Death Positivity,White Respectability: A Critical History of Cicely Saunders and the Hospice Model of Care

Abstract

Social histories of hospice focus on 1960’s counterculture and emphasize the progressive, anti-institutional bent of death positive activists. Our accepted historical narrative is that what began as a radical, grassroots movement to humanize end-of-life care gradually became part of the mainstream medical marketplace, making it difficult for hospice to fulfil its potential. This essay complicates that narrative with a close, critical reading of Cicely Saunders’ life and work. The death positive movement, I contend, was politically conflicted from the outset. Saunders’ approach was radical insofar as she troubled the gendered distinction between professional and personal care and insisted on the value of care work historically coded as feminine; this humanized dying people and caregivers alike. At the same time, Saunders was preoccupied with interior and intimate experience, and her vision of good dying hinged on performances of white respectability. This made hospice care seem apolitical, even as it advanced middle-class, Christian ideas about labor, gender, family, and moral worth. This analysis highlights the privileged, Eurocentric dimensions of death positive ideology and encourages us to look beyond hospice care as we reposition ourselves to address the challenges of 21st century dying.