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In Greece, lament for the dead, denial for the dying.

In Greece, Lament for the Dead, Denial for the Dying

Death in Greek folk culture is thought of as something dreadful, as "ugliness," "darkness," "chaos," blackness"--"My name is black cobwebbed earth." Life is accordingly often described as "silver that is tarnished by death" or "gold that rusts in death." [1]

What makes death dreadful in Greek folk tradition is its absolute finality:

When should I expect you? Until when should I wait for you? Until the sea runs dry and becomes a garden, until the crow turns white and becomes a dove. Expect me then. Wait for me until then. [2]

The acceptance of the finality of death as expressed in such laments is underscored by the exhumation ritual of rural Greece in which, five years after death, the bones of the deceased are exhumed by relatives and friends, washed in wine, and put in the village ossuary. This ritual symbolizes the realization that there is no hope for the deceased ever to come back. [3]

As the folk tradition shows, there is in the minds of the bereaved--albeit inconsistently with some of their other beliefs--a picture of the dead as somehow living on. This picture, however, totally lacks the romanticism associated with it in the Western Christian tradition. The deceased is simply imagined to have certain human needs, especially the need for love and communication, which the bereaved try to satisfy mainly through memorail services. Portrayed in many laments as in some sense alive, the deceased speaks:

I did not sleep last night, and today I am tired, because I talked for a long time with my good wife. I have not yet had my fill of her company. and my heart has been burned. [4]

An integral part of this conception of death in rural Greece is grief freely and fully expressed and socially accepted and valued. In many places, after the body of the deceased is prepared for the funeral, the close women relatives take part in the miroloyia. These are funeral laments, sung mainly by women, and forming part of a tradition that existed even in Homeric times and is associated with the expression of intense grief and sorrow. [5]

The above picture in which death is accepted, and dealt with, as a terrible but natural final stage of life refers to a social reality that is very different from contemporary urban reality in Greece. For a host of reasons, death in the Greek urban context has become increasingly distant from everyday life. Thinking of death is avoided and talking about it is regarded as morbid; health and youth are promoted and attention is drawn away from illness and old age; expression of the feelings of grief that come with death is not socially encouraged; children are excluded from scenes where death has struck. All these are forms of a denial of the existence of death, an attitude that is further supported by the fact that natural deaths are witnessed infrequently in urban Greece, as most of them take place out of view in hospitals and nursing homes. And this denial of course makes death much more frightening and difficult to face.

Care of the Dying Patient

The denial of death in urban Greece is especially evident in the context of medical training and practice. Whereas in the West, and especially in the U.S., the study of ethical questions connected with the care of the dying is now part of the curriculum of many medical schools, such issues are not at all considered in the course of medical education in Greece. As a consequence, doctors are trained to be specialists for dying patients, but not taught how to face the dying individual and meet his or her particular needs.

The ways in which most doctors relate to their terminally ill patients manifest their own denial of death and thus of the patients themselves. Physicians often decline to visit their dying patients. Or when they do, may cut their visit short, occupy themselves with other matters while ostensibly attending to the dying patient, or simply approach the patient in a very cold, "professional" manner. Only a superficial explanation of such behavior would attribute it to lack of interest. [6] They prefer to conceal the truth, even when the patient would clearly like to be informed. The reason usually given for such silenxe is that iw would cause the fatally ill patient acute distress to know the truth about his or her condition. The real explanation in many cases, however, is that by withholding the truth, physicians protect themselves from all the difficulties that arise in confronting a patient who knows her or she is dying.

In the context of the hospital the dying patient's condition is further denied during the last days of his or her life. These patients are isolated in small rooms, away from the public, other patients, friends, and relatives. The reason for this isolation is "social": by distancing the terminal patient from others, the latter are protected from being negatively affected by his or her condition and eventual death. All this is a terrible ordeal for the terminally ill patient, who very often is fully conscious. Meanwhile, others are not necessarily helped, as the wall that is raised in front of death only prevents them from becoming familiar with it and being prepared to face it. [7]

Medical Ethics Generally

The absence of any training in the care of the dying in medical schools in Greece can be seen as part of the more general phenomenon of the virtual absence, in this country, of the field of medical ethics. It was indeed only in April 1987 that the Hellenic Society for Medical Ethics was founded and that efforts toward systematic consideration of various ethical issues arising in medicine began in the course of various meetings and roundtable discussions organized by the Society.

But although there has been in this country virtually no scholarly debate on the various ethical issues that arise in medicine, there are nevertheless established medical practices relating to many of them, based, by and large, on similar practices in other countries. Thus there are, for example, established conventions on issues such as criteria for the determination of death and decisions about termination of life-support.

Until very recently, death was held to occur when the vital functions of respiration and circulation ceased. With the technical ability to maintain these functions mechanically, however, it became necessary to redefine death, which, as in most other countries, came to be identified with brain death. It is now agreed that permanent functional death of the brainstem constitutes brain death and that when this occurs, artificial life-support to patients is point-less and should be withdrawn, unless the brain-dead patient is a potential organ donor.

The criteria for diagnosis of brain death were clearly delineated in 1985 by the Ministry of Health on the basis of codes of practice of other countries. The diagnosis itself consists of two parts, "conditions under which the diagnosis of brain death should be considered" and "diagnostic tests for the confirmation of brain death," and it establishes when death has occurred in cases where vital functions are maintained artificially. It thus constitutes a reliable guide as to when to terminate life support to comatose and unresponsive patients.

But whether death is acknowledged as the natural end of life and grieved openly in the rural folk tradition, or reduced to clinical definitions and denial in urban hospital settings, it remains universally tragic in the separation it imposes on those connected by the bond of love:

My little partridge, why aren't you singing? Why should I sing? What should I say? I abandoned my mother without any solace. Don't cry, my sweet mother. Don't have a heavy heart. Our fate was written that we must be parted.... [8]

References

[1] I.N. Koufos, Ta Ellinika Dimotika Tragoundia, (Athens, 1970), 248.

[2] D. Petropoulos, Ellinika Dimotike Tragoudia (Athens: Zaharopoulos, 1959), 223.

[3] About the exhumation rite in rural Greece see L.M. Danforth, The Death Rituals of Rural Greece (Princeton, NJ: Princeton University Press, 1982), 15-23, 48-69 passim.

[4] Danforth, Death Rituals, 130.

[5] See Iliad 24:725-75. For a thorough study of miroloyia see M. Alexiou, The Ritual Lament in the Greek Tradition (Cambridge: Cambridge University Press, 1974).

[6] See Gerassimos Rigatos, "Antimetpizontas auton pou pethanei" in Eisagogi stin psychokoinoniki Ogologia (Athens, 1985), 149.

[7] See Rigatos, "Antimetpizontas auton pou pethainei," 148; also "O arostos pou pethainei," Arheia Iatrikon Etaireion 8 (1982), 11-30.

[8] Danforth, Death Rituals, 77.

Souzy Dracopoulou is a lecturer in philosophy at the University of Ioannina, Ioannina, Greece.

Spyros Doxiadis is a pediatrician and president of the Hellenic Society of Medical Ethics, Athens, Greece.
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Title Annotation:Special Supplement: International Perspectives on Biomedical Ethics
Author:Dracopoulou, Souzy; Doxiadis, Spyros
Publication:The Hastings Center Report
Date:Aug 1, 1988
Words:1456
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