Ageing and Death

Breaking a Taboo

Matthias Rauterberg and Kiarash Irandoust

Industrial Design, Eindhoven University of Technology, Den Dolech 2, 5600MB Eindhoven, The Netherlands

Keywords: Ageing, Good Death, Human Life, ICT, Meaning of Life, Oedipus Trilogy.

Abstract: This position paper argues for addressing ‘good death’ as part of ‘well ageing’ in human life. Although in

most societies death is protected through taboos, we have to provide solutions in helping citizens preparing

for their own death. The Oedipus Trilogy is an ancient narrative to describe clearly the three phases in any

human life, the unavoidability of those phase changes. We have to use the last phase of our life to prepare

for the end. We will summarize the different philosophical positons regarding ‘meaning of life’, and – alt-

hough addressing death is a mainly social issue – we describe the challenges for future ICT development in

supporting the important last steps of preparing for a ‘good death’.

1 INTRODUCTION

This position paper is all about human life in general

and the end of life in particular (Rauterberg, 2011)

(Vissers, Wang, Baha, Hu, and Rauterberg, 2012)

(Irandoust, 2013). The most common definition for

life is "the period between birth and death" and "the

quality which makes people, animals and plants dif-

ferent from objects, substances, and things which are

dead” (Cambridge Dictionary, 1995). The main

question which raises here is what the quality of life

is; a quality which at first place distinguishes living

humans from objects and secondly discriminates be-

tween human and animals or plants. A merely sim-

plistic answer to this question can be given in a bio-

logical manner. However, answering this question

from a sociological and humanistic point of view has

concerned philosophers, social scientists, care givers

and physicians for centuries, and defining the mean-

ing of life has been one of the most profound ques-

tions of human existence. In this paper we will focus

on the notion of a ‘good death’ as part of human life

(Kehl, 2006) and how ICT could play a role in here.

We are really in need of a new vision on life in gen-

eral and healthcare in particular (Marzano, 2009).

2 EXISTENTIAL QUESTION

In the Western world religious beliefs become less

and less influential to provide a framework for an-

swering this existential question about ‘meaning of

life’. So far we assume that our life is limited and

ends with death (Craig, 2008; Rauterberg, 2011).

But given these two empirical facts, how can then

death become a meaningful part of our life? In our

modern societies most ageing people do not want to

be confronted with their own death (Cappon, 1978),

and most contemporary societies try to avoid death

and dying (Todd, 2003). Young adults show fear of

dying and death when they search for meaning in

life (Cicirelli, 1998), but not if they show already

presence of meaning in life (Lyke, 2013). In an in-

ternational cross-cultural study “greater longevity

was not considered one of the most important com-

ponents of successful ageing“ (Fernandez-

Ballesteros et al., 2010, p. 52). Before we go into

more details for our topic of ageing and death, we

need some ontological framing. Philosophers have

been trying to develop and evaluate principles which

are meant to capture all the particular ways that a

life could obtain meaning. The primary views on the

meaning of life can be divided into (1) super-

naturalism, (2) objective naturalism, (3) subjective

naturalism and (4) nihilism (Metz, 2008).

2.1 Supernaturalism

The supernaturalist view in the monotheistic tradi-

tion is divided into God-centered and soul-centered

views (Cottingham, 2003) (Craig, 2008) (Seachris,

2011). While God-centered views believe God's ex-

istence, along with "appropriately relating" to God,

Rauterberg M. and Irandoust K..

Ageing and Death - Breaking a Taboo.

DOI: 10.5220/0005473900750080

In Proceedings of the 1st International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AgeingWell-

2015), pages 75-80

ISBN: 978-989-758-102-1

 2015 SCITEPRESS (Science and Technology Publications, Lda.)

is both necessary and sufficient for a meaningful

life, soul-centered views suppose having a soul and

putting it into a certain state makes life meaningful,

even if God does not exist. In God-based views

meaning in life is that one's existence is more signif-

icant, the better one fulfills a purpose God has as-

signed. Common idea is that God has a plan for the

universe and that one's life is meaningful to the de-

gree that one helps God realize this plan, perhaps in

the particular way God wants one to do so. Fulfilling

God's purpose (and doing so freely and intentional-

ly) is the sole source of meaning, with the existence

of an afterlife not necessary for it (Levine, 1987)

(Cottingham, 2003). Life would be meaningless, if a

person failed to do what God intends him to do with

his life. Generally, soul-centered view considers that

meaning in life comes from relating in a particular

way to an immortal, spiritual substance that super-

venes on one's body when it is alive and that will

forever outlive its death. If one lacks a soul, or if one

has a soul but relates to it in the wrong way, then

one's life is meaningless (Adams, 2002).

2.2 Objective Naturalism

The objective naturalism view proposes a physical

life without believing in presence of a supernatural

reality (Hartshorne, 1996). According to this view, a

meaningful life is possible and the meaning of life is

connected with solid or intrinsic nature and is inde-

pendent of mind- related matters. In other words, a

meaningful life by objective naturalism is not consti-

tuted based on a person's choice or will, instead it is

presented by inherently worthwhile or finally valua-

ble conditions. Objective naturalism is distinguished

from subjective naturalism by its emphasis on mind-

independence. Morality and creativity are widely

held instances of actions that give meaning to life.

These actions are meaningful regardless of whether

any autarchic agent (including God) believes them to

be or seeks to engage in them. To obtain meaning in

one's life, one ought to pursue these actions.

2.3 Subjective Naturalism

Similar to objective naturalism, subjective natural-

ism posits a meaningful life without believing in ex-

istence of a supernatural reality, however the current

view proposes that life is a function of what a person

wants or chooses. Therefore meaning of life varies

among different people, as mental status of one per-

son varies from another. Common views are one's

life is more meaningful if, the more one gets what

one happens to want strongly, the more one achieves

one's highly ranked goals, or the more one does what

one believes to be really important. "Lately, an in-

fluential subjectivist has asserted that the relevant

mental state is caring or loving, so that life is mean-

ingful just to the extent that one cares about or loves

something (Frankfurt, 1988).

Even though objective and subjective naturalism

disagree on the conditions for meaningfulness, both

are united in their rejection of supernaturalism and

necessity of God in order to secure a meaningful

life. In this way, both forms of naturalism can be

thought of as optimistic naturalisms, which agree

that meaningful life is possible in a godless universe.

2.4 Nihilism

Despite above mentioned views, which believe in

presence of a meaningful life, nihilism or pessimistic

naturalism denies existence of a meaningful life at

all. As some forms of nihilism is related to boredom

or dissatisfaction of human in life; in general, nihil-

ism argues that life is without objective meaning,

purpose, or intrinsic value, and if there would be a

value, there is no base for that. Most commonly,

Friedrich Nietzsche is the most often cited philoso-

pher associated with this life view (Hartshorne,

1996). The idea shared among many nihilists is that

there is something inherent to the human condition

that prevents meaning from arising, even if God

would exist. For instance, some nihilists make the

Schopenhauerian claim that our lives lack meaning

because we are invariably dissatisfied; either we

have not yet obtained what we seek, or we have ob-

tained it and are bored (Martin, 1993).

All these reading disclosed how drastically opin-

ions varied on the ‘meaning of life’. A question that

has a quite simple formulation has disputed complex

opinions; opinions which contradict or even coun-

teract each other. So, when talking about a society

and designing (designs which target cultural issues;

(Rauterberg, Hu, and Langereis, 2010)) for a society

means considering all these opinions (Vissers et al.,

2012).

3 POSSIBLE ANSWER(S)

Every human being walks a unique path through this

life. What happens in the life, regardless of being re-

ligious or non-religious, is in essence the salvation

history of that person (Girolimon, 1994). Probably

all people on this planet have this in common. In

many cultures and religions there was and still is the

conception that life happens in distinctive phases,

ICT4AgeingWell2015-InternationalConferenceonInformationandCommunicationTechnologiesforAgeingWelland

e-Health

each with a specific content, which were thresholds

for the next entrance (Rauterberg, 2011). Therefore,

it still is important to cross these phases consciously

and with the right effort. "When the time was right

the community prepared together with that person,

symbolized the transition often with a rite and cele-

brated the moment. This partition of life was an at-

tempt to procure conscious life" (Vissers et al.,

2012). In contemporary societies, little is left from

the earlier union of rites; however, the perception of

phases and transitions is still present in religious and

nonreligious people (Bax, 2009). These phases can

also be considered as ongoing processes of learning

and discovering that life is not all about ego, enjoy-

ment and achievement, but it is about living; living

with love, receptiveness and thus becoming a mild,

responsible and peaceful human being. A truly free

human being who knows what resignation is.

We can identify three main phases during each

individual life that are mostly common among dif-

ferent cultures: (1) childhood, (2) adulthood, and (3)

retirement. Of course we have also to consider the

phase before life (by coming into life through birth),

and the phase ‘after life’ leaving life through death.

In case of the supernaturalism we have to deal with

five different phases; for all the other four ontologi-

cal positions we can focus on the central three phas-

es only.

What is noticeable is that our lives are rich with

combinations of three major concerns in each of

those phases: love in (1), power in (2) and death in

(3) (Salem and Rauterberg, 2005). It seems that

power is the most attractive concern with utilizing

on death, and love the most desired means used to

overcome selfish and egoistic power (Gandhi’s doc-

trine of non-violent protest and civil disobedience to

achieve societal transformation has been hugely in-

fluential worldwide (Fischer, 1983)).

Our trilogy of emotional concerns – love, power,

death - has been developed by looking at several el-

ements of human history, culture and religions e.g.

remarkable events, lasting buildings and work of art

that have a certain historical or cultural value. In-

deed historical events are all reported within the per-

spective of one of the three concerns (e.g. king leg-

ends, wars and love stories). It is cross cultural and

cross centuries (Mahabharata 5BC – 2AD, Shake-

speare works such as Macbeth 1605-1606 AD, and

Romeo and Juliet 1594-1595 AD) (Salem and Rau-

terberg, 2005).

The three phases of life and the necessary trans-

formation between those is fully captured in the an-

cient occidental Oedipus trilogy (Sophocles, 2000),

first in 429 BC publicly performed in the polis of

Athens to educate and prepare all citizens for their

life divided in three parts (Higgins and Higgins,

2011). The whole tragedy in the Oedipus trilogy is

outlined in three separate books emphasizing differ-

ent aspects of human life and fate (Sophocles, 2000).

The life of Oedipus is described in three parts:

Part-1 in which - triggered by a special prophecy

- Oedipus as a baby was sentenced to death by his

own parents Laius and Jocasta (king and queen of

Thebes), but survived through the mercy of the exe-

cutioner; Oedipus grew up at Polybus’ neighbouring

kingdom, and become finally king of Thebes as the

oracle Creon predicted already after his birth.

Part-2 in which king Oedipus ruled Thebes and

had four children with Jocasta: Antigone and Ismene

(daughters) and Eteocles and Polynices (sons); when

he was forced to find out that he had unintentionally

killed his father Laius and had married his mother

Jocasta, he felt deeply ashamed.

In the final part-3 Oedipus was so shocked about

what he had done that he wanted to do penance by

blinding himself and searching for a way into the

Hades to become dead. His two daughters helping

him preparing for death accompanied him on this

last journey.

All three transitions from (1) being born into

childhood, (2) childhood to adulthood, and (3)

adulthood to retirement are inherently in a tragic

manner unavoidable to the character Oedipus; this

was and still is the main message to all citizens: Life

contains and requires these necessary and unavoida-

ble transformations from one phase to the other!

The final and most challenging fourth transfor-

mation is death. As long as humans are mortal, any

normative concepts prolonging life at any costs

seems highly questionable (Cosco, Stephan, and

Brayne, 2013). Of course, humans can live longer in

the future than today (WikiPedia, 2014); however

they still will be mortal. Instead of avoiding facing

death, effective preparation for this ultimate trans-

formation is preferable and therefore recommenda-

ble (Levine, 1987). Any culture and society neglect-

ing this can be considered incomplete and bound to

become inhumane (Leighton and Hughes, 1955)

(Platt, 1963) (Sankar, 1991) (Martinedale, 1998)

(Lamb, 2014).

3.1 The ‘Good Death’

Through the enlightenment period in the West most

of the rituals and other mystical ingredients seem not

at all or at least hardly applicable in Western cul-

tures although any healthy society seems to have a

fundamental need for intergenerational communica-

AgeingandDeath-BreakingaTaboo

tion supported by rituals (Rappaport, 1999). The dis-

appearance of rituals in our contemporary societies

seems to be influenced amongst others by urbaniza-

tion (Bax, 2009), and urbanization has a negative ef-

fect on the mental health of citizens (Lederbogen et

al., 2011). Busselle, Ryabovolova and Wilson

(2004) argues that content (i.e. norms, values, be-

liefs) with the potential to transport culture is very

important to cultivation effects, in particular when

the citizen is actively involved in the acquisition of

the cultural content.

The ending of life' might be a process wherein

life is gradually extinguished, or a momentary event.

The momentary event can be understood in three

different ways (Luper, 2009a): (1) Denouement

death, the ending of the dying process; (2) threshold

death, the point in the dying process when extinction

is definite; and (3) integration death, when the phys-

iological systems of the body irreversibly stop to

function as an integrated whole.

There are also three main philosophical views on

death concerned with the reality of human being: (1)

animalism (Olson, 2007), (2) personism (Luper,

2009b), and (3) mindism (Olson, 2007). The animal-

ism view suggests that we as human beings persist

our existence to remain the same ‘animal’. In this

view death is an irreversible end to all critical pro-

cesses, which maintain such existence. The person-

ism view says that we have self-awareness, it is

mostly involved with our psychological characteris-

tics, and loss of such characteristics results in death.

The mindism view indicates that regardless of hav-

ing self-awareness, we are minds and persist to re-

main the same mind. In this philosophy death is an

irreversible end to the processes that maintain exist-

ence of our minds.

Understanding death from these three point of

views have different significances, for example de-

mentia affects psychological characteristics (person-

ism view), but not the mind (mindism view). It can

be imagined that our mind can survive death, when

the body is already gone (assuming that mind is not

a part of the body). These examples show that the

way mindists interpret and understand death is dif-

ferent from animalist. In conclusion, approaching

death by different philosophical views has different

implications. Nevertheless, almost all of us want to

die in peace.

The phrase ‘good death’ as used in Kellehear

(1984) refers to the preparations around the death

scene initiated by the dying. It has little to do with

the theory and philosophy of Euthanasia - a term of-

ten translated from its Greek sources as meaning

‘good death’. Following Kellehear, the ‘good death’

is set in motion by the dying person him or herself

timely before the actual dying process. It is a set of

culturally sanctioned and prescribed behaviours, de-

signed to make death meaningful. “These behaviours

range from preliminary discussions with physicians

about life extending technologies, buying a grave

plot or stone, making a will, to talking about death

with family and other kin, making peace with God/s,

and so on” (1984, p. 8). Although it is difficult to in-

vestigate such tabooed topic (Walter, 2008), many

societies cross cultures and through time seem to

have had and still have concepts of a ‘good death’.

3.2 Possible ICT Support

According to Korhonen, Nordman and Eriksson

(2014) technology as a concept has three implica-

tions: (1) technology is ICT based devices and prod-

ucts to provide different services; (2) technology re-

fers to a process consisting of methods for helping

people; and (3) technology as a service indicates the

production of care by technology. Unfortunately, the

ethics of technology has yet not been fully estab-

lished as a guiding principle. In the overview by

Korhonen et al. some studies excluded completely

ethical reflections. Many studies in this overview

“discussed the ethics of technology as benefits such

as improved communication and symptoms man-

agement, and the simple use of e-health services

whilst others remained critical presenting ethical

problems such as unwillingness and the inability to

use technology, or conflicts with human aspects or

questions of inequality.” These issue are of serious

concerns for future research.

Now we will discuss the expressive possibilities

provided by emerging technology and upcoming de-

sign frameworks for supporting the dying process

ending with death (Corr and Corr, 2012). We can

distinguish the use of ICT in the last life phase as (1)

supporting the preparation for dying, (2) supporting

the dying event as such, and (3) support for connect-

ing with after-life.

(1) Support the preparation for dying: Possible sup-

port through ICT preparing for dying is any applica-

tion easily accessible for elderly to take actions;

such applications can provide getting an overview

over life extending technologies [see for more at

(WikiPedia, 2014)], organizing the dying event in-

cluding funeral (WikiHow, 2014), support lack of

social bonding (Davis, Hu, Feijs, and Owusu, 2015),

providing internet based discussion forums around

dying [e.g. see (Explore-Ideas, 2011)],

(2) Support the dying process: Tele-health was being

used by a range of health professionals (e.g. in on-

ICT4AgeingWell2015-InternationalConferenceonInformationandCommunicationTechnologiesforAgeingWelland

e-Health

cology care settings) that included specialist (i.e.

palliative) care, hospices, primary care settings,

nursing homes and hospitals as well as dying people

(Kidd, Cayless, Johnston, and Wengstrom, 2010).

The most common ICT based products and services

are advice services for palliative care patients, out-

of-hours telephone support, carers and health profes-

sionals, videoconferencing for interactive case dis-

cussions, consultations and assessments, and training

and education of palliative care and other health-care

staff. Kidd et al. suggest “that current technology is

usable and acceptable to patients and health profes-

sionals in palliative care settings.” A major ad-

vantage of robotic-assisted dying is that the robot

would always assist those dying persons that are

genuinely eligible, and thus such persons would not

be at the mercy of a willing care giver in order to

have some control over the timing and manner of

their death (van Rysewyk and Pontier, 2015).

(3) Support to transcendent death: Advanced tech-

nology can be used to establish a legacy through

leaving a digital trace for next generations, etc. To-

day we can already talk to people from the past

through appropriately designed conversational

agents, e.g. Confucius chatbot (Wang and Nakatsu,

2013) (Wang, Khoo, Nakatsu, and Cheok, 2014).

This technology could be used to build partner mod-

els as virtual communication agents to overcome the

isolation of high aged elderly.

4 CONCLUSIONS

The first conclusion we can draw regarding ICT in-

volvement support dying, is that we have to take the

ontological position of our end users into account.

Next to this, we need to know the local social setting

for something close to ‘good death’. However,

foremost we have to acknowledge that at the end of

each individual life on earth is the death. Facing this,

any society is well advised to prepare their ageing

citizens for dying instead of ignoring it. ICT can

play a mediating role in enabling ageing people to

prepare for this last challenge. The problem ad-

dressed in this paper is mainly a societal challenge

and not primarily a technological one. We need a

social and ethical discussion how and when to pre-

pare for and especially support dying, because death

gives meaning to life!

ACKNOWLEDGEMENTS

We are very grateful for all discussions about this

topic (in alphabetic order): Ehsan Baha, Loe Feijs,

Shadi Kheirandish, Ryohei Nakatsu, Ben Salem,

Naoko Tosa, Maarten Verbeek, Martien Vissers, and

many others. This paper was partially supported by

the Industrial Design department of TU/e and School

of Design, Jiangnan University, China.

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