Introduction

“Death is the possibility of impossibility” (Heidegger, 1962, p. 280). If death is an ontological impossibility, we can only learn about it indirectly by witnessing the death of another person (Schiappa et al., 2003). However, social changes since the early 19th century have made the witnessing of death by ordinary people a relatively rare occurrence in the global north. Second, the medicalization movement has taken over the administration of sick and frail bodies from family members (Foucault, 1988, pp. 183–184). For instance, family members now hire caregivers to take care of the personal hygiene of sick people at home; the same care is provided when the patient is moved to a medical center. Second, we hide many of the signs of imminent death such having a priest at the bedside of the ill (Ariès, 1981, p. 562) and mostly talk about death in terms of disease and treatments that might prevent it (Ariès, 1981, p. 554). Third, death has become dirty (Ariès, 1981, p. 564), with the emission of bodily fluids from incontinence, gangrene, transpiration, and other dying processes considered most repugnant. The dying process has also become more complicated and lengthier. Lawton (1998) calls this aspect of dying the “unbounded body” and argues that the more unbound the body becomes, the more likely the dying person will remain alone. Even when a person wishes to die at home, once their body becomes unbounded, they are moved to hospices or hospital settings to finish dying away from family and friends. Finally, people live longer than before. Most people are already middle-aged before they lose a grandparent, whereas previously they would have been children or young adults. As adults, they are called upon to make health decisions for their dying family members without having had any previous experience of death.

Four decades ago, Ariès (1981) argued from these criteria that the populations of western countries were in such a state of “death denial” that death had essentially become invisible. Walter (1994, p. 1) refuted the “death denial” interpretation and, noting a dramatic increase in the popularity of death as a subject of interest since the 1980s, argued that western society had instead become obsessed with death. Advanced communications technologies have made it possible for news outlets from all over the world to instantly inform us of natural disasters, war, violent crime, accidents, and other events with large death tolls. Death has also infiltrated our entertainment. By the early 2000s, there were an average of 13 death-related scenes per each award-winning American film, whether they focused on the tragic deaths of loved ones or heroes killing villains (Schultz & Huet, 2001, p. 141). Similar rates of death-related scenes have been found in children’s movies, where death is often treated as an obstacle to be overcome (Tenzek & Nickels, 2017). Finally, death is present on primetime television, especially in series where the protagonists solve murders or save lives every week. Given that death is now viewed daily in entertainment and news media, though seldom witnessed first-hand, we must interrogate how it is being depicted and what information about death the public might be learning. To address these questions, we discuss portrayals of death in two popular primetime medical series, Grey’s Anatomy and Saving Hope, and their implications for public education on the realities of death.

Theoretical Framework: Entertainment-Education

The concept of Entertainment-Education (E-E) describes the ways in which entertainment media can be used for educational purposes (Moyer-Gusé, 2008; Ye & Ward, 2010). Entertainment media broadly include news media along with movies and television programs. Health and medicine researchers have found that such forms of popular audiovisual entertainment can become sources of health information and influence public perceptions of health-related topics, including specific diseases and treatments (Burzynska et al., 2015; Gray, 2007). Information gathered from entertainment programing can also have an impact on behaviour (Hether et al., 2008).

Two theories from the field of psychology explain E-E’s influence on health behaviours and perceptions. Social cognitive theory explains how people might learn new behaviours from observation. The work of behavioral psychologist Albert Bandura and others since the 1960s attest to this (Bandura, 1969; 1973; 1977; 1986; Lansford, 2020). One of Bandura’s classic experiments involved having children watch a short video of their teacher interacting with a big, inflated doll called Bobo. If the teacher behaved aggressively with the doll, the children mimicked the behaviour when they later played with the doll (Lansford, 2020). From such experiments, researchers surmised that what children see on television could influence their behaviour in life (Engels et al., 2009; Greer, 2010; Murray et al., 1972; Paluck et al., 2015). Cultivation theory explains the positive correlation between television and the way people interpret the world around them (Ye & Ward, 2010). For example, Gerbner (2003) argues that the ways in which we learn or know about the world (our symbolic environment) is directly influenced by modern media and that we internalize the stories portrayed therein. Television in particular has become “a common culture through which communities cultivate shared and public notions about facts, values, and contingencies of human experience” (Gerbner, 1969, p. 123). This is especially true for primetime television, which combines visual and auditory stimuli, exciting plotlines, and ongoing relationships among characters as a very modern way of telling stories (Kellner, 2020). Taken together, these two theories suggest that analysing how death is being depicted in entertainment media would inform us about some of the shared assumptions people have acquired about real deaths.

Not all deaths get the same amount of attention in news media. Homicides, accidents, disasters, and the deaths of celebrities are more commonly covered by news media than other deaths (Frith et al., 2013; Hanusch, 2010). This leads the public to falsely assume that accidental deaths occur far more commonly than they actually do (Hetsroni, 2009). Moreover, explicit visual representations of death remain largely absent from the news (Hanusch, 2008). Death is more often implicit, with corpses hidden in body bags or draped with cloth (Morse, 2013). The deceased are often referred to with euphemisms such as “resting in peace” or “succumbed to injuries” (Lou & Liu, 2021). Such representations of death are preferred in the news because they are less disturbing to the public than more overt representations (Lou & Liu, 2021; Morse, 2013). However, as Ariès (1981) explains, trying to protect the public from death makes it seem ugly or dirty, which perpetuates the idea that it should be hidden. In the relatively rare instances when dead bodies are shown, they are often those of foreigners; their deaths appear to be from events that only affect others and not us (Sontag, 2003; Taylor, 1998).

Compared with news media, movies are dominated by sensationalized, violent deaths, and death itself is often portrayed as avoidable:

Any film-going American adult can point to memorable movie scenes in which death assumes a monstrous form, or to scenes in which heroic characters metaphorically ‘give the finger’ to death. Cinematic death may be grotesque and extreme, but our heroes can retaliate, escape, shrug, or laugh off death’s best shots and survive for the kiss in the final scene. (Schultz & Huet, 2001, p. 147)

Analyses of Disney movies reveal similar findings. Even though permanent death is more frequent in movies for children than in movies for adults, death is shown as reversible 31.5% of the time (Tenzek & Nickels, 2017, p. 57). Moreover, reactions to death are not always depicted accurately in films. Although sorrow or grief are portrayed in some movies, many do not depict strong responses to death. Instead, the topic is often dealt with through escape, relief, or even humour (Schultz & Huet, 2001, p. 147). In Disney movies, positive emotions or lack of emotion are just as common as displays of negative emotional responses to death; this provides mixed messages around the normalization of emotion when confronting the death of another (Graham et al., 2018, p. 10; Tenzek & Nickels, 2017, p. 57).

Television has been investigated to see whether it affects public attitudes towards death. After asking students to view 10 episodes of HBO’s Six Feet Under, which centered on a funeral home, Schiappa et al. (2003) found significant changes in their responses to the Death Attitude Profile, Fear of Death Scale, and Threat Index (short version). Freytag and Ramasubramanian (2019) conducted a narrative analysis of selected primetime shows to investigate whether each death portrayed was a ‘good death’ as characterized in the death and dying literature; they concluded that primetime television did not depict the ‘good death’.

To our knowledge, portrayals of death on medical primetime series have yet to be explored. To fill this gap, we conducted content analysis of two medical dramas to describe how death is being represented on primetime television. While acknowledging that the messages from such shows may be perceived differently by different viewers, we discuss the implications for what the public may be learning about death by viewing such popular shows.

Method

In 2019, we analysed two medical series using a combined quantitative and qualitative content analysis strategy. We wanted to compare a series aired in Canada with a series from the United States that followed similar plot lines and had been aired simultaneously. The only shows that fit these criteria were Saving Hope, set in Toronto, Ontario, Canada, and Grey’s Anatomy, set in Seattle, Washington, USA, both of which focused on surgeons working at hospitals. We analyzed five episodes each of four seasons of the two shows broadcast between 2012 and 2015, including seasons 9–12 of Grey’s Anatomy and seasons 1–4 of Saving Hope (Table 1).

We used a systematic random sampling strategy to select the episodes and ensure representativity for most of each season. We analysed the first five odd-numbered episodes from Grey’s Anatomy for season 9, first five even-numbered episodes from season 10, last five odd-numbered episodes from season 11, and the last five even-numbered episodes of season 12. The same strategy was used for Saving Hope, but we switched the odd-even episode sampling strategy. If a sampled episode was unavailable online, it was replaced with the following episode. This happened twice, in Saving Hope seasons 1 and 2. When an episode ended or began with one of the characters dying, the previous or following episode was watched so we could better understand the depiction of the dying process. This occurred twice, in Grey’s Anatomy seasons 9 and 10. These additional episodes were not included in our statistics.

Coding Procedure

Each episode was watched and coded twice. The first coding by the second author aimed at identifying every death in the sampled episodes and developing qualitative descriptions of them. Incidents where the characters should have died but did not were classified as ‘close calls’. For the second coding, the first author applied the coding scheme from Cox et al. (2005) to each depiction of death and verified the appropriateness of the qualitative descriptions of the deaths from the first coding. A few discrepancies were resolved by discussion.

The first author is a respiratory therapist and the second was a third-year student in respiratory therapy at the time of this study. Our medical education and experience as healthcare professionals were useful during coding, especially when it came to coding the ‘diagnosis’ and ‘close call’ categories.

Coding Scheme

Combined deductive and inductive approaches to content analysis were employed. For the quantitative deductive (directive) portion, we adopted a coding scheme developed by other researchers to evaluate the depictions of death in the media (Hamad et al., 2016). The scheme was originally created by Cox et al. (2005) to examine 10 Disney Classic movies, later extended by Tenzek and Nickels (2017) to include 57 Disney and Pixar films. We adapted some of the categories to fit television programs intended for an adult audience. Three of the categories from Cox et al. (2005) and Tenzek and Nickels (2017) were left unchanged: ‘character status’, ‘depiction of death’, and ‘emotional reaction’. Cox et al.’s (2005) and Tenzek and Nickels’ (2017) ‘death status’ category was replaced with the ‘close call’ because we assumed that adults are aware that death is permanent and final, even when not depicted as such. We also changed their ‘causality’ category to ‘diagnosis’ and coded for whether it was ‘known’ or ‘unknown’.

Character status: This category refers to the character status of each person who died. Three roles were identified: main, side, and extra. Characters seen in at least two seasons were coded as ‘main’. A ‘side’ character was someone seen in previous episodes or referred to by a main character but did not substantially contribute to the overall storyline (Tenzek & Nickels, 2017). ‘Extras’ were encountered for the first time and died within a specific episode.

Depiction of death: This category refers to how explicitly each death is portrayed (Tenzek & Nickels, 2017). We coded a death as ‘explicit’ when we saw the corpse. The finality of death was usually made further explicit by a flat line on a heart monitor or healthcare professionals stopping CPR and noting “time of death.” We coded a death as ‘implicit’ when a dead body was not seen and viewers were led to assume that a death had happened by hearing it announced to family members or mentioned later.

Emotional reaction: This category describes the emotional reactions displayed by other characters following a death (Cox et al., 2005). We coded displays of grief or anger at a death as ‘expected' negati emotions. We decided to use the term ‘expected' instead of ‘negative' used by Cox et al. (2005), because we beleived that this further perpetuated the negative conotation that is being given to grief and anger at the time of death, when this should be the norm. ¹ Instances where characters did not acknowledge or react to a death were coded as ‘lacking emotion’ (Tenzek & Nickels, 2017). ‘Positive’ emotions were indicated if any characters appeared happy or relieved. Since these shows were set in hospital contexts with healthcare professionals as main characters, we also coded for who (i.e., ‘family members’ or ‘hospital staff’) did or did not display emotional reactions to death.

Diagnosis: This category describes whether or not the cause of death is known to the viewer. An ‘unknown’ diagnosis was coded when the cause of death was not explicit. ‘Known and imminent’ referred to deaths that happened suddenly, such as from cardiac arrest or accident. ‘Known and chronic’ was coded for deaths that occurred because of a known fatal disease such as cancer.

Close call: This category describes patients who sustained life-threatening injuries but did not die. As medical professionals, we knew which injuries would have resulted in permanent disability and probably death in the real world. Incidents in which patients “pulled through” and returned to normal life without any severe consequences were thus coded as ‘close calls’.

We were also interested in developing overall descriptions of how each death occurred. For this qualitative portion of the research, we followed a conventional approach to content analysis by deriving relevant categories or themes inductively (Hamad et al., 2016). Each descriptive category was triangulated with scholarly literature on death and dying. Four themes were identified from this method: ‘the person dies but life goes on’; ‘the tragic death’; ‘the death with a purpose’; and ‘the well-timed death’. These themes are not mutually exclusive. In a few cases, a single death event fit more than one descriptive theme. The following section summarizes and discusses the results of our content analysis.

Results and Discussion

We present quantitative data obtained from deductive analysis, followed by qualitative data obtained from the inductive approach. Some of the quantitative data is discussed in the qualitative data section for a fuller understanding of how death is being depicted and possible implications for what viewers might be learning from primetime medical dramas.

Quantitative Results of Deductive Content Analysis

Death occurred in 85% (n = 34) of the 40 episodes analysed, with an even split between the two shows: Grey’s Anatomy 50% (n = 17); Saving Hope 50% (n = 17). Statistical analysis revealed no significant difference in the depictions of death between the Canadian and U.S. programs, so the results were combined for each category (Table 2).

Character status: A similar number of main characters (n = 3, 8%) and side characters (n = 3, 8%) died. This may suggest to viewers that even people who are close to us can pass away. However, the large number of deceased extras (n = 28, 82%) could imply that death happens more often to ‘unknown’ people. This demonstrates that everybody can die, while providing the message that death happens more often to ‘others’. Graham et al.’s (2018) analysis of Disney movies similarly supports the lesson that everyone is vulnerable to death, although ‘protagonists’ are just as likely to die as ‘antagonists’ in children’s films.

Depiction of death: Deaths were depicted explicitly 74% (n = 25) of the time; viewers could see the deceased and hear a heart monitor flatlining. Death was represented implicitly 26% (n = 9) of the time. In these cases, viewers do not see a person die, but hear another character refer to the death. These findings suggest that people may be less disturbed by death than previous scholars concluded from examining newscasts (Hanusch, 2008; Lou & Liu, 2021; Morse, 2013) or it may be that death is more sensationalized for entertainment purposes. Since newscasts depict real events, they may not follow the same rules as entertainment media (Linke, 2010).

Emotional reactio: Since no family members were present at 12 of the total 34 deaths observed, we were only able to code the emotional reactions of family members in 22 of the deaths. We found no cases in which positive emotions were displayed by either family members or hospital staff. Expected emotions were displayed by hospital staff in 32% (n = 11) of deaths observed and by family members in 59% (n = 13) of the deaths where they were present. Hospital staff lacked emotional responses in 67% (n = 23) of deaths, while family members failed to display any emotion in 41% ( = 9) of the deaths. These findings suggest that the normative reaction to death is not to demonstrate emotion. More expected emotional reactions to death are displayed in Disney movies (Graham et al., 2018), perhaps because more deaths are presented as tragic in children’s films than in primetime television shows aimed at adults.

Diagnosis: The diagnosis was ‘known’ for many more deaths 85% (n = 29) than ‘unknown’ (15%, n = 5). This could imply to viewers that medical professionals can usually discern cause of death without an autopsy. Although unexplained deaths do occur, they are much less common. According to George and Kimberley Molina (2015), the distribution of known to unknown causes of death as seen on primetime hospital shows matches reality.

When the diagnosis was known, 41% (n = 12) of the deaths were represented as imminent, while 59% (n = 17) of deaths resulted from a chronic process. This could imply that chronic deaths are only slightly more common than sudden deaths, which does not accord with reality. For example, fatal injuries and poisoning are often depicted on television, but they are responsible for only 5% of real patient mortality (Hetsroni, 2009). Viewers may tend to overestimate the likelihood of sudden death from watching television (Hetsroni, 2009).

Close call: We observed close calls in 75% (n = 30) of the 40 episodes analysed. This may suggest to viewers that medical professionals have the means and knowledge to solve the most complex medical issues. Kaufman (2015) similarly finds a “widespread assumption that the discoveries of biomedical science most always produce useful therapies” (p. 25). Such messages make it difficult for the public to draw the line between enough and too much medical intervention, since taking every measure to save a life is rarely questioned on primetime television.

We observed slightly more irreversible deaths (n = 34) compared to close calls (n = 30). However, more of the main plots in each episode revolved around close calls than permanent deaths. Although frequently occurring, death was not the dramatic focus of every episode. Some deaths just happened to extras in the background of the main storyline. We explored this further by describing the overall portrayals of deaths in the two primetime medical shows. The next section discusses the four themes we derived from our content analysis, including an examplar death scene for each.

Death Themes Derived From Inductive Content Analysis

Saving Hope S3E16 “Simple Plan”

The episode begins with a main female character, a surgeon named Alex, doing compression on an unnamed male patient in the ER.

Nurse: “It’s been 23 minutes.”

Alex continues compression a few more seconds, then takes the man’s vitals.

Alex: “He’s not coming back. Time of death 8:21.”

Another healthworker disconnects the manual breathing unit from the patient’s endotracheal tube.

Alex: “I’ll go fill out the death certificate.”

Alex leaves as the nurse draws curtains around the bed.

This theme captures instances where death is treated as an ordinary occurrence. This applied to 41% (n = 14) of deaths observed. Quantitative data support the omnipresence of this type of death. All the characters who died in this fashion were extras and the cause of all their deaths remained unknown to the viewer. Every time this type of death was portrayed, hospital staff lacked emotion and the 12 deaths that occurred without family members present were also presented in this way. This theme encompasses all but one of the implicit deaths observed (the exception is an episode in which a main character named Richard tells others that his wife has died).

This was the only theme that did not overlap with the other three. It demonstrates that death is an ordinary occurrence for healthcare professionals, especially those who work in critical or palliative care settings. This supports Sudnow’s (1967) point that death is “constituted by the practices of hospital personnel as they engage in their daily routinized interactions within an organizational milieu” (p. 8). We observed that such routine practices as calling the morgue or certifying death were often depicted in medical television series, but they never affected the main plot or disrupted the lives of main or side characters. The presence of such matter-of-fact deaths demonstrates the reality that all people die and thus mimics what we see in real hospital settings. Nevertheless, as the following three themes suggest, not all deaths have the same value nor are they addressed in the same ways in entertainment media (Sudnow, 1967); Timmermans, 1999).

Grey’s Anatomy S12E18 “There’s a Fine, Fine Line”

Gretchen McKay, an extra, is 34 weeks pregnant with a fourth child when she and her family are in a car accident. She is brought to the ER, then staff move her to another part of the hospital to have a CT scan. Her condition deteriorates while in transit. Two residents do an emergency C-section in the hallway, but Gretchen and the fetus die.

Miranda Bailey (a main character) enters the room where Gretchen’s three children have been waiting. The oldest daughter, Jasmin (about 10 years old) asks Dr. Bailey if she can speak to her outside the room.

Jasmin: “I am in charge now. You can tell me the truth.”

Dr. Bailey: “Your dad had a long surgery, so he is going to be asleep for a while.”

Jasmin: “What about my mom? Did she die?”

Dr. Bailey: (touches Jasmin’s cheek, speaks slowly) “I am so sorry.”

Jasmin: “I thought so.”

They talk a little longer, then Jasmin returns to the room where her siblings wait. As Jasmin turns her back, a closeup shows Dr. Bailey with tears in her eyes.

The tragic death accounts for 32% (n = 11) of deaths observed. The role status of characters whose deaths were portrayed as tragic varied widely: extras as well as side and main characters all died this way. All the tragic deaths were explicit in that we saw the bodies and other clear indicators of death in every instance. The causes of all tragic deaths were known; all were due to accidental or imminent death. Most of the deaths we coded as ‘tragic’ happened suddenly to younger individuals or hospital staff recognized the deceased. Timmermans (1999) coding of events involving ‘tragic resuscitative effort’ on the part of healthcare professionals echoes what we observed of the tragic deaths depicted on primetime television. He describes resuscitative efforts as tragic when “the health-care provider becomes emotionally involved with the patient or relatives” and their failed “efforts are second-guessed, extensively debriefed and played over and over again” (Timmermans, 1999, p. 170).

Because medical staff become emotionally involved in cases of tragic deaths, primetime television shows them displaying expected emotions. We noticed that hospital staff showed expected emotions almost every time death occurred in this fashion (10 out of 11 tragic death events), while family members more often lacked emotion (6 out of 9 events). The ways in which expected emotions on the part of staff were displayed are worth mentioning. In the example above, Dr. Bailey waits until the family member turns away before allowing herself to tear up. We observed that the expected emotions exhibited by healthcare providers usually go unwitnessed by relatives of the deceased. In the few cases where family members saw the emotional reactions of the staff, the healthcare professional was reprimanded by their supervisor. It seems a “display rule” is operating to limit emotional expression even in response to tragic death (Brighton et al., 2019).

The lack of emotion exhibited by family members is a drawback of primetime television’s portrayal of tragic death events. Their stoic countenances seem to valorize grief avoidance behavior. Although Baker et al. (2016) argue that avoidance behavior might be an adaptive response to loss, it can have damaging consequences when taken as a social value or sign of bravery. Souza (2017) argues that, “because western society has not provided ritualized or acceptable ways to recognize the social changes that are necessitated during bereavement, the bereaved are left to manage the process on their own” (p. 66). Death of a family member, especially a loved one, is a difficult event that generates sadness and anger in real life, but not showing grief or lacking such emotions is being normalized on television. If grief and the grieving process were instead being normalized on television, it would help us reintegrate death and death rituals in our society. Unfortunately, intense grieving is rarely displayed in medical primetime television shows.

Saving Hope S3E18 “All the Pretty Horses”

Joel and Zach (main characters, both attending physicians) go to assist the military following a training accident. They go to the military camp to help a soldier who has a bomb lodged in his abdomen. Inside the tent, Joel sends Zach back to the hospital to fetch medical supplies. After he leaves, Joel extracts the bomb from the soldier’s abdomen. When Zach realises that Joel lied about having forgotten medical supplies, he returns to the tent just as Joel exits slowly, carrying the bomb.

Military Officer: (yells to Joel) “Stay where you are; we are coming to you!” (Then to his team) “Bring the container!”

The camera turns to Joel, looking confused. A horse is heard. Joel turns his head and sees a white horse come running out of nowhere. Joel turns his head again; the bomb explodes, causing his death.

Death with a purpose represents 18% (n = 6) of all deaths observed. The purpose of Joel’s death was to save Zach and the soldier. Other purposeful deaths featured organ transplants. Half (50%, n = 3) of the people who died in this fashion were main characters and the other 50% (n = 3) were extras. All deaths in this category were explicit and the diagnosis was known (mostly due to accident). If present, family members showed expected emotions to purposeful deaths, while hospital staff mostly lacked emotion, especially when extras died. Staff more often exhibited expected emotions when a main character died.

The purposeful death resonates with Durkheim’s (2002) concept of “altruistic suicide.” We did not identify deaths as such because, even though the actions taken by the characters who died might have been high risk, they were never undertaken with the intention of dying; they were not suicidal behaviors. Nevertheless, purposeful death bears similarities to altruistic suicide, which has four features: abnormal excessive social integration; support from public opinion; benefit to society; and positive emotion (Stack, 2004). The purposeful deaths we observed on primetime television did have the support of public opinion. They also benefited society by ensuring that somebody else, usually younger than the deceased, survived. However, it is difficult to evaluate whether the characters who died with purpose had abnormal excessive social integration and none of the deaths we observed were accompanied by positive emotion on the part of other characters. We did see that death having a purpose became a consoling rhetoric used by loved ones after the event, especially when the purposeful death involved organ transplantation. This feeds into the “gift of life” rhetoric often used to promote acceptance of organ procurement (Shaw & Webb, 2015). When a patient’s condition is so dire that there is no possibility of procuring an organ for transplant, comfort is sought in being able to say one last goodbye. This necessitates a well-timed death, discussed next.

Grey’s Anatomy S11E21 “How to Save a Life”

Meredith (main character, attending surgeon) has to withdraw life support from her husband, Derek (main character, attending surgeon), who was severely injured in a car accident. She enters the room where he is on a ventilator.

Meredith: “It’s okay. You go. We will be fine.”

She strokes Derek’s face. Her eyes tear up, but tears do not fall. She stands and takes his hands. The nurse looks at her.

RN (an unnamed female extra): “Are you ready?”

Meredith: “No, but you can go ahead.”

The nurse nods, then turns away. We hear a machine being switched off. The nurse then pulls off tape and removes the ventilator tube from Derek’s mouth. Meredith has one hand on Derek’s chest. Once the tube is removed, Derek exhales. The camera shows the electrocardiogram monitor flatlining, indicating no heartbeat. Derek is dead.

A well-timed death was portrayed 23% (n = 8) of the time. We found that most (2 out of 3) of the main characters died in this fashion, while 6 well-timed deaths were of extras. Half of the well-timed deaths resulted from chronic conditions and the other half followed accidents. All deaths that occurred in this category were explicit. The immediate cause of all accidental deaths was treatment withdrawal, as in the example above, following which the dying person appeared to fall asleep. The moment of death was usually indicated by someone checking for a pulse and stating that there was none or by a monitor flatline (Chartrand, 2020). Family members were present in most cases and they all demonstrated expected emotions. Hospital staff demonstrated expected emotion in half the well-timed deaths but lacked emotion in the other half.

The ways in which some of the well-timed deaths were portrayed do not correspond to what happens in real hospital settings. First, these primetime television deaths always seemed to happen at the perfect predictable moment, giving family and friends the opportunity to be at the patient’s bedside and say their goodbyes, as Meredith does above, whereas real deaths always happen unexpectedly. The exact moment when the heart stops is impossible to predict even when death results from treatment withdrawal (Chartrand, 2020). Thus, in real settings, family members often miss the precise moment of death. Death and dying scholars have noted that not having a witness at the death bed is considered a ‘bad’ death (Porock et al., 2009). For example, Selman et al. (2021) found that family and friends often expressed despair on Twitter when their loved ones died alone in a COVID-19 ward. Having someone, even just a healthcare professional, witness the death of a loved one is highly valued.

Second, primetime television presents well-timed death as aesthetically pleasing even when the fact of death is made explicit. The well-timed television deaths resulting from treatment withdrawal seem peaceful, even pleasant to observe, as the person appears to fall asleep. Other well-timed deaths coincided with other more positive events. In Saving Hope S2E1, “I Watch Death,” a husband dies at the same time his wife gives birth. Such portrayals make death seem beautiful and romantic, not at all like reality. Viewers are left with the impression and expectation that they will always have time to say good-bye to their loved ones and be at their side when they pass away. They expect to see those they love take one last breath before seeming to fall asleep. For viewers, this epitomizes the ‘good’ death.

Conclusion

This study used a combined content analysis approach to explore how death was being depicted on medical primetime television and the type of messaging implied by such depictions. For the deductive part of the analysis, we adopted the same evaluation grid developed by Cox et al. (2005) and later used by Tenzek and Nickels (2017). Our content analysis suggests that many of the messages from primetime medical shows are generally representative of what occurs in hospital settings when people die. The main exception was for the category of emotional reaction. We found that a lack of emotional display, even amongst family members, was normalized on television.

We added the ‘close call’ category to the original grid. Events were coded as close calls when the characters who seemed to be about to die recovered even though, based on our medical education and experience, it would have been impossible for them to survive the injuries depicted. With the addition of this category to our content analysis, we found that primetime medical shows often showcase patients who make miraculous recoveries. Such depictions may provide viewers with the false assumption that there is a good chance of surviving even the most terrible accidents when proper medical knowledge and technology are available.

Using the conventional, inductive approach to content analysis, we then identified four thematic categories that encompass all the deaths observed in our sample. The first theme, ‘the person dies, but life goes on’, informs the public that death is a regular part of the healthcare profession and that dealing with this event is routinized (e.g., in the ER). The second theme, ‘the tragic death’, reminds us that not all death has the same status. Much more grief is shown for the deaths of children or young parents than for older people. The third thematic category, ‘the purposeful death’, informs viewers that altruistic gestures are highly valued, even when they result in one’s own death. Referring to the bravery of the deceased is also a comforting rhetoric used to console the bereaved family. Finally, the theme of ‘the well-timed death’ romanticizes death by rendering it beautiful and aesthetically pleasant. It also informs us of the importance of witnessing death and how highly valued it has become to have someone at the bedside of the dying person at the precise moment of death.

Regardless of whether the deaths on these primetime medical dramas were portrayed as tragic, purposeful, or well-timed, once they occurred, life returned to normal within the series. No rituals were conducted at the moment of death and little space was made for grieving. Such detachment from death amongst the living was particularly well-exemplified in the Saving Hope episode in which Richard’s wife Adele passes away. This death was implicit in that viewers only found out about it when Richard showed up at Bailey’s wedding and told people his wife had died. After this episode, Adele was rarely ever mentioned again in the series. The deaths of main characters such as Derek and Joel were handled a little differently, in that the sadness of their friends and family could be extrapolated from their behavior in subsequent episodes. Still, no rituals of grieving were ever portrayed. While death is indeed present, grief is definitively avoided.

There are some limitations to our research. First, we analyzed two series that both had seasons broadcast over the same 4 years, 2012–2015. Since then, there has been an explosion of hospitals shows on television. We have noticed some changes in the ways death are being portrayed in more recent shows. For instance, we have noticed that in well-timed deaths, patients or family members make requests before they die, which doctors endeavor to fill. The best example of this would be S16E13 of Grey’s Anatomy, where Dr. Schmidt turns the cafeteria into a ballroom so a man can dance one last time with his dying wife. These instances of well-timed deaths more closely emulate the ‘good’ death as defined in medical literature.

Second, both shows chosen were produced in North America. Our results would probably have been different if the TV series came from another region of the world. Third, we had expected to uncover some differences in how death is depicted on primetime television in Canada compared with the United States, but our statistical analysis showed no significant differences. We did observe some differences in categories such as display of emotion (or lack thereof) amongst hospital staff that approached statistical significance, however. To make a more appropriate comparison between Canada and the USA, we should sample more episodes.

Finally, this study was built on the coding scheme developed by Cox et al. (2005), which was used for Disney movies, not for ongoing televised series aimed at adult audiences. The modifications we made to the original scheme were exploratory, as were the qualitative themes we found through using the inductive approach to content analysis. It would be valuable if our study could be reproduced using other adult content to validate this methodological tool.

In future, we propose to continue examining the content of primetime television shows. A historical or longitudinal content analysis of medical primetime shows would be valuable for determining if some behaviours and assumptions have changed throughout various periods in entertainment media. The findings of this study could be used to evaluate how broader discourses on death and dying have changed. Investigating patient perceptions on death would also be valuable for assessing how primetime television messaging influences the public. Such a study could be used to modify medical programs to better match reality or address important issues that arise in real life when people are faced with death.

Acknowledgments

We would like to acknowledge Jaida Samudra for her feedback and English editing. This article would never have been published without her help. I would also like to acknowledge the comments of the reviewers who did point out really important aspect to improve this manuscript.

ORCID iD

Louise Chartrand https://orcid.org/0000-0002-4120-7409

Notes

Note

1 Thanks to the reviewer for pointing this out

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