British Journal of Social Work (2013) 43, 394410

doi:10.1093/bjsw/bct012
Advance Access publication February 18, 2013

The Understanding of Death in Social

Work in the Czech Republic during the
Socialist Era and in the Era of
Consumerism through Heideggers
Authenticity
Ivo Jirasek* and Pavel Veselsky

Ivo Jirasek works at the Faculty of Physical Culture, Palacky University Olomouc in the Czech
Republic, where he undertakes philosophical aspects of movement culture (game and play,
experience, body, movement) with the endeavour for formulation of philosophical
kinanthropology. The author of two books (in the Czech language: Philosophical
Kinanthropology: The Meeting Point of Philosophy, Body and Movement (2005) and
Experience and Possible Worlds (2001) and decades of journal articles and book chapters (in
both English and Czech languages), he became strongly interested in manifestations of
spirituality (e.g. the spiritual dimension of play, difference between tourism and pilgrimage,
spirituality of sports and so forth). Pavel Veselsky works at the Department of Sociology
and Andragogy of Philosophical Faculty at Palacky University Olomouc in the Czech
Republic, where he lectures on, among social work subjects, the evolution of andragogical
thinking (protoandragogy) wherein he is also concerned with the philosophical religious
and spiritual aspects of protoandragogical theories, hence his interest in the issue of
spirituality in education sciences, which he also investigated during his doctoral studies. In
spring 2011, he published a monograph on animation strategies in Buddhas original
teaching (e-mail contact: pavel.veselsky@upol.cz).

*Correspondence to Professor Ivo Jirasek, Ph.D., Faculty of Physical Culture, Palacky University
Olomouc, Tr. Mru 115, 771 11 Olomouc, Czech Republic. E-mail: ivo.jirasek@upol.cz

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 develop-
ment in the Czech Republic indicates. More profound understanding cannot be pro-
vided 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 in-
dividual human being) and the contemporary manifestations of consumerism (where

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of Social Workers.
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 The Understanding of Death in Social Work in the Czech Republic 395

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 au-
thenticity of human existence (being-toward-death). Since Heideggers understanding
of death in the horizon of human life in relation to social work has not yet been suffi-
ciently explored, our contribution will partly focus on the application of this philosoph-
ical system in palliative care.

Keywords: Authenticity, death, Martin Heidegger, palliative care, phenomenology,

social work

Accepted: January 2013

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 personsherein,
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 back-
ground, 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 per-
ception 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 cul-
tural spheres. Death can be approached through a number of various
discourses. The account that follows does not pretend to be exhaustive:
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
anotherunearthlyform of being, which is interpreted differently in
various religious systems. For instance, the Epic of Gilgamesh (George,
1999) describes the protagonists journey to immortality; the religion of
Ancient Egypt is marked by the probably boldest appreciation of
deathsuch care for the dead body, by means of mummification, the pyr-
amids, 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
396 Ivo Jirasek and Pavel Veselsky

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 histransformed and pneumaticbody, so biblical anthro-
pology 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); psych-
ology 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 biophi-
lic 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 (Jirasek, 2010) or disciplines dealing with the history of games
(sports and games, in todays 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 con-
cerning death and the immortality of the soul was Platon (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 bodythe 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 Hei-
degger (2008); however, we will deal with this philosophical concept later.

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 inter-
preted as the ultimate end of human life, as a boundary beyond which no
other way of personal existence is possible (that is the materialistic inter-
pretation, 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
 The Understanding of Death in Social Work in the Czech Republic 397

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 Heideggers 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 Senecas stoicism, or it may
involve belief in some dimension of reality that transcends the death of
ones physical body. But it is, in Heideggers terms, bad faith to try to
have it both waysi.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.

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 preva-
lent 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 knowl-
edge and experience between the generations, and the care for the dying
personno matter how unprofessionalwas quite satisfactory (Haskov-
cova, 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
patients life, but also, within the course of a few decades, to alleviate
pain (Misconiova, 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
398 Ivo Jirasek and Pavel Veselsky

dying provided improved, standardised medical and nursing care, nonethe-

less at the cost of the dying persons 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 soli-
tude. 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 hospitaltheir relatives slowly
forgot what to say to them (Haskovcova, 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 provedespite the relatively dramatic shifts in
the ideological, political and economical contextto be a permanent and
more profound problem, soluble more likely from a more fundamental
philosophical perspective.

The era of socialism (194889)

Care for dying people radically changed in Czechoslovakia after the Com-
munist putsch in 1948. Western countries were undergoing the process of
institutionalisation of dying people as well (Morin, 1970; Aries, 1974;
Kubler-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 spe-
cific divergencein further contrast to the development in the era of con-
sumerism after 1989presents 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 ac-
tivity was grounded in Marxist ideology (dialectical and historical material-
ism), according to which the relationship between the individual and society
became the key factor in care for the dying person. The ideological back-
ground 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, increas-
ingly 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
 The Understanding of Death in Social Work in the Czech Republic 399

for everyone with reference to social justice, however, also imply less im-
portance 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
(Misconiova, 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 main-
tain life at all costs (Haskovcova, 1975, p. 77). The physicians, after all, had
no other choicethe system of medical care did not allow them to apply the
principles of consolation medicine even formally and, as Charvat 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 (Charvat in Haskovcova, 1975, p. 46). The appli-
cation 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 Haskovcova (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 for-
merly played by family doctors and confidants, or even clergymen (accord-
ing to a tentative survey by Fukalova, only one out of eight citizens wanted
to know the truth during their hospitalisation (in Haskovcova, 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 sup-
pression 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 hospitalsrelatives
only had access on Sundays and Wednesdays and during defined hours, and
often were not even informed about the patients 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
400 Ivo Jirasek and Pavel Veselsky

make exceptions to the rule): the dying persons were left alone in their crit-
ical 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 rela-
tionships in order before death (Haskovcova, 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 polit-
ical powerthe 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 popula-
tion 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. Krivohlavy 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 (Krivohlavy, 1991, p. 69).

The era of consumerism (after 1990)

The situationonce againturned around radically after the Velvet Revo-

lution 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
erabringing along with it, among other things, the need for the assertion
of human rightsand on the waves of change, the ideas of palliative medi-
cine were accepted both by the public and the experts with considerable
openness. As early as at the beginning of the nineties, the essential litera-
ture was published in Czech translation (the works of Elisabeth
Kubler-Ross, especially her book from 1969, On Death and Dying (1992)
exerted a great influence). In academic circles, Helena Haskovcova was un-
doubtedly 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 Svatosova, the
founder of the first hospice and tireless promoter of the movement in the
Czech Republic.
Since the beginning of the ninetiesand it has remained so, to a certain
extent, until todaypalliative medicine has had considerable institutional
 The Understanding of Death in Social Work in the Czech Republic 401

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 educa-
tional training events for the general public. And, last but not least, from
1994, the Ministry even began financing some selected hospice services
(Mackova, 2002).
The first hospice in the Czech Republic was founded at the end of 1994 by
Marie Svatosova in Cerveny 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 Christophers
Hospice in London. And, similarly to St Christophers 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 facil-
ity). 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 in-
dependently). 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 Pal-
liative Medicine: Czech Medical Association of J. E. Purkyne, an associ-
ation 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 excep-
tion 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).
402 Ivo Jirasek and Pavel Veselsky

The scant contextual information that exists seems to imply that pallia-
tive care since 1989 has been almost perfect; even though the Czech Repub-
lic 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,
toocurrently 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 condi-
tions for their emergence. They have been operating for several years but,
despite the determination of the hospice movement, they are not recog-
nised 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 (approxi-
mately 31,200) on a hospice for minor administrative errors (which had oc-
curred 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 his-
torical 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
ones neighbour), the social reality is subordinated to the economic pres-
sure of consumerism. The economic standpoint, which is now paramount
 The Understanding of Death in Social Work in the Czech Republic 403

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 un-
suitable 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 pro-

gress there has been in the provision of palliative care, it must not be over-
looked 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, Svatosova 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 (Svatosova, 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 understand-

ing of this issue cannot be provided in mere chronological terms, since a
certain parallel can be daringly drawn between the socialist era (the collect-
ive and society as a whole were considered more significant than an individ-
ual, 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
404 Ivo Jirasek and Pavel Veselsky

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, spirit-
ual, 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 Heideggers being-toward-death. His ap-
proach can be relevantly applied to the situation in the Czech lands as well
as providing an inspiring alternative to the traditional philosophical anchor-
ing of death and dying developed in the West.
Moreover, since the spiritual context of palliative care has received suf-
ficient attention in the relevant literature (Holloway, 2007b; Lloyd, 1997;
Sheridan, 2001; Daaleman and VandeCreek, 2000), we are suggesting an in-
tellectual perspective that could address even a secularly oriented society
and academic communityit is an approach that is profound enough for
such an issue, yet expressed in non-religious termsHeideggers concept
of authenticity as being-toward-death.
Despite the fact that Heideggers 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 Heideggers fundamental ontology,
especially in the English-speaking world, which prefers analytical
approaches and positivist paradigm to philosophy and rather neglects phe-
nomenological systems of thought, might be considered unfortunate. Not
even Holloways very thought-provoking and extensive monograph
dealing with death in health and social care (Holloway, 2007a) reflects Hei-
deggers philosophy, just limiting itself to a few paragraphs of secondary as-
sessment of his thoughts in relation to social work with the dying. Likewise,
Thompsons (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 Heideggers under-
standing 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 move-
ment of our existence and extreme situations such as nausea, boredom,
anxiety: we are condemned to be free) who does not deal with phenomen-
ology 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,
 The Understanding of Death in Social Work in the Czech Republic 405

Heideggerian ideas have not appeared in the field of social work (they are
more influential in continental Europe and are only now having an increas-
ing 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 psy-
chologyRogers, 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 misinterpreta-
tions 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 Heideggers fundamental ontology with
respect to understanding death. Heideggers thinking was applied in
social work dealing with death through categories of totality and remem-
bering (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).

Heideggers 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
philosophers essential work Being and Time (Heidegger, 2008), even
though another work of his will be used for specification (Heidegger, 1993).
The reader unfamiliar with Heideggers 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 stand-
ing out into nothingness, this possibility of not being (the consciousness of
my own death, accepting ones 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
406 Ivo Jirasek and Pavel Veselsky

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 con-
ventional language: We are immersed in the values of our culture which we
tend to automatically assume. The pressures of the culture toward conform-
ity 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 feel-
ings 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, expec-
tations or requirements which should be only treated as aspects of the im-
personal 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 ones own finality: the responsibility for taking hold of ones
being as a being towards its ultimate end, being-toward-death. And this
involves, according to Heidegger, everyonethose 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 dis-
placed 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 ones own mortality, probably originating in the empirical experience of
the dying of others, may then be relativised by an impersonal turning away
without accepting ones own end in the full meaning of the word. The exist-
ential understanding of my own death as the horizon, as a possibility per-
taining 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 isnt 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 Daseins
end, in the Being of this entity towards its end (Heidegger, 2008, p. 303,
 The Understanding of Death in Social Work in the Czech Republic 407

emphasis). Only the full awareness of death allows a man to become a

genuine personality.
The difference between authenticity and inauthenticity lies in the ques-
tion 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 onmediocrity
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 sub-
mission to something impersonal and indefinite. A serious application of
Heideggers 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 au-
thentic 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 pro-
found 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 dir-
ective 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 ma-
jority 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 at-
tention into our unconsciousness, to the margin of society. The present
trend is to suppress the symptoms of ageing and dying, be it through post-
modern aestheticisation (plastic surgery, cosmetics) or through the em-
phasis 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 cere-
monies at all (Sokol, 2002).
We believe that it is the authenticity of relationships and genuineness and
openness in ones approach to others that is the distinctive feature of the
realisation of social work in its various modes (e.g. administrative versus
professional, Janebova and Musil, 2007; individualised versus communal,
Gray, 2008; or the metaphor of pilgrim versus tourist, Jirasek and Jiraskova,
408 Ivo Jirasek and Pavel Veselsky

2011). It also appears that social work provided on such authentic terms
includes the physical (care for material and medicinal security) and psycho-
logical dimensions (absence of mental illnesses or pressures), as well as the
social (with an emphasis on relationships and their development) and spir-
itual dimensions (accepting this work as ones 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 workers 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 in-
spiring 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 sup-
ported 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.

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