Hockey et al.’s text is another book which is part of the Facing Death series,
and it provides anyone interested in the area of bereavement with an excel-
lent introduction to key concepts, as well as a wealth of data from a range
of social scientists working in the area. The editors of this text are to be
commended not only for their clear ‘sign-posting’ of this book and their
explanations of terms and theories, but also the way in which they make
linkages between concepts and understandings of bereavement and the
nature of postmodern society. The introductory chapters to each section of
the book provide the theoretical context for the chapters which follow.
Indeed, if one were merely ‘dipping into’ this book, the chapters written by
the editors are to be recommended. I particularly enjoyed Hockey’s chapter,
‘Changing death rituals’, which provides a succinct review of a broad range
of research depicting the uncertain world those who are bereaved face
after their loss: the management and expression of emotion, finding the
appropriate ritual and service of remembrance, the ‘right’ professional to
use. The world of the bereaved is one of uncertainty and few ‘rules’, in
which in late modernity the person is left to draw on traditional practices
of grieving and memorial, combined with more idiosyncratic choices, to
try to do the ‘right thing’. This is the kind of text one will refer back to
time and time again, purely for the range of issues it covers: from
Komaromy and Hockey’s discussion of death in residential care, to Arnasan’s
and Anderson’s chapters on bereavement work, to Howarth’s discussion of
‘public grieving’, and Eyre’s reflections on post-disaster ritual, and as such
will be a useful reference for those working in the area of bereavement and
memorial.
Currer’s book Responding to Grief: Dying, Bereavement and Social Care
provides the social care practitioner with an introduction to the notion
of grief and grieving. Currer, who has a background in social work,
provides a useful overview of some of the research literature in this area,
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 Review article: the sociology of dying, death and bereavement 117

drawing on relevant sociological work. As Currer states in her introductory

chapter, however, this book does not seek to be a sociological account of
grief, but rather one designed to assist practitioners involved in caring
for people at this difficult time, and to highlight gaps in service knowledge
and provision, and identify support and training needs from this. The
book is easy to read and it will be useful to those social care practitioners
whose work may bring them into contact with people who have been
bereaved. For my own part, I found the use of personal examples of people’s
experiences of grief illuminating, but, having read the book, I am still
rather uncertain about the sources of these accounts. There is no reference
to data collection or analysis, and as such it is difficult to ascertain how
exactly one should view the ‘vignettes’ used: are these anecdotal accounts
collected during her work or are they part of a more systematic piece of
research?

The neglect of spiritual care

One area of care at the end of life which sociologists have been notably
absent in considering is that of spiritual care. To this extent, although not
sociological, Cobb’s book The Dying Soul: Spiritual Care at the End of Life
( part of the Facing Death series) provides some thought-provoking material.
Cobb, himself an ordained Anglican minister with experience of working
within hospitals and hospices, draws on a range of literature to explore the
problematic nature of providing spiritual care at the end of life. Cobb is to
be admired for attempting to address this issue which he himself accepts is
a term shrouded in confusion, ‘. . . a term from which can be inferred a vast
range of meaning, some of which I allude to in this book and some of which
the reader will bring to the text’ (p. 4). Spiritual care is ensconced as a funda-
mental part of the provision of palliative care, but Cobb illustrates how
this central theme is so difficult to achieve in practice. Providing spiritual
care seems to be one of the few areas of care without clearly delineated
boundaries; the responsibility of all, and yet it is without doubt one of the
most difficult ‘needs’ to either assess or meet. This is compounded by the
fact we live in a multi-cultural society, including many different religions as
well as the agnostic and the atheist, within which the notion of both death
and spirituality is difficult to define and can be essentially individual in
nature, scope and understanding. Cobb’s call for a more reflexive awareness
of spirituality is surely timely, as indeed is his repeated call to develop ways
of evaluating and understanding spiritual care. For my own part, I was
particularly pleased to read Cobb’s concerns about how spiritual care can be
provided to those dying of non-malignant terminal disease:

Where palliative care is extended towards a more generic form then it is

probable that spiritual care will develop in new ways shaped by those
© Blackwell Publishing Ltd/Editorial Board 2004
118 Catherine Exley

living and dying with terminal disease other than cancer. . . . To what
extent patients suffering with non-malignant fatal diseases are the
‘disadvantaged dying’ in terms of spiritual care has yet to be fully
explored, but there is certainly a moral case to be made for some form of
equivalent service to be available ( p. 127).

This is a fascinating read and would be of interest to anyone concerned with

palliative care generally, and the provision of spiritual care specifically.

Researching dying, death and bereavement

In terms of researching dying, death and bereavement, sociologists have had

a significant impact on the kinds of approaches and methods used. Some of
the sociological work conducted on the end of life has been quantitative
(Kellehear 1990, Seale and Cartwright 1994), but more generally, it has been
qualitative in nature, using interviews and/or observations. I would argue
that it has been a particular achievement of sociologists that, in a medical
field which has a dominant quantitative research paradigm, qualitative
research has become increasingly used and valued by all. It is, however,
important to recognise that conducting any research, but particularly in-
depth qualitative research with those who are dying or bereaved, is emotion-
ally draining for a researcher, and it is necessary to be aware of the impact
it may have both personally and in terms of the research conducted. It is
imperative, as Clark et al. (2000) have noted, that researchers are well pre-
pared for working in this environment, and well supported both during the
fieldwork and the analysis process. Conducting any social research can be a
lonely process, but in areas of ‘sensitive’ research, attention must be paid to
how to support the individual conducting the research. There may be an
argument that one should only ever spend a limited amount of time involved
in extremely emotionally-draining research, lest it has too great a personal
impact, or equally problematic, that one becomes somehow ‘immune’ to the
experiences of those confronting their own mortality and loss.
Field, Clark, Corner and Davis’s edited collection Researching Palliative
Care serves as an excellent example of how sociologists have impacted upon
the research methods used within palliative care research, and is indicative of
the multi-disciplinary nature of the research many sociologists are involved
with in this area. Divided into three parts: Key methods for researching
palliative care, Clinical research in palliative care and Needs assessment,
audit and evaluation, this book brings together many previously published
pieces relating to a broad spectrum of palliative care. It is a worthwhile
acquisition for those coming to research in this field for the first time. From
a personal point of view I particularly enjoyed the debates in Chapters 4
and 5, for and against placebo-controlled trials at the end of life; a partic-
ularly important and timely debate given the ever increasing number of
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 Review article: the sociology of dying, death and bereavement 119

Randomised Controlled Trials conducted at the end of life. As well as

exploring quantitative approaches, the book also examines qualitative meth-
odology and Clark’s chapter considering the contribution such methods can
make to palliative care research is much welcomed, and presented in a persuas-
ive and accessible manner. Equally, given the increasingly stringent ethical
requirements, Wilkie provides a useful aide memoire to the researcher poised
to embark on research for the first time. Researching Palliative Care succeeds in
its aim to be accessible to the increasing number of palliative care practitioners
who are engaging in research as part of their work. To this extent I think
it will be useful to postgraduate students and any healthcare professional
conducting research in this area.

The future? The ‘problem’ of the ‘disadvantaged dying’

It is clear that the number of people working in the area of the sociology of
dying, death and bereavement has increased dramatically in recent years.
While research on bereavement has considered a broad spectrum of people
bereaved for many different reasons, to date much of the work, particularly
around the experiences and management of dying and death, has focused on
the experiences of people who have cancer and on palliative care1. It remains
the case that the over-whelming majority of people in receipt of specialist
palliative care services in hospices are those who are dying of cancer. In
terms of research it seems that ‘palliative care’ or ‘care of the dying’ often
means care of the person with terminal cancer. Cancer is a particular kind
of dying in that it often has a relatively clear trajectory. In addition, those
diagnosed with cancer are likely to be younger, aware of their diagnosis and
prognosis and have access to a sophisticated package of palliative care.
In terms of research areas, those dying with cancer are relatively easy to
identify. But, what of the experiences and care received by those dying with
other long-term, non-malignant conditions – Alzheimers or end-stage cardio-
respiratory disease – the so-called ‘disadvantaged dying’? Just as these
people are less likely to receive palliative care, or even to be told of their
terminal prognosis in any overt way, so too are they noticeably absent from
sociological research.
The majority of deaths take place within a hospital environment, perhaps
unpredicted and unplanned for, as a result of a final terminal exacerbation
of a particular chronic disease. While people will continue to die in the
hospital setting, it is likely, given demographic changes in the UK, increased
social mobility and smaller family sizes, that many will face their own dying
and death in a nursing or residential home. Such deaths may occur as a
result of a sudden acute incident, but are more likely to be as a result of
long, protracted illness, characterised by oscillating between periods of relat-
ive good health and periods of much worse health, sometimes requiring
medical intervention and/or hospitalisation. It is only in relatively recent
© Blackwell Publishing Ltd/Editorial Board 2004
120 Catherine Exley

years that work has begun to be conducted within such settings (e.g. Katz
and Peace 2003). More research in this area is needed allowing sociologists
to explore the experiences of those in nursing and residential homes who
may be dying in the community with far from optimum support.
Sociologists need to broaden the scope of our research and explore the
experiences of the ‘disadvantaged dying’; those who are older and dying
with other long-term degenerative, and ultimately fatal illnesses, those who
are unlikely to be given the label of ‘terminally ill’ or to be aware of their
prognosis. These people are unlikely to have access to the range of services
afforded to those with a diagnosis of cancer and, in addition, are likely to
be living with multiple co-morbidities which have a deleterious effect on
health and quality of life. Research needs to focus on such people’s experi-
ences and whether the rhetoric in policy documents about expanding palli-
ative care to all is either appropriate or wanted. Sociologists have challenged
some of the fundamental principles of palliative care for people dying with
cancer, the time has now come to consider those who may not only be seen
as ‘disadvantaged’ in terms of their dying, but who, in too many ways, are
also ‘invisible’.
Address for correspondence: Catherine Exley, Centre for Health Services
Research, School of Population and Health Sciences, University of Newcastle
upon Tyne, 21 Claremont Place, Newcastle upon Tyne, NE2 4AA.
e-mail: catherine.exley@ncl.ac.uk

Acknowledgement

I would like to thank Simon Duckworth, David Field and Carl May for their helpful
comments on an earlier version of this paper.

Note

1 Exceptions here are Field (1989), Seale and Cartwright (1994), Seymour (2001).

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 Review article: the sociology of dying, death and bereavement 121

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