Good death | 2/3 | The Good Funeral Guide

Category Archives: Good death

To accept what cannot be helped

Monday, 14 February 2011

A very good account here by Ann Hulbert of her mother’s response to being told she had an incurable cancer:

Two years ago this coming June my mother—“an 80-year-old in a 60-year-old’s body,” the pulmonologist told her—was ambushed by a diagnosis of Stage IV adenocarcinoma of the lungs … In the windowless examining room at the hospital in Brooklyn, my mother said sadly yet matter of factly, “Well, I guess that’s pretty much what I’ve been expecting to hear. We’ve all got to go somehow, don’t we?”

In her case, facing it meant ruling out treatment—the chemotherapy and radiation that the pulmonologist urged to ease pain and eke out a few more months. “If geezers like me have lots of tests and treatments,” she told the doctor, “there isn’t going to be enough money to spend on the other end. This health-care mess isn’t going to be fixed if we aren’t ready to get out of the way.”

[S]he was a rarity—a grandmother in favor of having the plug pulled and ready to live, or rather die, by that all-but-taboo vision of the end of things. But right then, in that airless room, she needed most of all to rise above an abyss. Look at me, a very lucky old lady who has made it to 80; tell me it makes any sense to rack up huge bills trying to add on an extra couple of months (at best) to a life that isn’t likely to last out the year.

As soon as she’d gotten the cancer verdict, she wanted to dispense with the probing, so expensive and so intrusive. She wanted to escape the dingy hospital corridors, the endless waits, the nurses who dragged their feet and addressed her and my father as though they were dim children, the doctors who urged procedures knowing she was a patient with top-notch health insurance.

All of us wanted what she wanted. Or so we had been saying. We had mostly been believing it, too, and admiring her consistency in sticking to her pull-the-plug approach. How it cut through the confusion, the indecision about competing options, the intimidation in the presence of doctors who had plainly never paused to consider that a patient might simply opt out of their white-coated realm. How it pulled us together—that alone recommended her way, we had been saying, anxious to reassure ourselves that respecting her desires wasn’t just right, but wise. Her clarity didn’t come so clearly to us four. Reared on more than our mother’s staunch Swissness, we were baby boomers, accustomed to intervening and only distantly acquainted with death.

Read the rest of Ann Hulbert’s account of her mother’s dying. It’s a wonderful piece of writing full of things to reflect on. Click here.

A time to die

Sunday, 30 January 2011

Every week in the Spectator magazine Peter Jones takes an occurrence or development in contemporary society and politics and considers it in the light of what the ancients did when faced with the same circumstances. This week he considers the art of dying. I’d now bung you a link but I can’t: the Speccie does not unleash its content online til it has gathered some dust. The joy of the Spectator lies in the quality of its writing (sadly not its politics). It’s almost worth the cover price for Mr Jones alone. I hope he won’t mind a quote-strewn precis.

He begins:

“So everyone is going to live much longer and will therefore have to work much longer to pay for their pensions. But what is so wrong with dying, Greeks and Romans would ask?

“Homeric heroes sought to compensate for death with eternal heroic glory … Plato argued that the soul was immortal. The Roman poet Lucretius thought that was the problem. For him, life was an incipient hell because of man’s eternal desire for novelty. So as soon as he had fulfilled one desire, he was immediately gawping after another. What satisfaction could there be in that? The soul was mortal, he argued, and death, therefore, should be welcomed as a blessed release.”

Cicero concurred. We run out of things to interest us and are glad to go. “A character in one of Euripides’ tragedies put it more succinctly: ‘I can’t stand people who try to prolong life with foods and potions and spells to keep death at bay. Once they’ve lost their use on earth they should clear off and die and leave it to the young.’

“For Seneca the question was whether ‘one was lengthening one’s own life — or one’s death.’ “

Jones concludes: “Marcus Aurelius put it beautifully: ‘Spend these fleeting moments as Nature would have you spend them, and then go to your rest with a good grace, as an olive falls in season, with a blessing for the earth that bore it and a thanksgiving to the tree that gave it life.’”

Materialism gone mad and the what’s-it-all-about question

Friday, 26 November 2010

Here’s an interesting piece by Peter Popham in the Independent, first published in May. I’ve only just found it.

He begins by talking about Christopher Hitchens, who has oesophageal cancer, and how impending death has reconfigured his identity:

“…when the bitter laughter dies away, there is Hitch, locked away from healthy us, in a land where, he discovers, the powers of argument and invective that have made him so widely loved and feared and admired are no longer of any relevance.

“That will be a massive but passing frustration for him, because he has other, more weighty problems on his plate. But it should be a matter of reflection for the rest of us, because we have made of Hitch a modern sage, one of the people we turn to to put us right about things. And suddenly, with death breathing down his neck, what he has to say is of no use to him, and is no use to us, either. He has failed us, and in his blunt way he comes clean about the fact. We treated him like a wise man, but it turns out he was just a clown.”

Which brings him to his point:

“Death is a problem for our age as it was not for ages past, precisely because (speaking of the non-religious majority) we behave as if it were a problem we had already solved.”

But we haven’t, of course.

“Church-goers are confronted week in week out with images of agonising death, talk of the “mystery” of death, exhortations to prepare for it, prayers for those approaching it … But in spurning all that we also spare ourselves the weekly dousing in the fact of mortality. And this allows us to go through life as children and animals do, giving the ugly fact that we won’t be here very much longer only the occasional fleeting glance. Then comes the stroke, the aneurysm…”

He then considers those unbelievers and atheists who confront their own demise with equanimity and courage,

“who face the fact of their dying calmly and soberly and treat the disposal of their own life as if it were merely another item in the will … But there is a delusion at the heart of this activity … And the delusion lies in believing that the self is a fixed, unchanging entity, while one’s life is something distinct and separate from it which we can enjoy like an ice cream when it is in good shape but may discard like poison when it turns bitter.”

He quotes the example of a woman who tried to kill herself rather than suffer a long and horrible death. She failed. Popham draws this conclusion:

“Her error lay in having arrived at a commodified view of life, as if it were a piece of property whose disposal was entirely her own business: exactly the sort of mad idea that our materialistic society breeds. Whereas the truth is that the self, to the extent that one can speak of such a thing, is in constant flux, one’s expectations from life are in constant evolution, and nothing we do is “our own business” – everything impinges on everything else in the universe.

We needed to rouse ourselves from the sleep of superstition, but in doing so we have collapsed into the narcosis of materialism. And waking from that to the reality of death is a far nastier matter.”

Read the whole article here.

Demos report: Dying for Change

Monday, 15 November 2010

There’s a report just out from Demos on death and dying (why don’t we get chronological and say dying and death?). It’s by Charles Leadbeater, somewhat of a hero of mine, and Jake Garber. It’s called Dying for Change. It comes out at the same time as the National Council of Palliative Care’s The Missing Piece: Meeting People’s Spiritual Needs in End of Life Care. I’ll talk about the latter another time. I would only make the observation now that the 136pp Demos report is free to download; the 20pp NCPC report costs a bloody tenner.

Here are some extracts from the Demos study to whet your appetite. The scope of the full report is wider and, of course, fuller. It also offers radical alternatives to the way we do things now. Leadbetter begins by describing the death of his father:

Bill’s death was not a tragedy. He lived a long, happy and healthy life. Some of that life he owed to interventions by the medical profession: operations to fix his knees and sight.

Without modern medicine he would not have been alive at the age of 86. Yet the medical profession that had extended his life was unable to provide him with a good way to die.

Around threequarters of deaths in the UK are ‘predictable’ and follow a period of chronic illness. Dying has become protracted,complex and painful.

Unless we can devise ways to get people to talk about how they want to live while they are dying, our efforts to improve services will be like groping in the dark. It should become standard for people reaching the end of life to create advanced care plans with

the help of friends, family members, trained peers or professionals. Evidence from the USA suggests this can dramatically reduce unnecessary admissions to hospital and

improve care.

· Training in palliative care needs to be much more widespread among doctors, nurses and care home staff at large. Too few doctors, nurses and care home staff are ready to have open conversations with people about the prospect of death and how they want to die.

· We should draw on the models of federated schools to link hospices to groups of care homes, so that hospice skills and values can migrate into care homes.

· Services should be commissioned by end of life trusts in an integrated way that bring together public, private and voluntary providers within a community. – £500 million pa

Our challenge is to help people to achieve what is most important to them at the end of life. That will require the creation of a network of health and social supports so that people can die at and closer to home, with the support of their family and friends, as well as professionals.

If we do not create this social network, then in the decades to come many hundreds of thousands of people will experience unnecessarily distressing deaths. We will die badly in places not of our choosing, with services that are often impersonal, in systems that are unyielding, struggling to find meaning in death because we are cut off from the relationships which count most to us.

Communities and families have coped cooperatively with death for centuries. Only very recently have we become heavily reliant on institutional, professional solutions – care homes and hospitals. There is mounting evidence that the services these institutions offer are costly and inappropriate. A lot of money is spent on public services that people do not want as they are currently delivered, and which are poorly designed to meet their needs.

Download the complete report free here.

Broken survivors

Saturday, 13 November 2010

Watch the full episode. See more FRONTLINE.

Superb if gruelling documentary examining end of life issues from PBS.

One of the contributors is Judith E Nelson, professor of medicine at the Mount Sinai School of Medicine and associate director of Mount Sinai Hospital’s Intensive Care Unit:

The burdens of intensive care can be very, very heavy, and the outcomes are often not good. So we have to face this extraordinarily difficult challenge of knowing when to use this miraculous technology and for how long and knowing when to try to preserve for people a peaceful and dignified process of dying. Walking that line is the very hardest part of my job, and constantly recalibrating myself from one side of it to the other.

Although we can never be 100 percent certain until the moment of death that someone is dying, there are clinical situations where the odds are so overwhelming that someone can['t] survive the hospitalization in a condition that they would find acceptable, that we can see that outcome and compare that with the burden of the treatment. When it is virtually a foregone conclusion that that unacceptable outcome is going to occur, then using this technology to support the physiology of the patient doesn’t make sense. And it is invasive, and it’s burdensome.

It’s a situation in which a person is completely dependent for all of their care on a nurse and a physician; where the patient cannot even attend to their most personal care and has to be cleaned from head to toe and every place in between by another individual; when they’re not even awake. And our nurses do that in the most unbelievably respectful way, but still, it’s a part of this experience. It is being attached to machines with constant noise from alarms and signals. It is being surrounded by electrical devices and monitors, with no control over any of your bodily functions, quite literally. And although we strive as hard as we possibly can to prevent discomfort, it’s probably impossible to prevent it at every moment. So there are discomforts, and one hopes rare but occasional pain and other kinds of distress, fear, delirium. All these things are occurring for people.

In addition to that, you’re in a bed that has side rails to protect you from falling, but also may make it more difficult for the people who love you to get close to you. Even if there’s open visiting in an ICU, which some ICUs have and some don’t, it is not a place where loved ones move about freely. They’re uncomfortable and unhappy and fearful. And all of that is part of the surrounding. So it’s a very disconnected, depersonalizing and occasionally even painful and frightening experience. I don’t think anybody wants to die that way. I think most of us, not everybody, but most of us would be willing to go through it for a good outcome, but nobody wants to be like that if nothing good is going to come of it.

Full interview transcript here.

At the end

Friday, 24 September 2010

I was struck by the sweetness of this in the Victoria Times Colonist (Deaths and Funerals):

“Life provides a puzzle for us when we outlive our friends, when we forget our memories, and when the new technologies pass us by, but we are ever loved when we remember our manners and treat others with love and respect.”

It is in quotation marks, but I think it is original.

Practicalities and suicide pacts

Saturday, 21 August 2010

Here’s a highly recommended post over at the Exit blog: Heartache of a death not shared — a helium suicide fails.

It discusses this story as reported by the Times:

Early one morning in September, William Stanton heard footsteps coming up the stairs of his cottage in Somerset. He knew who it was and panicked. “I shouted out: ‘Go away, Nigel, leave me to it, leave me to it!’”

Nigel, a neighbour and family friend, did not go away. He came into the bedroom and found Stanton in distress and his wife Angela lying dead with a plastic bag over her head.

The Stantons had made a pact to end their lives together and put it into effect just days after the director of public prosecutions revealed how he would apply the law prohibiting assisted suicide. It did not work out as they planned and stands as a terrible cautionary example for anybody thinking that self-inflicted death is easily arranged…

The sun that bids us rest is waking

Monday, 3 May 2010

It’s going to be interesting to track the development of, both, the right to die and its concomitant, the responsibility to die. Old age doesn’t just become physically unendurable, it gets to be economically unaffordable, too.

The darkness is increasingly going to fall at our behest. Choosing the moment will be straightforward enough. Humans live in the future. Our zest for now resides in our expectation of what lies in store for us next. We’ll know when we want to go: no next, no point. Pass the dose, doctor.

Here’s a new poem by Fleur Adcock in this week’s Spectator:

Charon

Where is Dr Shipman when we need him
to ferry us across the fatal stream
and land us gently in Elysium?

Shipman, boatman, ferryman – whatever
the craft he plies to help us cross the river –
we seem to have been waiting here forever.

How did we get the timetable so wrong?
Things are becoming vague, and we’re not strong.
Life was OK, but it went on far too long.

When we’ve forgotten how to keep afloat,
Scoop us up, Doctor, in your kindly boat,
And carry us across the final moat.

Putting death where it belongs

Thursday, 19 November 2009

http://www.flickr.com/photos/homefunerals/3522283997/

Time was, when life was hard, death wasn’t so bad, especially if you believed, as so many did, that your recompense for a life of unrelieved misery and privation here below was the reward of unlimited bliss up there. The prospect of paradise makes a lot of sense when you inhabit a vale of tears. And it makes it easier to die, too, both for the dying person and for those around the deathbed. “He’s gone to a better place,” people used to say to each other knowingly, comfortingly. And they felt the justice of it, truly believed it, even looking forward, somewhat, as they said it. But what was once an attractive offer has lost its allure. We lead lovely, comfy lives, now. We’d rather stay where we are, thank you.

It’s the lack of any inclination to contemplate anything better that accounts for attitudes to death today. Call it denial if you want, but I think you’d be missing the point. It’s more the case that we’re having such a lovely time playing out with our friends that we simply don’t hear Mum calling us in for our tea.

You feel the aftermath of this as a celebrant, sometimes, when you go to visit the freshly bereaved. You walk into shock. Paralysed disbelief. It makes no sense to be planning a funeral. Why, he could just be upstairs. The absolute absence of the dead person has yet to begin to make itself felt. And what I often think, as I sit on the sofa while everybody tries to get their head around the presence of this extraordinary stranger, is ‘I wish he was upstairs’. Nothing would better translate unreality into altered reality and enable everyone to get their heads around it.

Dying is bad and it’s getting worse. Now that the priests can tempt no more than a few of us with a next instalment that’s going to be even better, the government dangles before us, instead, the allure of the good death and the new Personal Care at Home Bill. I have my reservations about this good death myth and about the desirability of dying at home. It’ll suit a few of us, for sure. But drawn out decrepitude and protracted expiration call for very expert attention. Nursing homes and hospitals are exactly the right places to be.

In summary, therefore, dying at home can be overrated; being dead at home cannot.

Now lettest thou thy servant depart in peace

Wednesday, 16 September 2009

So, farewell, then, Keith Floyd. Others have celebrated your cooking and your maverick and disastrous lifestyle. It is the custom of dull people to envy tortured souls who hit the heights and plumb the depths. In truth, it was only sometimes fun being you. You taught us much, though, about what a marvellous thing the human spirit can be when unhitched from judiciousness.

While others celebrate the life, it behoves the Good Funeral Guide to celebrate the death, for here, too, Keith Floyd has much to teach us. He made it look easy. Enviable. We’d all like to go like that, with a bellyful of oysters and partridge washed down with a selection of fine wines. In the words of Rabbie Burns, “If there’s another world he lives in bliss; / If there is not, he made the best of this.”

He was only 65, his life shortened, perhaps, by reckless boozing and far too many fags. We can hear the lifestyle police, the virtue-riddled rectitudinous pleasure-poopers, tsk-tsk-ing as they do when almost anyone dies these days, as if death were a self-inflicted alternative to immortality, despite the fact that even the virtuous, some of them, die young for no good reason, as if death ever did reason.

We’ve never lived longer and we’re supposed to feel very pleased about this. The government takes great, self-congratulatory pride in it. But at what cost? If we follow the puritanical precepts of the lifestyle police there’s now every chance that our virtuous, pulse-nourished bodies will outlive our blameless, dementia-raddled brains by years and years and years and years of incontinent bewilderment. Are we living longer or merely lingering longer?

There’s a lot of talk these days about the good death. Why? Because dying has become so protracted and horrible. Because it’s never before taken so long to succumb to the illness that’ll do us in. As a result there have probably never been so many alive who earnestly desire to depart in peace, or whose death is earnestly desired by those who love them. Never before has there been so much talk about assisted dying. Never before has death been so feared—and for good reason.

Yes, we understand all too bleakly that our end will likely be a difficult rearguard action protracted by the helpful, often urgent intervention of brilliant medics. If you have spent time by the bed of a dying person, you know that keenly.

Keith Floyd’s life teaches us that the more fully we live, the better we die; that rather than eke out our days on a diet of self-denial we should use them up with gusto, in a spirit of recklessness born of an understanding that Reaper G is as likely to cull the good as spare the wicked; that we know not the day nor the hour. It’s death, dammit, that makes life precious.

Keith Floyd was felled by a heart attack at the end of a bloody good day. Among his last words were: “I haven’t felt this well for ages.”

For all that, the paramedics still spent a fruitless and possibly brutal 45 minutes trying to revive him.

Page 2 of 3«123 »