On death, dying, and terminality: today, yesterday, and tomorrow.

Not long ago, America viewed death and dying with a familiar fear and hostility. But today the subject has become fashionable, part of the transient pop culture, and as a consequence, trivialized and sentimentalized. When lifespans were shorter, deaths quicker, and man felt helpless before nature, death and dying were repeated intruders into the daily routine, usually occurring at home. But with the birth of the modern clinic in late eighteenth century Europe, the focus shifted from the patient to his affliction. Medicine became more scientific and effective as a result; yet the patient has suffered from this change, too, often feeling profoundly alienated from the entire medical apparatus. For terminally ill patients, the problem is especially severe; but the hospice approach (patient-centered like the old medieval hospital, and yet owing much to modern specialization and technology) promises physical and emotional amelioration of suffering in an imperfect but valuable departure from recent tradition.