The good death as a democratic right: a discourse-theoretical analysis of the representation of end-of-life care in the Belgian newspaper coverage

In late modern societies, a 'good death' is more and more regarded as a democratic human right. This evolution is the result of a new approach on death and dying, one in which a good death is seen as a crucial aspect of quality of life (Cohen, 2007: 6-7). More and more, this good death is defined in terms of control over the dying process (Seale, 2000: 925). The aspect of control, then, is central to the discourses of the palliative care movement and the 'right to die' movement which dominate the contemporary discussions on the permissibility of human intervention in dying. These discussions have in different countries resulted in the development of legal-political frameworks, such as the Patient Self-Determination Act in the United States and the Euthanasia laws in the Benelux, which indeed define a good death in terms of a democratic human right. One dominant argument in late modernity includes the claim that the dying patient's basic human rights are violated when they lack the knowledge and the power to make their own end-of-life decisions. Hence, patients should have the right to know their conditions (Kearl, 1989: 438). However, resistance to scripts of an aware and controlled death is experienced by a minority who prefers to (partly) rely on others for decision making and to (partly) avoid information because 'ignorance is bliss' or because bodily events and conditions do not allow for an aware and controlled dying process (Seale, 2004: 967). These societal discussions on end-of-life care often take place in the field of mass communication. To examine these mediated struggles is highly relevant since media professionals operate within a cultural-ideological space in which particular dominant discourses on end-of-life issues exist. In this way, these discourses are brought into circulation and are confirmed and enforced by mass media. This paper, which analyses articles with reference to end-of-life care published in the year 2007 in both 'qualitative' and 'popular' Belgian (Dutch spoken) newspapers, indeed shows that media representations give little space to resistant readings opposing a fully controlled and aware death. Using a combination of discourse-theoretical analysis (Carpentier & De Cleen, 2007) and CDA (Fairclough, 1995), this paper shows more specifically that a good death is represented as a democratic right, but that this representation is accompanied by a discursive normalization of the dying subject who actively participates in the planning of his death. This representation often suppresses how the dying subject sometimes exclusively relies on others for decision-making or simply refuses a conscious and controlled death. Moreover, media representations rarely show the struggles and conflicts that sometimes still occur during the dying process and the way the dying subject interacts and negotiates with representatives of different fields (e.g. the medical and the religious fields) in an individual practical context. Arguably, these discursive exclusions support the hegemonisation of one specific model of 'the' good death, ignoring the diversity and complexity of dying practices and a pluralist articulation of the good death, and discursively curtailing the good death as a democratic right.