The final chapter: end-of-life identity constructions in hospice narrative performances

Through a post-colonial narrative turn, scholars created space for alternative illness narratives to be performed; narratives that reflected the fragmented and unpredictable ways of ailing bodies, and allowed for multiple and diverse identities to be constructed. However, even with this post-colonial turn, illness narratives in U.S. culture often depict situations in which individuals overcome their illnesses, and death is somehow avoided (Langellier & Peterson, 2004), which present potential constraints for what narratives individuals at the end-of-life (EOL) are able to tell and what identities they are able to construct. Using post-colonial narrative theory (Frank, 1995) as a framework, I engaged in a thematic narrative analysis of 16 hospice patient narratives, to understand whether narratives and identity constructions are constrained for dying individuals as they attempt to make sense of the end-of-life.

Patients constructed the five identities of the experienced individual, the believer, the ailing individual, the good dier, and the individual who is still living, through several themes. Ideals of both post-colonialism and modernism were present in identity constructions, suggesting some acceptance of alternative narratives for individuals at the EOL. However, notably a new type of colonization emerged as patients' identity constructions and themes reflected elements of ars moriendi or the good death (Faust, 2008). Specifically, it appears that end-of-life narratives must reflect that the individual nearing the end-of-life is doing so in a culturally acceptable way which involves acceptance, sacrificial or selfless qualities, dying gladly, and dying not alone. This nuanced type of colonization suggests that specific illness situations might present unique narrative colonization.

I end by offering practical implications for health care providers and family. Specifically, these findings might inform traditional practitioners and encourage them to broaden the clinical definition of the good death, with an understanding that elements such as esteem and emotional support or empowerment might be paramount for some patients' good deaths. Additionally, these findings offer awareness to family members regarding cultural expectations of the good death, so that they might consider whether they are adding pressure to their loved ones to achieve such a death.