‘A Sense of Mercies’: End of Life Care in the Victorian Home

At the dawn of the twenty‐first century palliative care in England is undergoing significant change. The value of enabling the dying to be able to exercise choice over
their place of death and to make death at home an available option has been recognised by hospice professionals for some years and has recently been incorporated into Government policy. To reconsider end of life care in the Victorian period, the last age before hospitals started to be widely regarded as the usual location for death, and when the majority still preferred to, and did, die at home, is therefore both timely and relevant.
This study presents evidence from diaries, letters, novels and visual art, and introduces important and previously unexplored sources. Based on this evidence, it is suggested
that the family’s central role in the decision making process, and in providing care, allowed them to draw on shared emotional and psychological support and derive
comfort from their shared religious beliefs. The wider community of friends, neighbours, extended family and the many middle class women who undertook to visit the sick as a Christian duty, all provided further support to carers and helped to prevent the ‘social death’ so often experienced by the terminally ill in the twentieth
century.
Throughout the nineteenth century Christianity still provided the framework within which most people understood death. Christian end of life care was focussed upon
spiritual preparation and gave the dying respect and a dignity conferred by their perceived proximity to God. For carers, emphasis on preparedness provided them with a comforting role praying and reading from scripture with the dying, when otherwise they could feel impotent in the face of untreatable bodily suffering.
Contrary to suggestions that Christians disapproved of pain relief, the evidence suggests that pain relief was mostly welcomed once available, but when pain was encountered Christian teachings about its purpose were drawn upon as a source of consolation and strength.
Doctors, although becoming increasingly influential in end of life care provision through an increase in their professional status and an improving ability to provide
effective pain management, did not, it is argued, generally exercise the levels of authority and control over the home deathbed that they could later in a hospital setting. These limitations can be observed in the process of negotiation through which diagnosis was arrived at, frequently involving recourse to second opinions, and through the constraints imposed by the lack of effective treatments.
Finally, the persistent preconception that the Victorians were morbidly ‘obsessed’ with death is challenged. Instead it is suggested that the Victorian response to death was
both pragmatic and rational, given its prevalence in their society. Much Victorian language, imagery and behaviour surrounding death was influenced by Romanticism
and by notions of ‘respectability’, which, it is contested, created the false impression of an obsession with death itself.
Through focussing on these aspects this study aims to re‐evaluate end of life care in the Victorian home and reveal the neglected positive aspects of such care, many of
which are finding renewed relevance today.