**5. Discussion: Ritualizing Everyday Care Practices**

The two examples show that everyday care practices are enriched with non-instrumental elements that have a strong symbolic value. The way a practice is performed, both following the protocol and adding personal elements, adds to the spiritual dimension of palliative care. On the one hand, this is just 'good and professional care', while on the other, it turns this specific care practice into a 'sacred' moment in time. We use the word 'sacred' here in accordance with Gordon Lynch's cultural-sociological approach of the sacred, referring to the moral or guiding values on which people build their lives (Lynch 2012). What is sacred to us is set apart because it transcends the physical reality of everyday life. The moral or guiding values that we hold sacred seem natural and fixed, so we are often not aware of them. However, they are products of culture and history that are constantly being negotiated and recreated. The main sacred, moral value that is both produced and expressed in the ritualized care practices is the value of the 'good death'. The concept of 'good death' is closely linked to the hospice movement as initiated by Cicely Saunders as of 1967 (Milicevic 2002). Within the healthcare community and, more specifically, in hospice and palliative care, there has been discussion of the concept of a good death (Gawande 2015; Raisio et al. 2015). According to an Institute of Medicine report (USA), a good death is one that is "free from avoidable distress and suffering for patient, family, and caregivers, in general accord with the patient's and family's wishes, and reasonably consistent with clinical, cultural, and ethical standards." (Field and Cassel 1997, p. 24). However, as Raisio et al. state, "a good death can be considered a 'wicked issue'—that is, a highly divisive and complex matter on which no consensus is evident." (Raisio et al. 2015, p. 159).

The concept of the good death can be linked to the history of cultural attitudes towards death, as coined by Philippe Ariès (Ariès 1974, 1983). Ariès made a distinction between pre-modern and modern conceptions of the good death, but actually, this is too simple. Both conceptions are part of modern day reality and coexist next to each other. The 'pre-modern' conception of a good death focused on the religious dimension: being at peace with God at the moment of death. This way of thinking about the dying process is still an issue, even though it is not phrased in religious terms. In literature, we see that 'being at peace' with the impending death, with family, friends and oneself is the norm according to many palliative care professionals and patients (Coward and Stajduhar 2012, p. 141; Bramadat et al. 2013, p. 107).

The 'modern' conception of a good death came out of advances in medical science. As the dying process became increasingly medicalized, the imperative became to avoid suffering and pain and to postpone death. Ariès coined this attitude as the taboo on death or the denial of death (see also Becker 1973). At the same time, a new attitude towards death emerged of which the hospice movement is part. The keyword in this new attitude is 'control'. In the hospice movement, this has been translated in controlling the suffering and helping people to die in dignity and without pain. This conceptualization of a good death, however, is complex and contested. A good death does not refer to a fixed moment in time but should be seen as a complex set of relations and preparations (McNamara et al. 1994). It does involve a range of attributes, such as being comfortable, a sense of closure, recognition of the value of the dying person, honoring of beliefs and values and optimizing relationships (Kehl 2006). These characteristics or attributes of the good death are made visible in the ritualized care practices as described and analyzed above. Palliative care professionals are trying to hide the 'ugliness' of death, at least from the dying person's family perspective, and to make the dying process as comfortable as possible.
