A hundred years ago, a typical Canadian died at home from an infectious disease. The demise was usually swift, and the patient of any age from newborn to senior citizen. In the 1920’s, for example, 10 per cent of infants died before their first birthday.
"Disease was part of life", says Shelley McKellar, an associate professor of the History of Medicine and Disease at the University of Western Ontario. "It was ubiquitous." And in the time before antibiotics and mass immunizations, disease was also a death sentence.
If a Canadian managed to outwit disease there was still a good chance he/she would die prematurely through conflict, childbirth or accident. The Red River Rebellion in 1870, and the North West Rebellion in 1885 both claimed many lives. And tens of thousands of Canadian soldiers died in each of the two world wars.
Canadian woman often died in childbirth. In the 1920’s the rate was over four deaths in childbirth per day. Accidental injury led to infection and infection often led to death.
Today, how we die looks much different.
A century of medical breakthroughs, better public sanitation, and health care facilities has led to, "more and more people are dying at very old ages and/or at very advanced states of chronic illness", says Donna Wilson, a professor of nursing at the University of Alberta, and co-author of the book Dying and Death in Canada.
And today, most of us are dying in hospitals, not at home. This shift began about 60 years ago when Parliament passed the 1948 National Health Grants legislation, which led to the construction of new, and the expansion of existing, hospitals across the country. In 1957, the introduction of the Hospital Insurance and Diagnostics Act again resulted in the building of better facilities. It also provided Canadians with better access to medical interventions leading to a drop in death rates.
But with better care, came an unintended consequence: dying stopped being a part of life, says Dr. JoQuim Madrenas, professor of Microbiology, Immunology and Medicine at the University of Western Ontario.
It became invisible
A century ago, death was a public event with the deathbed acting as one of the central features of community life. "People basically saw a death as a social gathering in which the person dying was supported by the community, and the community basically got some type of closure from the dying person," says Madrenas.
But, with modern medical advances death, according to Madrenas, "stops being a social event. It becomes a very private event between you and your doctor, maybe your immediate family and group of friends. People die more and more alone."
"Death, which had been common and familiar, became unfamiliar, remote, invisible and expected only in old age," says Madrenas.
As Wilson notes: "Why talk about death and dying when they can give you a new heart, they can give you new lungs, they can give you antibiotics? Who died anymore?"
But the trend may be shifting away from a death in a hospital once again. One reason is that more and more Canadians living with terminal illness want to die at home, where they can be comfortable, rather than risk more medical treatments and interventions in a hospital. But another reason, says Wilson, is budget cuts.
"We really cut back hospital beds in the 1990s, the number of hospital beds declined by 25 per cent across Canada. It’s not as easy to get into hospitals as it was in the past. You don’t want to be stuck for 20 hours in an emergency department as you wait to get into hospital, " according to Wilson.
Wilson says that after 50 years of living life separated from death, we are starting to reconnect with it.
"We’re now getting back into a growing awareness that people are dying, again. But it’s a different kind of dying. It’s not the dying of younger people, it’s the dying of older people, and [we're starting to realize] how much help they’re going to need in the last months or years of life."