Care for the Dying in the Late USSR (1970–80s)

Disclosure of the diagnosis is a structural element of modern hospice ideology: the patient must be aware of the diagnosis in order to manage their dying and allow care instead of treatment. Care in hospices makes the last period of one’s life comfortable and maintains the habitual way of life of the dying person. Disclosure of diagnosis, awareness of death, and normalization of dying are thus three interrelated elements of modern hospice infrastructure. However, the case of the late USSR does not completely fit into this rule. On the one hand, there were no hospices in the Soviet Union because any formal disclosure of a diagnosis was banned. On the other hand, based on the study of archival and personal sources, I conclude that despite the concealment of the diagnosis, almost all dying people were aware of their impending death; in the absence of hospices, the dying received homecare; the patients also continued to lead their usual way of life. Hence, concealment of the diagnosis did not lead to unawareness of impending death and a lack of care infrastructure. To explain this paradox, I apply theoretical frameworks developed by Oleg Kharkhordin and Alexei Yurchak who argue that Soviet society had a binary structure consisting of a public ritual part and a private natural life. The nondisclosure of the diagnosis in the USSR was of a ritual form with a reversible function – hiding the diagnosis meant indeed disclosing it. This explains the structure of the Soviet model of care for the dying. The state did not officially deal with the dying and discharged them to their homes, providing them with some support. When the Soviet health care system sent a person home to die, it essentially segregated the private and the public, making it possible for care and dying to happen at home.