Knowing Death Well: Intimate and Contextual Death Competence among End-of-Life Laborers

Abstract

End-of-life workers, regardless of occupational status, work against a transformed culture of death and dying. Against that backdrop of technological brinkmanship, segregation of aging and dying from other aspects of life, and a cultural denial of death’s inevitability, end-of-life workers develop competence and expertise; however, that competence varies, shaped by the training and occupational status of its purveyors. Based on three years of participant observation and interviews with end-of-life laborers, I identify two types of death competence—intimate and contextual—that develop at different levels of the occupational hierarchy. One situates death philosophically and morally, the other garners insight from the body to sustain elders’ personhood in the face of diminishing capacities. These ways of knowing are valuable in a death-denying culture. Surfacing the less apparent expertise of nurse’s aides also contributes to existing social theory about death competence and raises questions about occupational knowledge more generally.