Dr Michael Ashby1
1University Of Tasmania, Australia
Biography:
Michael Ashby is a Consultant Physician in Palliative Care and Pain Medicine, and Professor of Medical Ethics and Death Studies School of Medicine, University of Tasmania and Joint Editor-in-Chief, Journal of Bioethical Inquiry.
He has interests in law, ethics and the humanities as they apply to palliative care, the interface between psychodynamics and death and dying, grief and loss. He has extensive experience of mediation, supervision and open disclosure techniques and is now working on the concept of ‘realistic’ medicine and a palliative approach in acute medicine for frail elderly people with chronic diseases and dementia.
Abstract:
It goes without saying that death, and foreknowledge of its inevitability, is a major driving force, at conscious and unconscious levels, of everything that is done, thought and believed. Given the dominant worldview of logical positivism, scientific mastery, and personal control, coupled with modern epidemiological realities, decision-making and care for people who are approaching death is a major challenge for society and health systems. For over 50 years the lead has been taken by the hospice/palliative care ‘social movement’, and recently more broadly in health, especially in aged and intensive care, and by policy makers.
The overwhelming discourse and methodological approach tends to be linear, empirical and logical, in line with the zeitgeist, the ‘regimes of truth’ and ‘evidence base’ that are dominant in the system. This paper explores the possible unconscious personal and organizational forces at play when health services and society engage with the threat of death. It posits the view that a wider reticence to acknowledge the possibility of deep instinctual forces limits the capacity of the health system, its professional teams, individuals and wider society to work towards ‘healthier’ relationships with death, the dying, the dead, and ourselves as ‘mortally threatened’ at all times. Concepts such as identification, projection, transference and ‘organisation in the mind’ will be explored in the death, grief and palliative care context, as well as a notion of ‘ingestion’ or ‘transmission’ of pain and loss of others as a driver of organizational discord and burn out.