Palliative accompaniment: biomedical and social resignification of dying during the COVID-19 pandemic

ABSTRACT

The COVID-19 pandemic has led to unprecedented changes in the accompaniment of the sick, the dead, and their loved ones. This article analyses the intertwined accompaniment practices performed by health professionals working in hospitals and nursing homes and by the relatives of those who died or striving during the first few months of the pandemic in Barcelona, Spain. We argue that isolation, fear of contagion, and lack of biomedical professionals and infrastructures, produced a resignification of palliative care, social support and grief practices. Moving beyond the Western biomedical professionalization and the institutionalization of dying processes to give more agency to the dying and their loved ones, we apply the term palliative accompaniment to disentangle healthcare and psychosocial support practices adapted to the extreme circumstances of COVID-19, which includes old and new practices to alleviate patients’ suffering, relieve their loved ones’ anguish and support health professionals. Following the stories of our respondents, the interruption of the face-to-face visits and dying and mourning rituals was eased by the appearance of innovative healthcare practices, communication, and ritualization. However, this necessary evil was not enough to cope with the feelings of abandonment that emerged in response to dying alone and postponing mourning.

KEYWORDS:

• Palliative accompaniment
• dying processes
• COVID-19
• resignification of social practices
• bad death
• good death

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. On March 14, 2020, a State of Alarm was declared by Royal Decree 463/2020 to manage the health crisis due to COVID-19.

2. Allowed in exceptional cases such as children’s or health care (Ministry of Health, 2020). However, according to their criteria, some healthcare centres allowed a single family member for a limited time in cases with the worst prognosis.

3. The autonomous communities continued to maintain ordinary health management as stipulated in the General Health Law (LGS) 14/1986 of April 25.

4. It is estimated that 235,037 people have been infected in this community since the beginning of the pandemic according to the Statistical Institute of Catalonia Data collected between 01/03/2020 and 10/31/2020: https://www.idescat.cat/indicadors/?id=conj&n=14358.

5. Number of deaths due to the incidence of COVID-19. Data collected between 03/01/2020 and 10/31/2020 according to the Statistical Institute of Catalonia: https://www.idescat.cat/indicadors/?id=conj&n=14356 These figures are for people who had a confirmed test of COVID-19. However, the figures might be higher because few diagnostic tests were available at this time.

6. The notion of ‘white lies’ has been researched in dementia care, humanitarian intervention, and war death stories, among others. Nevertheless, it is beyond this article’s scope to analyse the repercussions of such bad breaking messages for patients, families and clinicians.

Additional information

Notes on contributors

Jana Mercadal-Sánchez

JanaMercadal-Sánchez holds a Degree in Social Education and a MSc in Autism Spectrum Disorders. Interested in anthropology of health-related quality of life, her dissertation research on accompaniment and grief during the Covid-19 has been awarded by the Higher Institute of Psychological Studies and the Open University of Catalonia.

Emilio Ferrer-Romero

EmilioFerrer-Romero is a PhD candidate in Anthropology at the Autonomous University of Barcelona, and he is a collaborating professor at the Open University of Catalonia (UOC) and at the Autonomous University of Barcelona (UAB), Spain.

Ignacio Fradejas-García

IgnacioFradejas-García is a post-doctoral researcher at the University of Iceland (School of Social Sciences). Ignacio holds a PhD in Social and Cultural Anthropology from the Autonomous University of Barcelona for his research on the interplay between mobility and informality. With extensive fieldwork experience in Gambia, Chile, Morocco, Haiti, RD Congo, Turkey, Romania and Spain, he conducts research on migration, transnationalism, (im)mobilities, humanitarianism and informality. He has been the main editor of the anthropological journal Perifèria (2018-2021), and his work is published in various peer-reviewed journals such as Social Anthropology (2019), Mobilities (2019), Migration Letters (2021) and Social Inclusion (2021).