COVID-19 has reinstated the sovereign enclosures of corpse management that mothers of the disappeared had so successfully challenged in the past decade. To explore how moral duties toward the dead are being renegotiated due to COVID-19, this article puts forward the notion of biorecuperation, understood as an individualised form of forensic care for the dead made possible by the recovery of biological material. Public health imperatives that forbid direct contact with corpses due to the pandemic, interrupt the logics of biorecuperation. Our analysis is based on ten years of experience working with families of the disappeared in Mexico, ethnographic research within Mexico’s forensic science system and online interviews conducted with medics and forensic scientists working at the forefront of Mexico City’s pandemic. In the face of increasing risks of viral contagion and death, this article analyses old and new techniques designed to bypass the prohibitions imposed by the state and its monopoly over corpse management and identification.
The handling of the deceased during the COVID-19 pandemic, a case study in France and Switzerland
Gaëlle Clavandier, Marc-Antoine Berthod, Philippe Charrier, Martin Julier-Costes, and Veronica Pagnamenta
The COVID-19 pandemic has brought about an unprecedented global crisis. To limit the spread of the virus and the associated excess mortality, states and governing bodies have produced a series of regulations and recommendations from a health perspective. The funerary aspects of these directives have reconfigured not only the ways in which the process of dying can be accompanied, but also the management of dead bodies, impacting on the dying, their relatives and professionals in the sector. Since March 2020, the entire process of separation and farewell has been affected, giving rise to public debates about funeral restrictions and the implications for mourning. We carried out a study in France and Switzerland to measure the effects of this crisis, and in particular to explore whether it has involved a shift from a funerary approach to a strictly mortuary one. Have the practices that would normally be observed in non-pandemic times been irrevocably altered? Does this extend to all deaths? Has there been a switch to an exclusively technical handling? Are burial practices still respected? The results of the present study pertain to the ‘first wave’ of spring 2020 and focus on the practices of professionals working in the funeral sector.
Liliana Sanjurjo, Desirée Azevedo, and Larissa Nadai
This article analyses the management of bodies in Brazil within the context of the COVID-19 pandemic. Its objective is to examine how the confluence of underreporting, inequality and alterations in the forms of classifying and managing bodies has produced a political practice that aims at the mass infection of the living and the quick disposal of the dead. We first present the factors involved in the process of underreporting of the disease and its effects on state registration and regulation of bodies. Our analysis then turns to the cemetery to problematise the dynamics through which inequality and racism are re-actualised and become central aspects of the management of the pandemic in Brazil. We will focus not only on the policies of managing bodies adopted during the pandemic but also on those associated with other historical periods, examining continuities and ruptures, as well as their relationship to long-term processes.
Presumed black immunity to yellow fever and the racial politics of burial labour in 1855 Portsmouth and Norfolk, Virginia
Michael D. Thompson
Epidemic disease regularly tore through nineteenth-century American cities, triggering public health crises and economic upheaval. These epidemic panics also provoked new racialised labour regimes, affecting the lives of innumerable working people. During yellow fever outbreaks, white authorities and employers preferred workers of colour over ‘unacclimated’ white immigrants, reflecting a common but mistaken belief in black invulnerability. This article chronicles enslaved burial labourers in antebellum Virginia, who leveraged this notion to seize various privileges – and nearly freedom. These episodes demonstrate that black labour, though not always black suffering or lives, mattered immensely to white officials managing these urban crises. Black workers were not mere tools for protecting white wealth and health, however, as they often risked torment and death to capitalise on employers’ desperation for their essential labour. This history exposes racial and socioeconomic divergence between those able to shelter or flee from infection, and those compelled to remain exposed and exploitable.
The chapter is prefaced by a brief summary of the policy background. Urgent and emergency care is, by its very nature, different from planned care. The diagnosis is not always easy to nail down, the patient might be in considerable pain, distress or shock, and the trajectory of care can be uncertain. Cancer care raises issues of its own. Emergency, planned and cancer care all have waiting time targets in the NHS in England. These were successful in significantly reducing long waits. However, the system was already coming under increasing pressure before the COVID-19 pandemic, with performance deteriorating and an inexorable rise in waiting times. Coordination of care with GPs and other primary care services remains an issue. This chapter contains four stories in which hospital was a significant site for care. The stories cover planned care, emergency care and a story about cancer. The first story is about what happened to Jill following an accident involving her knee, including her follow-up care. The second is about a planned operation to remove Andrea’s gallbladder. The third concerns Lucy’s experience when she was hospitalised with sepsis. The final story concerns Shona’s journey to recovery from breast cancer, and what helped along the way. We invite readers to assess how these narratives compare with the four characteristics of patient-centred care outlined in Chapter 1. As with the other chapters, we pose questions arising from these stories, to simulate thinking and reflection. We have divided these into questions of immediate or operational concern, and those which are more strategic or policy-related.
The chapter is prefaced by a brief summary of the policy background. A number of child health outcomes in the UK lag behind those in other comparable countries. Children from deprived areas or with a black or other minority ethnic family background are twice as likely to be obese and this inequality is widening. Children with complex needs and disabilities are often under-served. Four contrasting stories are presented here. Dan is a normally healthy teenager who was hospitalised with an acute bacterial infection from which he has now recovered. His father Jonathan tells the story from his perspective. Dan’s illness took place during the COVID-19 pandemic. Jim was a severely disabled young man from birth until his death aged 36. His parents Justin and Lucinda cover his entire life – and death – in their account. In a story fragment, Eve remembers as a child how she came to be diagnosed with type 1 diabetes. Finally, Eileen tells of her experiences as a carer for a teenage son with a diagnosis of scoliosis, including the length of time taken to get an appropriate tertiary referral. She found a support group was helpful. We invite readers to assess how these narratives compare with the four characteristics of patient-centred care outlined in Chapter 1. As with the other chapters, we pose questions arising from these stories, to simulate thinking and reflection. We have divided these into questions of immediate or operational concern, and those which are more strategic or policy-related.
In this concluding chapter, we examine how far William Osler’s injunction – to just listen to the patient – is heeded in today’s NHS. We assess the value of gathering stories in this way as a contribution to truly listening to patients and their families. We reflect on the extent to which the spirit of the NHS Constitution is being upheld, especially in relation to whom the NHS belongs. From the stories we identify five dimensions to care which is organised around patients: kindness, attentiveness, empowerment, organisational competence and professional competence. We compare these themes with the case and the evidence for patient-centred care outlined in Chapter 1. We consider what the stories tell us about the things that patients value, the extent to which these things are put into practice, and what the obstacles are. We reflect on the five themes as the basis for a call to action for improvement. We discuss vital questions of context: in particular, straitened funding and workforce shortages in the NHS, and the experiences of COVID-19. Finally we touch on future trends, for example the rise of digital healthcare, and consider the implications for better organising care around patients.