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Death, Dying, Culture
 Probing the Boundaries

Series Editors
Dr Robert Fisher Lisa Howard
Dr Ken Monteith

Advisory Board

James Arvanitakis Simon Bacon

Katarzyna Bronk Stephen Morris
Jo Chipperfield John Parry
Ann-Marie Cook Karl Spracklen
Peter Mario Kreuter Peter Twohig
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The Making Sense Of Hub

‘Death and Dying’

2013
 Death, Dying, Culture:

An Interdisciplinary Interrogation

Edited by

Lloyd Steffen and Nate Hinerman

Inter-Disciplinary Press
Oxford, United Kingdom
© Inter-Disciplinary Press 2013
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The Inter-Disciplinary Press is part of Inter-Disciplinary.Net – a global network

for research and publishing. The Inter-Disciplinary Press aims to promote and
encourage the kind of work which is collaborative, innovative, imaginative, and
which provides an exemplar for inter-disciplinary and multi-disciplinary
publishing.

All rights reserved. No part of this publication may be reproduced, stored in a

retrieval system, or transmitted in any form or by any means without the prior
permission of Inter-Disciplinary Press.

Inter-Disciplinary Press, Priory House, 149B Wroslyn Road, Freeland,

Oxfordshire. OX29 8HR, United Kingdom.
+44 (0)1993 882087

ISBN: 978-1-84888-173-0
First published in the United Kingdom in eBook format in 2013. First Edition.
 Table of Contents
Introduction vii
Lloyd Steffen and Nate Hinerman

PART 1 Culture and Caregiving

Habits of the Heart in End of Life Care 3

Nate Hinerman

The Dying: Individual Need or Professional Prerogative? 13

David MacKintosh

So Far and So Close: The Challenge of Death 25

Abílio Oliveira and Rute Rodrigues

Significance of Mental and Spiritual Support for Cancer Patients 39

Suvi Saarelainen

PART 2 Culture and Dying

Lessons About Dying and Death from Disasters 53

John F. Freie

Death through the Eyes of Innocence: Perceptions of Death 63

in Childhood
Alejandra Freitas, Abílio Oliveira and Rute Rodrigues

How Mortality Salience Affects Religiosity: Considering Life 73

History Theory, Terror Management Theory and IQ
Sarah Heany

Fatum and Fragility: Mario Perniola’s Philosophy of Death 89

Stein A. Hevrøy

Satire’s Mirror: Exposing Death Denial in Swift’s 97

Gulliver’s Travels
Larissa Fitzpatrick

On Kevorkian, Vivisection and Beneficent Execution 107

Lloyd Steffen

Determining Death: Perspectives from World Religions 117

Susan M. Setta
 Peter Brueghel’s Triumph of Death 125
Jean-Louis Claret

PART 3 Culture and Mourning

Exploring Funeral Fashions and Music pro defunctis in the 137

Southern Netherlands (1600-1799)
Stefanie Beghein

Honour(ing) The Departed: How Death Facilitates Honour in 153

American Culture
Gabrielle Kristjanson

Resisting Intimations of Immortality: Aubrey de Grey’s Science 161

and Saramago’s Novel
Susan M. Behuniak

Death and the Maiden: Bataille, Blanchot and the Deathly 175
Female Figure
Leslie Anne Boldt

The Death of the Author’s Mother: Postmodern Uncertainties in 185

Contemporary Memoir
Linda K. Karell

Showing Mourning in Slow Motion 195

Inga Schaub

Near-death Experiences throughout the History of Art 205

and Science: Challenges for the XXI Century
Ana León

The Film Musical as Cultural Vehicle for Dealing with Death 217
and Dying
Christina Lovey
 Introduction

Lloyd Steffen and Nate Hinerman

1. Death, Dying and Culture
This inter- and multi-disciplinary volume examines how culture impacts care
for the dying, the overall experience of dying, and ways the dead are remembered.
Over the past three decades, scholarship in thanatology has increased dramatically.
This text localizes a broad array of perspectives that research, analyze, and
interpret the many interrelations and interactions that exist between death and
culture. Culture not only presents and portrays ideas about ‘a good death’ and
norms that seek to achieve it, but culture also operates as both a vehicle and
medium through which meaning about death is communicated and understood.
Sadly, too, culture sometimes facilitates death through violence.
In general, the twenty authors in this volume approach their topic in one of the
following ways: ‘death’ as an expression of doctrinal beliefs and/or core values,
death and dying as an on-going movement between an individual and a larger
socio-cultural matrix, or death as essentially a cultural construction. These
investigations engage cultural studies from a variety of perspectives, and they
interrogate the stability of meaning(s) assigned to terms such ‘culture,’ ‘death,’
‘dignity,’ ‘care,’ etc. Authors included here produce conversations that engage
historical, ethnographic, normative, literary, anthropological, philosophical,
artistic, and political dynamics relevant to the interplay between death, dying and
culture. This collection of chapters strives to (re-)produce, then, an
interdisciplinary conversation about how death and dying are shaped by relevant
cultural factors.

2. The Conference and the Goal of this Book

The Eighth Global Conference: Making Sense of Dying and Death convened in
November of 2011 in Prague, Czech Republic, asking as its orienting question,
‘How does culture impact death and dying?’ As a component of Inter-
Disciplinary.Net’s Probing the Boundaries project, the conference brought
together physicians, psychologists, therapists, hospice workers, nurses,
philosophers, religion scholars, sociologists, artists and film-makers interested in
researching and reflecting on how culture affects meaning- and decision-making at
the end of life. The conference provided a forum for encounter, dialogue and
exchange; and it sponsored a thorough interaction of ideas, research methods, and
points of view regarding a wide variety of important end of life issues.
As a result of this framework, the conference promoted and sponsored inter-
and multi-disciplinary encounters by bringing people together from differing
contexts, disciplines, professions, and vocations, with the aim to engender and
nurture engagements that cross the boundaries of intellectual work in death studies,
broadly conceived. The organizing principle of the conference involved a firmly
viii Introduction
__________________________________________________________________
held conviction that inter-disciplinary dialogue about end of life issues can enable
people to surpass the boundaries they might usually encounter in their respective
disciplines, and instead offer new perspectives to ‘try on,’ which may perhaps be
novel, challenging, and lead to new frontiers of analysis, problem-solving and
meaning-making.
Indeed, perhaps because of its commitment to inter-disciplinary and multi-
disciplinary discourse, this edited compendium of conference papers illuminates
crucial end of life arenas, suggests new possibilities for approaching perplexing
dimensions of dying and death, and creates exciting horizons for future
conversations – with persons from a wide variety of national and international
backgrounds.

3. Content of the Book

The editors have divided the chapters into three sections.

A. Culture and Caregiving

The chapters in this section explore connections between health care systems,
caregivers, and matters of public policy that affect those at the end of life. It
includes discussion of how, where, when, and why dying occurs, and the role
culture can play in each phase. Authors in this section explore managed care
settings, the role of life-extending technologies, and how culture shapes caregiving
at life’s end.
In his chapter, ‘Habits of the Heart in End of Life Care,’ Nate Hinerman
elaborates how, given newly evolving care paradigms, caregivers might best attend
to and serve a client's life narrative, cultural identity, and goals for care. After first
contrasting caregivers who conduct their practice by demonstrating ‘unreflective’
care habits with those committed to seeing each client as a unique individual,
Hinerman considers the relationship between habit-taking and caregiving at life's
end in light of increasingly common ‘producers vs. consumers’ health care models
that constantly strive for more ‘efficient’ client encounters.
David MacKintosh uses his perspective as a palliative care physician to address
a fundamental question at the end of life in his chapter entitled, ‘The Dying:
Individual Need or Professional Prerogative?’ MacKintosh acknowledges that the
palliative care movement has made a significant contribution to improving the
conditions under which many die. Yet, he goes on to explore how ‘the dominance
of death in the management of the life of the dying, as opposed to the relief of
suffering, can be seen as a product of a diminished recognition of individual need.’
MacKintosh’s then analyzes why there is a real need to reassert the needs of the
dying against possible competing demands of ‘dominant ideologies and
professional power in the dying process.’
In the next chapter, Abílio Oliveira and Rute Rodrigues present results from a
research study they conducted regarding how age and gender play a role in
 Lloyd Steffen and Nate Hinerman ix
__________________________________________________________________
peoples’ reactions to death. Looking at the social context of death by showing short
films to both caregivers and patients, they found evidence to support the idea that
an individual’s reaction to death is largely shaped by whether the death was private
or public, and the extent to which the death was perceived to be ‘controlled.’
In the final chapter from this section, Suvi Saarelainen explores research results
derived from a study consisting of data from 13 letters and 7 interviews. By using
various methods of content analysis, the results of the project supported the thesis
that ‘it is possible to help cancer patients’ express their needs for support, including
spiritual support.’ Saarelainen then explains how caregivers might conduct such
support.

B. Culture and Dying

Dying occurs always in a cultural context where social structures, shared
perspectives and embedded values guide the process of understanding and meaning
making. Within culture are to be found the resources for critique of established
patterns when political and moral problems arise in the communal dimension of
dying and death.
John F. Freie’s chapter, ‘Lessons About Dying and Death From Disasters,’
connects the San Francisco earthquake of 1906, Hurricane Katrina and the recent
2011 Japanese tsunami to the mutual aid that disaster survivors provide one
another in the experience of physical and psychological trauma. Freie challenges
the false perception that the masses are out of control during disasters and
demonstrates how many of the problems that arise in the wake of disaster are
actually caused by political, governmental and social elites whose fear of the
masses compounds problems.
In their empirical study, ‘Death through the Eyes of Innocence: Perceptions of
Death in Childhood,’ three researchers in Portugal – Alejandra Freitas, Abílio
Oliveira and Rute Rodrigues – present evidence for the way children represent
death in thought, imagination and practice, with differences noted between boys
and girls, younger and older children, and those children who have experienced
death and those who have not. Their study challenges a common assumption
among adults that children cannot understand death or grapple with its meaning,
when, in fact, the evidence produced by this study shows how extensively they do.
Taking a social psychology approach, Sarah Heany inquires into ‘How
Mortality Salience Affects Religiosity: Considering Life History Theory, Terror
Management Theory and IQ.’ In a thickly researched finding, Heany argues that
heightened awareness of death (salience) can be correlated with various factors,
including life history and IQ, to show that religion provides an adaptive and even
constructive grouping behaviour for people when they are facing death. Religion,
she argues can increase group coherence and cooperation, thereby improving a
group’s − and each member’s − chances of survival.
x Introduction
__________________________________________________________________
Stein A. Hevrøy’s chapter, ‘Fatum and Fragility: Mario Perniola’s Philosophy
of Death,’ connects the insights of the Italian philosopher Mario Perniola to
Nietzsche, the Zen samurai and even Jesuitical teaching, for in all of these places
one can find the argument put forth that in order to live authentically and well, one
must live as though dead. The idea of cultivating indifference and, as Nietzsche
said, accepting one’s fate and embracing one’s situation as one’s own (amor fati),
is to cultivate an ethical attitude in which loss of identity – death – becomes the
very essence of ethics and living well.
In her contribution to the volume, ‘Satire’s Mirror: Exposing Death Denial in
Swift’s Gulliver’s Travels,’ Larissa Fitzpatrick draws on Ernest Becker’s insights
about symbols, immortality and culture to argue that satire holds up a mirror to
society to expose the many ways the denial of death can lead to intolerance and
destructive violence. She analyzes Jonathan Swift’s Gulliver’s Travels to
demonstrate how humour and satire express resistance to all that is done in culture
to deny death, offering the view that becoming aware of death anxiety – and
confronting its many symbols – is actually necessary for cherishing life.
In the chapter, ‘On Kevorkian, Vivisection and Beneficent Execution,’ Lloyd
Steffen criticizes the proposal made by Dr Jack Kevorkian that executions should
be voluntary research opportunities for science made possible by live but
anesthetized prisoners condemned to death. Kevorkian’s proposal represents the
triumph of utilitarian thought in service to a beneficent end, and it fails because it
denies any role for human rights in the execution practice and negates moral
meaning in punishment itself.
Susan M. Setta considers how religions address the different ways of
establishing death in her chapter, ‘Determining Death: Perspectives from World
Religions.’ The broad overview examines attitudes toward neurological versus
heart and lung criteria of death in the traditions of Judaism, Christianity, Islam as
well as in Hinduism and Buddhism, with differences on this ethics questions
apparent not only between traditions but also within them..
Jean-Louis Claret examines ‘Peter Brueghel’s Triumph of Death,’ a 1560s
painting that presents a variety of macabre scenes that evoke European religious
conflicts and even the Black Death. Claret seeks out a deeper meaning about death
in the canvas, finding clues in an actor and a woman’s smile. With Shakespeare at
hand he offers an alternative view that the true subject of the painting, prior to the
death that is imminent for so many, is life, art and even, ultimately, love.

C. Culture and Mourning

Ritual and cultural performance function to help people confront the death of
loved ones and face their own mortality as well. The chapters in this section
explore how the living respond to the presence of death by utilizing creative forms
and cultural symbols and representations to mourn and remember and come to
terms with death.
 Lloyd Steffen and Nate Hinerman xi
__________________________________________________________________
Stefanie Beghein’s chapter, ‘Exploring Funeral Fashions and Music pro
defunctis in the Southern Netherlands (1600-1799),’ examines music as part of
funeral culture in the Southern Netherlands during the seventeenth and eighteenth
centuries. Focusing on the case of Antwerp, she explores church records and the
printing of funeral masses by local publishers to investigate the role of funereal
musical fashion in a particular time and place, with attention given to the influence
of the baroque on funerary practices.
Gabrielle Kristjanson’s chapter, ‘Honour(ing) The Departed: How Death
Facilitates Honour in American Culture,’ focuses on the Martin Scorsese film, The
Departed, to inquire into cultural attitudes towards death in American society,
especially as they are related to public and private dimensions of honour. As
Americans frequently attribute honour to the deaths of public servants and to the
community of public service itself, Scorsese’s film problematizes this idea by
demonstrating a scenario in which these honours are constructed under false
pretenses. This analysis exposes the falseness of these honours and demonstrates
how social and cultural constructions are involved in the ways Americans negotiate
fear of death.
In ‘Resisting Intimations of Immortality: Aubrey de Grey’s Science and
Saramago’s Novel,’ Susan M. Behuniak explores Aubrey de Grey’s SENS project
(Strategies for Engineered Negligible Senescence), an ‘immortality’ project that
supports the effort to repair all human age-related damages and ‘cure’ old age.
After examining objections to this effort, Behuniak asserts the continuing value of
death acceptance that is the heart of thanatology projects. She concludes with a
thanatological appeal to the wisdom of José Saramago, whose imaginative and
curious novel, Death with Interruptions, demonstrates the practical folly and
cultural chaos that would result from actually doing away with death.
Leslie Anne Boldt undertakes a literary analysis of death and its relationship to
the feminine in ‘Death and the Maiden: Bataille, Blanchot and the Deathly Female
Figure.’ Drawing on theorists who have demonstrated how the female protagonist
can be associated with death, Boldt examines two novels, Bataille’s Blue of Noon
and Blanchot’s Death Sentence, to show how these two creative literary artists
depict the deathly female, which then becomes a key to literary interpretation.
In her chapter, ‘The Death of the Author’s Mother: Postmodern Uncertainties
in Contemporary Memoir,’ Linda K. Karell draws on Roland Barthes’ insights
about the unrepresentability of death in language to investigate three authors who
wrote memoirs about the deaths of their mothers. In a postmodern mood and
including a reflection about her own mother’s death, Karell considers Terry
Tempest Williams’s Refuge, Mary Gordon’s Circling My Mother, and Meghan
O’Rourke’s The Long Goodbye to conclude that different as these memoirs are,
they all reveal a psychological need to read and write narratives about death
despite ever shifting meanings
xii Introduction
__________________________________________________________________
Roland Barthes’s classic of photographic theory, Camera Lucida, provides the
starting place for Inga Schaub’s chapter, ‘Showing Mourning in Slow Motion,’
which considers the role photography plays in mourning. Schaub analyzes
Barthes’s reflections on the loss of his mother, published as Mourning Diary, then
goes on to examine the artistic work of photographer Seiichi Furuya, who focused
camera attention on his wife both when alive and when dead by suicide. Schaub’s
chapter concludes with an examination of the political dimension of mourning as it
is revealed in Pia Lindman’s New York Times Project, which brought to the fore
transformed newspaper images of mourners grieving losses in war and other
politically related disasters.
Ana León subjects near-death experiences to analysis in her chapter, ‘Near-
Death Experiences throughout the History of Art and Science: Challenges for the
XXI Century.’ Noting that near death experiences or NDEs have been reported
throughout history, León makes a case that it is important that those resuscitated
discuss their NDE with medical personnel, and while currently such
communication is rare, it should be made a part of high-quality health care. These
experiences can advance our understanding of the science and biology of death,
León argues, since those resuscitated with NDEs seem to challenge ideas about
irrevocable death and how that is determined.
Christina Lovey, a video and photographic artist, considers how certain film
musicals, like Carousel and A Star is Born, provide a popular and accessible
cultural medium through which people can express grief and work toward the
reconstitution of the grief-stricken self. When this parataxically written chapter,
‘The Film Musical as Cultural Vehicle for Dealing with Death and Dying,’ was
presented at the Global Dying and Death Conference 8 in Prague in 2011 Lovey
included a musical performance,

4. Conclusion
Readers should be aware that the papers presented at the 8th Global Dying and
Death Conference were all delivered in English, but English is not the native
language of many of the participants, including some of those whose papers are
included in this volume. The editors have taken some small liberties to improve the
smoothness of communication at certain junctures in some of the chapters, but all
such efforts were made only to increase intelligibility. We trust that this volume
will offer worthwhile insights into the work of this particular group of dying and
death scholars who came together in a wonderful city at a particular moment in
time. We also hope that this collection will provide some further insight into – and
evidence for – the importance of dialogue given the inherent difficulties and often
unexpected learning opportunities that arise from serious inter-disciplinary
conversation.
 PART 1

Culture and Caregiving

 Habits of the Heart in End of Life Care

Nate Hinerman
Abstract
Clinical caregivers, including physicians, nurses, social workers, and chaplains,
cultivate habits particular to their respective disciplines. In our medical
communities, such habits naturally provide guides for caregiving and assessment.
Although habits can start off thoughtful, well-intentioned, and reflective, they
quickly can become routinized during implementation. Given our respective
trainings, our particular care setting’s regulatory requirements, and the larger
‘culture of care’ each care setting manifests, the following challenge arises: how
can caregivers keep their (inter-)actions with clients from becoming overly rigid
and routine? Given newly evolving care paradigms, and in the context of current
medical models, how might caregivers attend to and serve each client’s life
narrative, cultural identity, goals for care, affections, and/or religious
understandings sensitively, especially given overburdened care delivery
environments? Caregivers who conduct their practice demonstrating unreflective
care habits may be prone to overlook the uniqueness of each clinical encounter.
This chapter considers the relationship between habit-taking and caregiving at
life’s end in light of increasingly common ‘producers vs. consumers’ health care
models.

Key Words: Caregiving, habits, end-of-life, dialogue, narrative.

*****

1. Introduction
In his brilliant article entitled, ‘The Military Metaphors of Modern Medicine,’
Abraham Fuks, M.D., writes:

Medical discourse is replete with the language of war and such

phrases as ‘the war on cancer,’ ‘magic bullets,’ ‘silver bullets,’
‘the therapeutic armamentarium,’ ‘agents of disease,’ ‘the body’s
defenses,’ and ‘doctor’s orders’ are deeply engrained in our
medical rhetoric. The mindset engendered by this discourse of
war renders the patient as a battlefield upon which the doctor-
combatant defeats the arch-enemy, disease… Diagnostics
becomes centered on the putative agent and therapeutics revolves
around extirpation and conquest. Arguably, the most important
effect of this framing of medicine is the eradication of the
patient’s voice from the narrative of illness. The dialogic
construction of the narrative of illness is supplanted by the
4 Habits of the Heart in End of Life Care
__________________________________________________________________
physician’s case record of his search for the physical seat of
disease and the healing effected through the development of
meaning falls victim to a militarized discourse. The military
metaphors that pervade medicine undermine the ability of
physicians and society to deal with the burgeoning burden of
chronic illness. 1

The scenarios Fuks describes demonstrate well ‘unreflective habits’ in the

clinical setting. American philosopher Charles Sanders Peirce maintains that all
ideas are habits, and that habits function as guides for action. Yet, communication
and caregiving are habit-taking arts, not a routine science of actions, no matter how
much practice one has trying to model them:

Just in the degree in which a physician is an artist in his [sic]

work, he uses his science, no matter how extensive and accurate,
to furnish him with tools of inquiry into the individual case, and
with methods of forecasting a method of dealing with it. Just in
the degree in which, no matter how great his learning, he
subordinates the individual case to some classification of
diseases and some generic rule of treatment, he sinks to the level
of the routine mechanic. His intelligence and his action become
rigid, dogmatic, instead of free and flexible. 2

American philosopher John Dewey asserts that habits, no matter how

thoughtful and reflective when they start off, can become ‘routine’ and ‘mechanic’
during implementation, which usually occurs in a practical context (i.e., working
with an actual patient). Like any occupation, caregivers, including physicians,
nurses, social workers, and chaplains, must cultivate certain habits in their
caregiving activities and attitudes. How can caregivers keep their actions from
becoming overly rigid, unreflective, and rote? Instead, how can conversations
emerge from reflective habits of care that allow for accurate medical assessment on
the one hand, and yet extend freedom in meaning-making which may sponsor
important insights for the patient on the other? This article next will examine C.S.
Peirce’s philosophy for clues to these challenges.

2. Human Inferences in the Cosmos: An Exercise in Habit-Taking

The connective strand in C. S. Peirce’s cosmological system that links the
cosmos to the human he calls mind (also referred to as ideas). Peirce presumes that
from our anthropomorphic starting point, if we can trace the growth of ideas in
human inquiry then we will discover something about how the cosmos grows, too.
Peirce felt strongly that human ‘ideas’ functioned analogously to ideas operative in
the larger cosmos.
 Nate Hinerman 5
__________________________________________________________________
The crucial position that enables Peirce to apply the concept of mental growth
beyond the blatant context of human cognition lies in his hypothesis that ‘ideas are
habits’ and ‘habits are rules of action.’ Defining ideas in this way allows Peirce the
flexibility to apply the same term beyond the conversation of human beliefs to the
physical realms of cosmic habit-taking (i.e. natural ‘laws’). Both the laws of nature
as well as our human beliefs operate as ‘ideas’ because an idea is simply a habit of
activity. What is the goal of this activity? Ideas, as they become increasingly more
general, exert teleological direction over other habits. These habits range from
human beliefs or the hardened regularities of matter. Growth, for Peirce, is possible
only because ideas, as habits, have the capacity to change, as they are not governed
entirely by necessity. Habits can change spontaneously, or in response to other
habits. Change occurs when a habit becomes frustrated. ‘Developmental teleology’
describes the action that habits take upon being frustrated, as they seek to attain a
new end, or augment previously held beliefs so that the same end can be
accomplished through a different habituation.
A belief functions as the most basic example of an idea. Peirce argued that the
human mind commonly employs four ways of fixing a belief: tenacity, authority,
taste, and shared systematic inquiry:

• Tenacity clenches belief so tightly that irrespective of any

data to the contrary, the belief will not be altered. Seen as a
not-so-oblique synonym for stubbornness, Peirce felt this
manner of ossifying a belief revealed problems of an obvious
sort.
• Authority fixes belief by privileging those who support a
particular belief and persecuting those who reject it.
Obviously, when holding beliefs for this reason, people often
exert hurt, abuse, and destruction upon those that do not tow
the party line. Peirce argued that the evidence concerning
how reality behaves was not restricted to merely a few minds
of people in positions of power. On the contrary, Peirce
argued that truth is available to any mind that carefully
monitors its behaviors (actively listens).
• Taste asserts belief instinctively, predominately on the basis
of some spontaneous appeal to the senses. Peirce argued that
taste cannot establish the truth or falsity of any claim. It
simply desires what it desires.
• Ongoing systematic inquiry within a community, Peirce
asserted, was the best way to fix our beliefs. This effort
requires the solitary, finite mind to search for truth in
dialogue with the experiences and insights of others.
6 Habits of the Heart in End of Life Care
__________________________________________________________________
Beliefs, as ideas, guide our activities in the world, although not all beliefs
manifest themselves in consciousness. A belief, insofar as it displays the operations
of an idea, exemplifies a habit of response. A belief, then, functions as a habitual
idea that responds to or guides our actions, depending on the conditions. Beliefs
themselves are not the specific actions which arise from a particular belief.
Furthermore, since beliefs function like rules that govern our actions, these
habituated responses operate teleologically. That is, the habitual response of our
actions is always directed towards some end. Habits dictate responses of action
through bringing into fruition certain events that achieve a final end or cause.
Beliefs foster general actions, given some particular circumstance.
The ends we desire to achieve get accomplished through a sequence of
causation that stems from our beliefs, which propel habituated actions. For
example, the belief that eating organic produce will better one’s health may lead to
a series of actions where one navigates to certain stores that sell such produce so
that later these items can be prepared and consumed at home. Such activities might
become entrenched and habitual should one desire strongly enough to achieve
good health and also believe that organic produce genuinely supports such an end.
Beliefs generate habits of action, and the desired ends inherent in a belief provide a
direction and influence over the actions.
When beliefs change, or grow, then the telos will change and grow (and vice
versa). Inquiry, then, provides us with the capacity to reflect on possible beliefs,
and compare them to other beliefs already held (we might call these actual beliefs).
As actual beliefs generate habits of action, or habit-taking in the broadest sense, we
tend only to revise our beliefs until a habitual action becomes frustrated (which
Peirce believed results in ‘irritation’). When a habit of action becomes frustrated,
the belief that generated it will probably be irritated by doubt. Doubt irritates belief
when an already established habit of action cannot achieve its more general
purpose, or end. Habits, each with a cause, also usually facilitate more general
causes. Thus, when habits of action become frustrated, the irritation of belief tends
to cause growth, i.e. a shift in the belief.
A belief-habit in its development begins by being vague, special and meager; it
becomes more precise, general and full, without limit. The process of this
development, so far as it takes place in the imagination, is called thought. When we
experience the ‘irritation of belief,’ also known as doubt, we usually commence
some form of inquiry, however rudimentary. Seeking to accommodate the
unexpected result that frustrated our habit-taking during action, we reconsider how
new habits for action might better serve the achievement of our desired ends.

3. Challenges to Habit-Taking
Caregivers who function out of rote habituation in their interactions with
patients, especially those at the end-of-life, overlook the reality that not all patients
bring the same life narrative, cultural identity, goals for care, affections, and
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