The Good Funeral Guide

The Natural Death Handbook, Fifth Edition

A thoroughly updated and revised edition of the Natural Death Centre‘s celebrated handbook. Now presented alongside a new collection of essays on death, dying and funeral practices by doctors, historians, authors, poets, theologians and artists including Richard Barnett, David Jay Brown, Dr Sheila Cassidy, Charles Cowling, Bill Drummond, Stephen Grasso, Maggi Hambling, Graham Harvey, Gary Lachman, Nick Reynolds, and Dignity in Dying.

It’s out in May 2012!

“Last week, I attended the funeral of one of my uncles. His irresponsible lifestyle, which included eating meat, smoking, drinking alcohol and ignoring sell by dates, resulted in his life being cut short at the age of 94.”

Source

We’ve just read in the Guardian that today is reckoned to be the most depressing of the year. Gosh. If you are sitting in a puddle of seasonal misery and wretchedness, this may cheer you up:

I recently changed primary care physician. After a comprehensive history and physical exam and a bunch of lab tests, she said I was doing “fairly well for my age.”

I did not like that comment so I asked her: Do you think I will live to 85?

She asked: Do you smoke tobacco or drink alcohol? Oh no, I replied. And I don’t do other drugs either.

She said: Do you have many friends and entertain frequently? I answered: No, I usually stay at home and keep to myself.

She asked: Do you eat rib eye steaks and barbecued pork? I said: No, my other doctor told me all meat is unhealthy.

She asked: Do you spend a lot of time in the sun, like playing golf, sailing, hiking, or bicycling? No, I don’t, I said.

She persisted: Do you gamble, drive fast cars, or have a lot of sex. I said, No, I don’t do any of those things.

So, she looked at me and said, then why do you give a (expletive deleted) whether you will make it to 85?

Source

Pic stolen from here

This will interest some of you at least — the more numerate and analytical. It’s an online diagnostic tool to determine longevity.

Here’s the rationale as described by the New York Times:

To help prevent overtesting and overtreatment of older patients — or undertreatment for those who remain robust at advanced ages — medical guidelines increasingly call for doctors to consider life expectancy as a factor in their decision-making. But clinicians, research has shown, are notoriously poor at predicting how many years their patients have left.

Now, researchers at the University of California, San Francisco, have identified 16 assessment scales with “moderate” to “very good” abilities to determine the likelihood of death within six months to five years in various older populations. Moreover, the authors have fashioned interactive tools of the most accurate and useful assessments.

“We think a more frank discussion of prognosis in the elderly is sorely needed,” said Dr. Sei Lee, a geriatrician at U.C.S.F. and a co-author of the review. “Without it, decisions are made that are more likely to hurt patients than help them.”

If that’s whetted your appetite, you can read the whole article here.

And you’ll want to have a look at the interactive longevity-calculating tool, ePrognosis, too. Tip: sign on as a healthcare professional to get the tool to work. Find it here. 

Posted by Charles Cowling

Extracted from an article in yesterday’s New York Times: 

I hope you had the chance to read and reread Dudley Clendinen’s splendid essay, “The Good Short Life”. Clendinen is dying of amyotrophic lateral sclerosis, or A.L.S. If he uses all the available medical technology, it will leave him, in a few years’ time, “a conscious but motionless, mute, withered, incontinent mummy of my former self.” 

Clendinen’s article is worth reading for the way he defines what life is. Life is not just breathing and existing as a self-enclosed skin bag. It’s doing the activities with others you were put on earth to do. 

But it’s also valuable as a backdrop to the current budget mess. This fiscal crisis is about many things, but one of them is our inability to face death — our willingness to spend our nation into bankruptcy to extend life for a few more sickly months. 

Years ago, people hoped that science could delay the onset of morbidity. We would live longer, healthier lives and then die quickly. This is not happening. Most of us will still suffer from chronic diseases for years near the end of life, and then die slowly. 

Obviously, we are never going to cut off Alzheimer’s patients and leave them out on a hillside. We are never coercively going to give up on the old and ailing. But it is hard to see us reducing health care inflation seriously unless people and their families are willing to do what Clendinen is doing — confront death and their obligations to the living. 

My only point today is that we think the budget mess is a squabble between partisans in Washington. But in large measure it’s about our inability to face death and our willingness as a nation to spend whatever it takes to push it just slightly over the horizon. 

Lessons applicable to the UK, obviously. Read the whole article in the NYT here. If you missed Dudley Cleninden’s piece, read it; it’s brilliant and important. Here. 

If you like waking up to war, famine, pestilence and people shouting at each other you like Radio 4. Oddly, I do.

This morning I emerged from a day-denying doze to hear medical people warning of the cancerous perils of alcohol, even small amounts of it. You too perhaps. Chilling stuff. The advice seems to be to knock it on the head altogether, though if you’ve ever drunk, stopping only partially reduces your chances of avoiding, in Betjeman’s words, ‘A losing fight with frightful pain / Or a gasping fight for breath.’ The tones of the medics’ voices seemed to be high in gloat-factor. Read the Indy report of this latest health scare here.

As both a resolute drinker and a tenacious smoker I should have been especially terrified but I wasn’t at all and lit up instead. I don’t kid myself, as these doctors seem to do, that the healthy alternative to life-enhancing recreational drugs is immortality. On the contrary, I wanted to reach out to them and warn them that if they eke themselves out rather than use themselves up they’re in for the most terrifying fate of all. The price of longevity can be the cruellest death of all.

In response to the terrifying longevity epidemic that is now beginning to overwhelm ‘advanced’ societies, an excellent website, SOARS, has established itself in Brighton. It promotes rational suicide for the over 85s. It’s well worth an hour or so of your time. Here, to whet your appetite, are some extracts:

In 1900, the average life expectancy at birth for the world as a whole was only around 30 years, and in the Western world just under 50. The figures now, according to an Economist report last year, are 67 and 78 respectively, and still rising.

SOARS is mainly concerned about those who are 85 and older. Today, in the UK, there are 1.3 million individuals in this age group: by 2020, it is believed there will be at least two million: and, by 2035, it is  estimated that there will be 3.2 million, accounting for five per cent of the population.

A Newcastle University “85 plus” study, published last December, stated that nine in ten of these elderly people would be expected to have at least three health problems, such as heart disease, osteoarthritis and impaired vision, which would require treatment. Ageing populations put increasing burdens on a nation’s health and social services. In an ideal world, the rising financial costs involved should not be an issue, but, unfortunately, this world is very far from ideal.

“In my 30 years as an Emergency Room physician, I have watched many people die. I’ve learned from them that the modern American death is often a chronic illness, spanning some five to 10 years, in which a person slowly looses their mobility, their independence, their ability to perform basic activities of daily living, their intellect, and all ability to enjoy life. At some point in this decline, many of us would choose to say, ‘enough suffering, just let me die” – Dr. Jeanne Fitzpatrick, writing in The Huffington Post, February 9, 2010.

SOARS website here.

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.’”

I know I go on about this, but I think it important. Long, long life is getting to be a problem. Thirty years ago dying was a relatively brief, often unexpected episode. Clever medics can now prolong it – intolerably and expensively.

That last goodbye for most of us just keeps getting put off and the state has to find more and more money for more and more tottering and tumbledown folk. Not for me, I drink and smoke at lot, I’ll go down like a felled ox thank god when that big vein in my forehead goes bang. But you self-denying abstinence- and exercise freaks – how many years of decrepitude, double incontinence and dementia is it all buying you?

Here’s some food for thought, perhaps:

In the Jan Oldie magazine there’s an interview with a man called John Barnes. He’s eighty-something and fit as a flea. The interviewer asks him this question: ‘Have you found a way of coming to terms with death?’ And he replies: “You have to learn to accept that you don’t come to terms with it. Sometimes I think that people who’ve got blind religious faith and believe they’re not going to die are the luckiest. My feelings swing to extremes. Life seems marvellous when my old ramblers [he takes oldies walking] are enjoying sunshine in the country, when I’m holding an attractive girl in a dance, or when I’m entertaining a crowd of people with my songs. The rest of the time I wonder whether the NHS ought to be spending so much effort on keeping me alive.”

Over at the Morialekafa blog we read this:

Somehow I found myself last night in a discussion of what should happen to old people if there is not enough money available to keep them all alive. That is, would there ever be enough money available for health care for all, and if not, what about “death panels.”

You are all doubtless aware of the claim that Eskimos would sometimes leave their old people to freeze to death when there was not enough food to feed everyone. There is little doubt that old people accepted this as a necessity and perhaps even volunteered themselves …

First of all, I doubt that anyone really knows very much about what happens to old people in the United States at this time. For example, it is clear that the suicide rate for those over 65 goes up rather sharply … I think it is entirely possible that many of these suicides are deliberate senilicides, carried out to relieve the potential burden on their survivors, but does anyone really know this? …

How much is a week of life, when one is ninety, really worth?

…

Where I worked for a time in the New Guinea Highlands, when a person is considered so old they are obviously near death, their survivors and others hold a funeral ceremony for them while they are still alive, to let them know they are respected and will be missed (also to placate their potential ghost so it will not hang around causing misfortune). These occasions, perhaps needless to say, are very emotional, the speeches can be endless, and the oldsters are sometimes overcome, weeping and even falling to the ground. This seems to me to be a more sensible and genuine way of saying goodbye and expressing grief than by feeling guilty and regretting you did not do and spend more to prevent the inevitable. [Source]

Now hop over to the excellent Death Reference Desk for a series of articles about Republicans and Tea Party nutters in the US who either out of stupidity or malignity have been confusing end of life planning (a now ex-component of the Obama Patient Protection and Affordable Care Act) with death panels. [Source]

It’s a whole new ethical area, isn’t it? As abortion once was…

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