Pharmaceuticalization and the End of Life. Deep Continuous Sedation as a New Ideal of the "Good Death"

The field of palliative care and serving the dying reflects the broader individualization of death. Focused on the notion of autonomy, the ideal death is now defined as discrete, unsconscious and hygienic. Based on a significant medical expertise which allows to alleviate physical pain, to chemically control anguish and fear, to neutralize odours and marks of agony, this ideal involves an ongoing tension between control and dependance. Emblematic of what sociologists Nikolas Rose refers as biocitizenship, that is a form of citizenship focused around the politicisation of individual health and the emergence of identity-based claims bound to biomedical issues, the hospice palliative care movement is embedded in the global process of pharmaceuticalization that characterises contemporary western societies. Starting from a sociological questionning on the increasing use of continuous deep sedation in the biomedical management of the end of life, this article analyses the phenomenon of pharmaceutical control of suffering from the theoretical perspective of pharmaceuticalization. Beyond the death denial and pain refusal thesis, the article shows that deep sedation is indissociable from a will of control and self-enhancement that is symptomatic of biocitizenship. Far from a simple refusal of pain, the norm of deep sedation rather indicates that unproductive pain - that is pain that is not part of therapeutic, enhancement or experimental rationales - tends to become socially intolerable. In this way, deep sedation both appears as the limit and the ultimate expression of biocitizenship.