The Understanding of Death in Social Work in the Czech Republic during the Socialist Era and in the Era of Consumerism through Heidegger's Authenticity Open Access

Abstract

The theme of death in social work is never the issue of routine everydayness; it has always been concerned with transcendence. The relation between different modes of social work thus merges with the theme of spirituality and authenticity, as the development in the Czech Republic indicates. More profound understanding cannot be provided in mere chronological terms, since a certain parallel can be drawn between the socialist era (the collective and the society were considered more significant than an individual human being) and the contemporary manifestations of consumerism (where the tendency to maximise output is even stronger and where money can be perceived as more significant than human beings). Both approaches do not fully appreciate the authenticity of human existence (being-toward-death). Since Heidegger's understanding of death in the horizon of human life in relation to social work has not yet been sufficiently explored, our contribution will partly focus on the application of this philosophical system in palliative care.

Specification of the theme

The ‘bedside manner’ or approach of social workers towards their dying clients (as well as the approach of physicians, hospital personnel and other experts whose task it is to take care of the dying persons—herein, however, the term ‘social worker’ will be used, applicable further for other aid professions with the identical target group of clients) depends, in many respects, on the understanding of death and the relationship to death on the part of the specific social worker. Their ideological background, religious denomination, philosophical reasons and other cognitive predispositions determine the relationship of the caretaker or assistant towards the dying person. In order to be able to understand the deeper roots of how the care for the dying person is related to its specific target group, it may be relevant to analyse the phenomenon of death in its broader context. This examination is a prerequisite for our adequate perception of the consequences of death in the context of social work.

The phenomenon of death as an important moment and meaningful event within the human way of being can be seen in the history of almost all cultural spheres. Death can be approached through a number of various discourses. The account that follows does not pretend to be exhaustive: If we are going to view the phenomenon of death in the area of social work as a fundamental discourse, we should not neglect, at the same time, the fact that this approach cannot be applied without taking a certain ethical or philosophical position, albeit not always explicitly declared. The ideological stance of the specific social worker will determine whether death is interpreted as the ultimate end of human life, as a boundary beyond which no other way of personal existence is possible (that is the materialistic interpretation, such as in Marxism) or whether it is perceived as a transition into another form of being, usually incorporeal (which is the substance of religious signification, such as in Christianity). It is so not only because the traditional religious systems considered death to be the essential and substantial difference between the human and divine ways of being, but also because this moment essentially raises some fundamental metaphysical insecurities, so collaboration and assistance in the moments of dying cannot be an everyday routine issue. The transcendent, namely the spiritual, dimensions of human experience are principally entered into here and reflected by philosophy. However, full concentration on the reality of death, the ‘here and now’, is the key element of true understanding according to Heidegger's concept of being-toward-death:

… in the belief that ‘good faith’ requires that we honestly face our own mortality. This may take the form of atheistic existentialism, of the sort Sartre espoused, and lead one back to Seneca's stoicism, or it may involve belief in some dimension of reality that transcends the death of one's physical body. But it is, in Heidegger's terms, ‘bad faith’ to try to have it both ways—i.e., a sense of immortality that turns away from the reality of our own death (Thomas, 1995, p. 30).

The notion of an authentic versus non-authentic relationship of the social worker towards the dying client will be much clearer after a description of the development of care for dying people in the Czech Republic during two historical eras, namely the era of socialism and the present era of consumerism.

• Religion: death is perceived as a turning point, a kind of transition from one form of being into another. Death is a fundamental breakpoint, for which one should make preparations. Through the event of death, one enters another—unearthly—form of being, which is interpreted differently in various religious systems. For instance, the Epic of Gilgamesh (George, 1999) describes the protagonist's journey to immortality; the religion of Ancient Egypt is marked by the probably boldest appreciation of death—such care for the dead body, by means of mummification, the pyramids, the Book of the Dead, etc. (Heller, 1988), as has never been seen elsewhere; the main Greek myth dealing with the theme of overcoming death is Demeter and Persephone, from which the Eleusinian mysteries were inspired, symbolised in the birth of a new plant through the death of the seed (Eliade, 1995); the significance of the funeral rites in Ancient Greece (Burkert, 2004; Mikalson, 2005); in Christianity, death does not involve the physical body only, but the complexity of personality as well; or the overcoming of death can be assumed through the resurrection of a man including his—transformed and pneumatic—body, so biblical anthropology is rather holistic in comparison to the Greek dualism (Tresmontant, 1970);

• Science: death and dying person are the subject of medicine in particular (in the following section, we shall demonstrate how the attitude of medical experts influenced the social climate in the former Czechoslovakia); psychology and psychiatry, of course, as other scientific discourses significantly highlight different approaches to death, such as with the differentiation of the life (bios) and death (thanatos) instincts (Freud, 1991), or the biophilic and necrophilic character orientations (Fromm, 1969); the theme of death appears, however, in other scientific disciplines as well; an example may be provided in kinanthropology (Human Kinetics, or sport sciences) examining, among others, the specific attributes of dying during sporting events (Jirásek, 2010) or disciplines dealing with the history of games (sports and games, in today's understanding) which embraced death as one of their authentic parts, obvious especially in the gladiator games in Ancient Rome (Kyle, 2001); a specific discipline examining death from the interdisciplinary point of view is thanatology;

• Philosophy: the first philosopher who attempted provide arguments concerning death and the immortality of the soul was Platón (1994), whose metaphysics, bridging the realm of shadows of our experiencing and the realm of the real existence of ideas, perceived the soul as separable from the body—the body decays after death, the separated soul returns to the realm of ideas where it can directly see the truth and other ideas (beauty, justice, goodness, etc.) in the fullness of their being. Human life in the mode of being-toward-death was brought to our attention by Martin Heidegger (2008); however, we will deal with this philosophical concept later.

The historical context of the care for the dying in the Czech Republic

In the Czech lands, as in neighbouring countries, people traditionally died while being looked after at home with the assistance of a priest and, later, a family doctor would be called to the deathbed, too. Some people died without this kind of care, or they died in the church hospitals and asylums (almshouses, poorhouses or old folks' homes); however, the prevalent model was the family dying model, based on the participation of close family members. As a result of this sharing of death, every family member knew he or she would not be left alone on his or her deathbed. Family care was complemented by church care, particularly through the last testament, confession and sacrament. This model allowed the interchange of knowledge and experience between the generations, and the care for the dying person—no matter how unprofessional—was quite satisfactory (Haškovcová, 1998). Professional medical care began to be widely available around the beginning of the nineteenth century, when the family model grew to include a physician, whose duty was not only to save the patient's life, but also, within the course of a few decades, to alleviate pain (Misconiová, 1998).

In the course of the twentieth century, the effort to improve the medical and nursing care of dying people eventually led to the professionalisation of the care for the dying and to the diversion of the dying person into the modern hospitals that were then emerging. This institutional model of dying provided improved, standardised medical and nursing care, nonetheless at the cost of the dying person's psychological and spiritual needs. In the thirties, when the institutional model started to dominate, the idea became prevalent that the dying person needed to be left in quietude and privacy, so they were isolated behind a white curtain, abandoned in solitude. The institutionalisation of dying and death and the separation of the dying person from their families gradually resulted in the loss of the ability of family members to take care of the dying person directly or even the loss of the ability to provide meaningful psychological support when visiting their dying loved ones in hospital—their relatives slowly forgot ‘what to say’ to them (Haškovcová, 1998). The loss of authenticity is clearly apparent already in this phase of depersonalisation in the process of dying. The issue of absence of the authentic relationship to the dying person will further prove—despite the relatively dramatic shifts in the ideological, political and economical context—to be a permanent and more profound problem, soluble more likely from a more fundamental philosophical perspective.

The era of socialism (1948–89)

Care for dying people radically changed in Czechoslovakia after the Communist putsch in 1948. Western countries were undergoing the process of institutionalisation of dying people as well (Morin, 1970; Ariès, 1974; Kübler-Ross, 1992), and its main effects were in essence similar to those in Czechoslovakia. However, while Western palliative care begins to develop in the 1960s, the institutional model of dying in the Eastern bloc countries was specifically reinforced by the Communist ideology. This specific divergence—in further contrast to the development in the era of consumerism after 1989—presents a view which underlines the impact of ideological–philosophical premises on the approach to dying.

In the era of socialism, every scientific, theoretical and even practical activity was grounded in Marxist ideology (dialectical and historical materialism), according to which the relationship between the individual and society became the key factor in care for the dying person. The ideological background and the value system were expressed by the atheist belief that death is a bio-medical fact and a definitive termination of existence, without continuation in any other individual form. From this arises the effort to prolong the earthly existence and to maintain the vital functions as long as possible and so scientific knowledge was bound to serve such a purpose. Although this philosophical (and with the passing years, increasingly ideological and political) impulse provides grounds for, among other things, the role of an individual in history, as a matter of fact, society was considered more valuable. The dignity of the group was greater than individual freedom or personal experience. Equal conditions for everyone with reference to social justice, however, also imply less importance being attributed to the unique experiences of an individual person. The fact that the individual was of less value than the solution of issues affecting society as a whole naturally had its effect in the care for dying people as well.

In the fifties, the practice of house calls by doctors ceased to exist (in the year 1952, the government further terminated the application of the right of domicile and thereby even the system of poorhouses and almshouses for the elderly and dying people established as long ago as during the reign of Franz Joseph I) and care for dying people definitively fell within the competence of hospitals and of their medical and nursing staff. More than 87 per cent of the population then died in hospitals and other medical facilities (such as detached hospital departments, officially named ‘Hospitals for Terminal Diseases’ from 1974), while the rest were allowed to die at home only because of the respect for past traditions paid by their family members (Misconiová, 1998).

In this and the following era, triumphalist medicine took over, established on the basis of a claim ‘followed like a law’ and ‘saying: prolong and maintain life at all costs’ (Haškovcová, 1975, p. 77). The physicians, after all, had no other choice—the system of medical care did not allow them to apply the principles of consolation medicine even formally and, as Charvát notes in his Perspectives in Medicine from 1971, ‘physicians are not educated to take on the onerous role of Charons and take the pilgrims to the other side with peaceful minds’ (Charvát in Haškovcová, 1975, p. 46). The application of the principles of triumphalist medicine, focused on the effort to maintain the patients' vital functions, eventually led to the suppression of dying and death to such an extent that the doctors did not even bother to consider telling the truth to the hospitalised patient or provide any kind of psychological–spiritual support to the dying. Helena Haškovcová (1975), one of the few experts who dealt with this issue in the socialist era, noted in 1975 that the specialised medical facilities have voiced the claim ‘so that “someone else”, for example a psychologist, performed the role formerly played by family doctors and confidants, or even clergymen’ (according to a tentative survey by Fukalová, only one out of eight citizens wanted to know the truth during their hospitalisation (in Haškovcová, 1975, p. 59); in hindsight, it is difficult to assess whether it had something to do with the doctors' lack of willingness to tell the truth, or the generally unfavourable conditions under which people died at that time, or the fact that the suppression of the issue of dying and death reached its climax then).

The dehumanisation of dying and the dying persons' feelings of isolation were also aggravated by the strict visiting hours in the hospitals—relatives only had access on Sundays and Wednesdays and during defined hours, and often were not even informed about the patient's health condition and the approaching end of their life. The chance to die within the family circle was minimal (in proportion to the arrogant reluctance of the medical experts to make exceptions to the rule): the dying persons were left alone in their critical moments, and their relatives and those nearest to them did not get an opportunity to show their love and care, let alone put their ‘affairs’ and relationships in order before death (Haškovcová, 1998).

The dismal situation concerning the ‘last affairs’ was related not only to the dominance of triumphalist medicine over consolation medicine, but also to the political situation and the atmosphere that pervaded society at that time. Triumphalist medicine was backed by the arrogance of those in political power—the power system trained every ordinary citizen to submit his or her own free will, and therefore the acceptance of a solitary death in a medical facility and the non-existence of any other perspective on the horizon was only a logical consequence of what the majority of the population experienced in life. Moreover, the so-called ‘constructive enthusiasm’ (initially genuine, later only declared) of that era did not provide much space for the darker side of human life. Křivohlavý claims that, in this era, ‘speaking of death in “decent company” was banned. One could only talk of youthfulness and joy, never of illness and death. The theme of death was a taboo’ (Křivohlavý, 1991, p. 69).

The era of consumerism (after 1990)

The situation—once again—turned around radically after the Velvet Revolution in 1989, which brought dramatic changes into all spheres of the life of society. Beside triumphalist medicine, the ideas of palliative medicine began to win recognition.

The initial endeavour was carried by the idealism of the post-revolution era—bringing along with it, among other things, the need for the assertion of human rights—and ‘on the waves of change’, the ideas of palliative medicine were accepted both by the public and the experts with considerable openness. As early as at the beginning of the ‘nineties, the essential literature was published in Czech translation (the works of Elisabeth Kübler-Ross, especially her book from 1969, On Death and Dying (1992) exerted a great influence). In academic circles, Helena Haškovcová was undoubtedly the most prominent and active figure; even though in her book, The Confined Life (1985), she speaks of hospices in pejorative terms such as ‘houses of death’, her profound concern for medical ethics in general and for the issue of the terminally ill, dying people and death in particular helped to gradually transform the attitudes of medical and other experts, as well as the general public (most of her work is popular science literature). The doyenne of the hospice movement itself is Marie Svatošová, the founder of the first hospice and tireless promoter of the movement in the Czech Republic.

Since the beginning of the nineties—and it has remained so, to a certain extent, until today—palliative medicine has had considerable institutional support (the terms palliative care and hospice movement are not always used in this article in their specific meaning; they are deliberately used as synonyms). An example could be seen in the initiative of the Ministry of Health, establishing as early as in 1991 a Working Group Supporting the Development of Home and Hospice Care, made up of both experts and non-professionals, whose task was to prepare a project of palliative social services. The project was eventually not realised in its intended form; however, the long-term tradition of expert committees established under the patronage of the Ministry was launched. Furthermore, the Ministry of Health began to finance relatively extensive educational projects, such as specialised courses in palliative medicine for experts in the field or educational training events for the general public. And, last but not least, from 1994, the Ministry even began financing some selected hospice services (Macková, 2002).

The first hospice in the Czech Republic was founded at the end of 1994 by Marie Svatošová in Červený Kostelec. It was named after Saint Agnes of Bohemia, the patron saint of the sick, poor and suffering, and gave rise to the entire hospice movement in the Czech Republic. Right from the start, the Czech hospice movement found inspiration in the British practice. The Hospice of St Agnes of Bohemia itself is a copy of St Christopher's Hospice in London. And, similarly to St Christopher's Hospice in London, the Hospice of St Agnes of Bohemia served as a model for other Czech hospices founded at the time. It was a hospice in-patient unit (a freestanding building that exists independently from the medical facility). Its independence probably influenced the future development of the whole Czech hospice movement: the majority of the hospices founded later were also in-patient units. On the other hand, the majority of home care facilities providing home hospice care were set up later (mostly as an additional service provided by an existing hospice but in some cases independently). The Association of Hospice Palliative Care Providers came into existence quite recently (2005). Their objective is to promote palliative care and to help improve the attitude of Czech society towards death and dying people (in the Czech Republic, there is also the Czech Society of Palliative Medicine: Czech Medical Association of J. E. Purkyně, an association of medical specialists). According to their statistics, seventeen hospices have been established to date in the Czech Republic (among these there are four in-patient units, five home care facilities and eight that are a combination of these). Some hospices provide respite care—helping families to take care of their dying members. There are also a few medical facilities that offer a certain part of their bed capacity for hospice care (this practice, however, is rather exceptional). With the exception of the few beds offered in health facilities, hospice care is provided by non-governmental non-profit organisations (mainly by the charitable organisations of the Church).

The scant contextual information that exists seems to imply that palliative care since 1989 has been almost perfect; even though the Czech Republic started introducing features of palliative care into its health/social system much later in comparison with the Western countries, the hospice movement established itself, obtained support from the state, etc. However, hospice care still faces apparent problems. The original plan of the Ministry, which has not yet been fully implemented, is to secure at least one freestanding hospice in-patient unit in every region. To this day, there are at least three regions in the Czech Republic that do not satisfy this norm. The bed capacity available for hospice care is unsatisfactory, too—currently there are 400 beds, whereas the recommended number of beds for the whole Czech Republic is 515. Another solution would be home hospice care. Unfortunately, at the moment, there are not enough home care hospices in the Czech Republic, and nor are there proper conditions for their emergence. They have been operating for several years but, despite the determination of the hospice movement, they are not recognised by law (and hospice in-patient units were not legally incorporated until after over ten years of struggle).

Non-profit organisations as they are, they have to face continual financial problems. The state covers only 50–60 per cent of the costs from the health insurance scheme. The rest of the money remains to be raised, often with difficulties, by the hospices themselves: hospices are mainly non-governmental non-profit organisations without an ‘independent’ founder (e.g. the regional council) to pay for the costs from their budget. In practice, the management does not know in December whether they will get enough money to run the hospice in January and pay its employees. Recently, the already difficult situation took a turn for the worse when the biggest Czech health insurance company imposed a fine of three million crowns (approximately £31,200) on a hospice for minor administrative errors (which had occurred in the documentation previously, although the inspection from the insurance company never even commented on them). After paying the fine, the hospice had to close down for lack of funding. After the director of the insurance company had been questioned, it came to light that some people should not have been admitted (although they had passed the standard selection procedure, which was also conducted by independent specialists) while others had just ‘not died on time’. Such cases indicate that the current social reality, which seems to be the opposite of the previous historical period, is actually just as insensitive to the value of human lives. The position of society (the community comes before the individual) has been taken over by the financial position (money comes before human beings). Despite liberalisation and ideological pluralism, and despite the restoration of religious freedom (palliative care and the hospice movement in the Czech Republic are largely motivated by the very Christian idea of loving one's neighbour), the social reality is subordinated to the economic pressure of consumerism. The economic standpoint, which is now paramount among other social phenomena, puts care for the dying person together with other services which are a part of the market and business relations, thus overlapping the dimension of authentic relationship to dying and death.

Last but not least, despite the efforts at enlightenment of the hospice movement members, the terminally ill are often unnecessarily sent to an unsuitable facility (they either never find out about hospices or they turn the palliative care down for lack of information). The key is in the hands of general practitioners, since, to be:

… in the care of a general practitioner can have two results at the present time. The dying person can be ‘lucky’ and come across an enlightened doctor who is well informed about the possibilities of palliative care and able to explain them, justify them, and apply them. On the other hand, if the patient is not ‘lucky’, he ends up being treated by a doctor employing the outworn practices he acquired from his time at the School of Medicine. His behaviour and treatment of the patient will then correspond with the practices of the old school (Prokop, 2009, pp. 20–3).

Nonetheless, despite the above-mentioned efforts and the indisputable progress there has been in the provision of palliative care, it must not be overlooked that many Czech citizens are still dying beyond its reach. Often they end up in ordinary medical facilities which are unable to address the needs of the dying person in a proper way. In this respect, Svatošová emphasises, among other things, the invasiveness of triumphalist medical care (as one patient summed it up: ‘When it comes to doctors, you have no place to run and no place to hide’). She also points out that it is improper to put these people in the same room as others and criticises the unwillingness of the doctors to allow their relatives longer visits and the lack of support from the non-medical staff. The last rebuke relates above all to the spiritual needs of the dying patient: ‘It is a sad truth that our healthcare system has learnt to see spirituality as one big taboo’ (Svatošová, 1998, p. 29).

Authenticity and palliative care

Needs for different explanation than chronological and political understanding

It is evident from the previous overview that a more profound understanding of this issue cannot be provided in mere chronological terms, since a certain parallel can be daringly drawn between the socialist era (the collective and society as a whole were considered more significant than an individual, a single human being) and the contemporary manifestations of consumerism in the market economy (in which, compared to the socialist era, the tendency to maximise output is even stronger and where the liberal ideology allows social work to become privatised and changed into goods; money can be perceived as being more significant than human beings). This reality implies that a genuine change in the attitude of the entire society to palliative care and to dying people as such cannot arise from the socio-political level, but from a deeper level: psychological, spiritual, philosophical and ethical. One of the possible responses in the social work practice is the Rogersian person-centred approach (Bryant-Jefferies, 2006). Despite the undoubted relevance of this approach, we suppose that the theme of dying and death should be specifically deepened with the philosophical theme of authenticity. In central Europe, whose philosophical tradition is closely connected to the German idealist philosophy, the most fitting concept seems to be Martin Heidegger's being-toward-death. His approach can be relevantly applied to the situation in the Czech lands as well as providing an inspiring alternative to the traditional philosophical anchoring of death and dying developed in the West.

Moreover, since the spiritual context of palliative care has received sufficient attention in the relevant literature (Holloway, 2007b; Lloyd, 1997; Sheridan, 2001; Daaleman and VandeCreek, 2000), we are suggesting an intellectual perspective that could address even a secularly oriented society and academic community—it is an approach that is profound enough for such an issue, yet expressed in non-religious terms—Heidegger's concept of authenticity as being-toward-death.

Despite the fact that Heidegger's philosophy relates closely to the essence of social work and palliative care, it has not been truly appreciated. The absence of a thorough reception of Heidegger's fundamental ontology, especially in the English-speaking world, which prefers analytical approaches and positivist paradigm to philosophy and rather neglects phenomenological systems of thought, might be considered unfortunate. Not even Holloway's very thought-provoking and extensive monograph dealing with death in health and social care (Holloway, 2007a) reflects Heidegger's philosophy, just limiting itself to a few paragraphs of secondary assessment of his thoughts in relation to social work with the dying. Likewise, Thompson's (2010) book, dealing with the theory of social work and using the term ‘authenticity’, restricts its relevance to Merleau-Ponty and Sartre, but does not relate to their model of thinking, namely Heidegger's understanding of authenticity. (While Thompson uses three texts by Merleau-Ponty and even five texts by Sartre, Heidegger is never used as a relevant source.) We suppose that there are, however, quite large differences in these types of thinking (and in the impulses they bring to practice). While J. P. Sartre is a typical representative of existentialism (analysing the movement of our existence and extreme situations such as nausea, boredom, anxiety: we are condemned to be free) who does not deal with phenomenology at all, M. Merleau-Ponty is acknowledged as a phenomenological philosopher (dealing with corporeality). However, both of them follow and popularise Heidegger, who brought authenticity into philosophy through Dasein analysis (he never regarded himself an existentialist), which might be an interesting theme for social work. Surprisingly, Heideggerian ideas have not appeared in the field of social work (they are more influential in continental Europe and are ‘only now having an increasing impact in England and the United States’ (Chessick, 1996, p. 208)), although ‘practical applications of existential theory have been successful in a variety of social work settings’ (Kominkiewicz, 2006, p. 48). Due to the lack of distinguishing between different discourses (phenomenology and existentialism in philosophy, different approaches in humanistic psychology—Rogers, Maslow, Frankl, Fromm) and due to the deficiency visible also in branches other than social work, phenomenology tends to be imported into social sciences through secondary sources (Kerry and Armour, 2000), the reason for which being all the possible misinterpretations and therefore a lack of interest by social work experts. This article is meant as a possible supplement to cover a certain gap, as an opportunity for deeper reflection provided by Heidegger's fundamental ontology with respect to understanding death. Heidegger's thinking was applied in social work dealing with death through categories of totality and remembering (Kominkiewicz, 2006) or fear-based climate (Floyd and Rhodes, 2011). We prefer his philosophical category of authenticity as more useful for this task; it was also adapted by the psychotherapy of adolescents (Chessick, 1996), while the perception of death as a part of the human experience in the mode of being-toward-death was also utilised in a study on ageing (Thomas, 1995).

Heidegger's thinking on death and authenticity as an inspiration for social work

During the following overview of the main ideas that could be related to palliative care, we will deliberately focus on the English translation of the philosopher's essential work Being and Time (Heidegger, 2008), even though another work of his will be used for specification (Heidegger, 1993).

The reader unfamiliar with Heidegger's way of thinking will, at first, be taken aback by the emphasis Heidegger puts on the differentiation of the categories of beingness (things, entities, the way things are) and being (the very fact that they exist). Only man cares about his or her own being (the way of life), namely about being in general. The existence of man is being here, dwelling (Dasein), the destiny of a creature who is aware of his or her finality, mortality. This is the privilege of human beings only: if animals perish and gods are immortal, then only people die because they are aware of their death. This awareness of the approaching end, this standing out into nothingness, this possibility of not being (the consciousness of my own death, accepting one's own finality or mortality) is an experience which only constitutes the possibility of being authentic. The important fact is that many of the possibilities of our own existence are forfeited in favour of others. Heidegger explicitly points out that these others are not any concrete, specific others, but the impersonal ‘the They’. If we submit to this dictate, we submit to the mode of mediocrity, and then we do what ‘they do’, we wear what ‘they wear’, we submit to the general conformist taste and morals, the pressure of advertising and social power. Or, in more conventional language: ‘We are immersed in the values of our culture which we tend to automatically assume. The pressures of the culture toward conformity are much increased by the influence of the mass media’ (Chessick, 1996, p. 211). It means that inauthenticity is alienation; it is an improper relation to oneself mediated by surroundings. We impose limitations on our own personal individuality, uniqueness, distinctiveness and exceptionality: thus, we forfeit our authenticity and live in a mode of inauthenticity, in a diffused indefiniteness. And, conversely, we live authentically only when we are ourselves. Authenticity is an immediate and responsible relationship of human existence towards itself. ‘Thus, authentic social workers relate to consumers as real people, expressing and taking responsibility for their feelings instead of denying them or blaming the client for them’ (Floyd and Rhodes, 2011, p. 312). Authentic personality trusts his/her thoughts and feelings and does not care about their harmony with societal norms, expectations or requirements which should be only treated as aspects of the impersonal ‘the They’. Any social worker taking care of the dying person is required to help people to transcend this existential crisis, with personal comprehension of the meaning of death. This authenticity includes the awareness of one's own finality: the responsibility for taking hold of one's being as a being towards its ultimate end, being-toward-death. And this involves, according to Heidegger, everyone—those who are dying, those who take care of them, even those who might not be fully aware that they are approaching this horizon.

Death (as a loss of being here) in an inauthentic mode of being is displaced from our attention; we tend to trivialise the death of others by saying ‘everyone dies’. Nonetheless, this ‘everyone’ is not even I, or any other particular other. This impersonality permits adherence to a routine approach without any concern. On the contrary, the authentic awareness of death as a possibility of our being, which no one will ever assume on our behalf, as our most personal possibility indicates that death is always mine because it is my own specific being, my own dwelling. The awareness of one's own mortality, probably originating in the empirical experience of the dying of others, may then be relativised by an impersonal turning away without accepting one's own end in the full meaning of the word. The existential understanding of my own death as the horizon, as a possibility pertaining entirely to my own life, thus defines my being as being towards its own end. In other words, if being-toward-death ‘is the defining quality of human existence, then this concern isn't likely to go away in a decade, or a generation’ (Thomas, 1995, p. 22). Aware of this finality, I can schedule the possibilities that this complete being involves. ‘Death is, as Dasein's end, in the Being of this entity towards its end’ (Heidegger, 2008, p. 303, emphasis). Only the full awareness of death allows a man to become a genuine personality.

The difference between authenticity and inauthenticity lies in the question of whether we are able to become truly ourselves in the full meaning of the word, or if the possibilities of our lives are manipulated by others, the indefinite ‘the They’, characterised by mediocrity: mediocrity of what is appropriate, what is done, what is worn, what is said and so on—mediocrity as a restriction on personal individuality, distinctiveness and uniqueness. The dictates of fashion, advertising, the market or bureaucratic power that we all yield to are a testimony to the loss of our authenticity, because it is not a matter of an order given by a specific person, but our submission to something impersonal and indefinite. A serious application of Heidegger's arguments leads to the conclusion that any social worker living an inauthentic existence cannot really accompany another person on the journey towards death in a meaningful way. The role of a social worker who is able to cope with death would then be represented by an authentic individuality who has not submitted to the impersonal ‘the They’ and perceives his own existence authentically as a being-toward-death. Then he or she can understand even the death of someone else— not in the anonymity of an ordinary event, but in a mode of compassion and a profound relationship. The social worker becomes not only an expert, but also, and most importantly, an authentic, socially sensitive individual who is able to accompany others on their last journey in a mode other than that of directive work and who masters the art of telling the truth without taking away hope. On the contrary, social workers lacking the dimension of authenticity are restricted to routine bureaucratic work without a genuinely engaged approach.

In regard to recent development in the Czech Republic, should we find the courage to look forward into the future and ask ourselves whether the mode of authenticity towards death is present in the attitude of the majority of society, we would have to be realistically sceptical. We can see the evident reality that dying and death have been displaced away from our attention into our unconsciousness, to the margin of society. The present trend is to suppress the symptoms of ageing and dying, be it through postmodern aestheticisation (plastic surgery, cosmetics) or through the emphasis on output and youth. People do not usually die in their homes, but in hospitals, sanatoria or, in better cases, in hospices. The relationship towards the older generation has also been manifested in the fact that more than half of those who die in the Czech Republic have no funeral ceremonies at all (Sokol, 2002).

We believe that it is the authenticity of relationships and genuineness and openness in one's approach to others that is the distinctive feature of the realisation of social work in its various modes (e.g. administrative versus professional, Janebová and Musil, 2007; individualised versus communal, Gray, 2008; or the metaphor of pilgrim versus tourist, Jirásek and Jirásková, 2011). It also appears that social work provided on such authentic terms includes the physical (care for material and medicinal security) and psychological dimensions (absence of mental illnesses or pressures), as well as the social (with an emphasis on relationships and their development) and spiritual dimensions (accepting this work as one's calling, as a realisation of ethical values in the verticality of the human way of being). So we are, in spite of the empirical evidence, still optimistic: while we can see ‘a growing move towards a view of clients as potential threats to the livelihood or potential litigants’ (Floyd and Rhodes, 2011, p. 308), an increased concern for authenticity in a social worker's life can result in returning to the traditional mode of the dying person as a partner. If authenticity should be understood as genuineness, the contact between the client and the social worker should be seen as a mutual and reciprocal sharing of their selves. In this view, the space for understanding and meaningful palliative care provided in the mode of authenticity remains wide open in the Czech Republic.

Acknowledgements

We would love to thank anonymous reviewers sincerely for their very inspiring observations which helped us to improve the article, namely to make coherent connections between the ideas on authenticity in social work with the dying and the concept of palliative care. This paper was supported by the ECOP project ‘Strengthening scientific potential of the research teams in promoting physical activity at Palacky University’, Reg. No. CZ.1.07/2.3.00/20.0171.

References