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!

“The current law exists to protect those who are sick, elderly, depressed, or disabled from feeling obliged to end their lives. It requires every case to be reviewed by the police and the DPP to determine whether a prosecution is appropriate. The present law protects those who have no voice against exploitation and coercion, acts as a powerful deterrent to would-be abusers and gives discretion to judges to temper justice with mercy in hard cases. The current law does not need changing.”

Dr Peter Saunders, Campaign Director of Care Not Killing

The Commission finds that there is a strong case for providing the choice of assisted dying for terminally ill people. Even with skilled end of life care,
the Commission finds that a comparatively small number of people who are terminally ill experience a degree of su+ering towards the end of their life,
which they consider can only be relieved either by the ending of their life, or by the knowledge that they can end their life at a time of their own choosing.

Download (free) the Commission on Assisted Dying report here. 

From the review in the Guardian:

Last year Chris Larner took his ex-wife Allyson – with whom he had remained good friends – to the Dignitas clinic in Switzerland where she ended her life. It was a life that had become unbearable because of the constant pain, indignities and limits imposed upon her by multiple sclerosis, a condition she had lived with for more than 25 years. Allyson decided that enough was enough.

It is its total lack of sentimentality that makes it so moving, and half the audience is in pieces long before the end. That, and because the redoubtable Allyson is so fully present in the show. Planning her own funeral, she declares: “I don’t want any stiff upper lip. I want weeping and wailing and inconsolable.” This was not a woman to go gently into that good night, and this is a show that reminds us that how we die is as important as how we live.

Posted by Charles

When Meg Holmes was diagnosed with brain cancer in 2009 her husband Andrew started a blog so that he could update friends about her condition.

Meg died on 1 October. The following post describes her death.

My wife Meg died on the morning of Saturday October 1st in the loving company of her brother, sister, son, daughter and husband.

Suffering from a disease that robs one of intellect and dignity, she had the option, as a Washington resident, to choose the time of her death. She used the provisions of Washington’s ”Death with Dignity” Act to hasten her death, while she was still able to converse with and understand her family members. (Oregon has long had a very similar “Death with Dignity” act, Vermont and Massachusetts are considering one).

Her family gathered on Friday and spent the day with her. She was much more alert and animated than of late and visited with each of us. Despite knowing that her death was the next day, we all slept well that night (I slept much better than for many weeks), showing us that we were prepared for her passing.

Social workers (she met privately with one from hospice and one from Swedish Hospital to affirm her decision) and the volunteer from Compassion and Choices Washington all remarked on her readiness (and that she had not been ready the previous week).

The volunteer from “Compassion and Choices Washington” showed immense skill and empathy in helping Meg and in caring for us. 

Meg died peacefully and quickly, with no signs of discomfort. It was a remarkable end to a long struggle, and released Meg from what we all knew could be a long, distressing, undignified and inevitable end. Our preparations, the company of relatives, Meg’s peaceful passing and the knowledge of her command of the situation all served to make her passing much easier for us all. 

Find Andrew’s blog here.

Grateful thanks to the excellent Death With Dignity blog for alerting me to this. 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. 

Leonard Cohen, Dance Me to the End of Love, London 2009

Posted by Charles Cowling

I HAVE wonderful friends … one, from Texas, put a hand on my thinning shoulder, and appeared to study the ground where we were standing. He had flown in to see me.

“We need to go buy you a pistol, don’t we?” he asked quietly. He meant to shoot myself with. 

In addition to wonderful friends, New York Times journalist Dudley Clendinen has ALS, commonly called Motor Neurone Disease in the UK. In a very powerful piece he describes what he’s going to do about it.

There is no meaningful treatment. No cure. There is one medication, Rilutek, which might make a few months’ difference. It retails for about $14,000 a year. That doesn’t seem worthwhile to me. If I let this run the whole course, with all the human, medical, technological and loving support I will start to need just months from now, it will leave me, in 5 or 8 or 12 or more years, a conscious but motionless, mute, withered, incontinent mummy of my former self. Maintained by feeding and waste tubes, breathing and suctioning machines. 

No, thank you. I hate being a drag.  

I think it’s important to say that. We obsess in this country about how to eat and dress and drink, about finding a job and a mate. About having sex and children. About how to live. But we don’t talk about how to die. We act as if facing death weren’t one of life’s greatest, most absorbing thrills and challenges. Believe me, it is. This is not dull. But we have to be able to see doctors and machines, medical and insurance systems, family and friends and religions as informative — not governing — in order to be free. 

He’s not going to do anything to prolong his life:  “Lingering would be a colossal waste of love and money.”

Read the whole beautifully thought, beautifully written piece here.

Daily Mail article here.

Here’s a roundup of news stories I’ve tweeted in the last fortnight. It looks rather a lot — but I try never to fob you off with quantity at the expense of quality. I hate having my own time wasted, so I try hard not to waste yours. Take your pick and enjoy — or gobble the lot and gorge yourself.

Before you do, though… If you missed last night’s Dispatches on end-of-life care, do catch it on 4OD. I don’t know what you’ll think of it — or did, if you’ve seen it. For me, it was the contrast with the care given to those at the start of life that most struck me. We don’t have elders in our society, it seems, only disgusting old people.

Upgrade work at Shrewsbury crem ditched. Aren’t crems easy targets of cuts?! http://bbc.in/dK68PX

Satan’s undertaker’s online memo site is http://bit.ly/eRn1HT Is it any relation of this: http://bit.ly/ebnw8e? Wha gwan?

Priest makes off with bones of child saint - http://bit.ly/gCyKd4

“The Freudian implications of filming a sex scene in the shadow of a soaring obelisk” - http://bit.ly/g4fTKF

Some interesting #funeral industry analysis here- much that is typical - http://bit.ly/elobdS

“Now that I’m dead, I want to tell you a few things.” Last letters. I love this site - http://bit.ly/cRpFuX

DeathRef Death Reference Desk

by GoodFunerals

Happy Valentine’s Day darlings. http://fb.me/T6DJ7iOE

What’s the fuel cost of a cremation in the UK? Guess! Okay, I’ll tell you… £16.25

Lovely topical mezzotint on the Morbid Anatomy blog today – of two dissected hearts. Typical! http://bit.ly/eI5iHw

Nice wheeze for a floral eulogy here - http://bit.ly/hqaHTd

Bio-cremation “could warp metal pipes and burn crematorium workers” - http://lat.ms/i2d1m3

Bad guys always go to the funeral. That’s the place to arrest them -http://bit.ly/ekDmpj

The Top 20 Most Inappropriate Songs To Play At A Funeralhttp://youtu.be/MkYXS4CDU6Y

Really nice sendoff here culminating in a Viking funeral for the ashes – http://bit.ly/gugn2j

My Big Fat Gypsy Funeral? I’d like to see this - http://bit.ly/eYplL0

Malidoma Some and the power of ritual. A great man. Catch him here: http://bit.ly/eY9h8T

“Trad Brit stiff-upper lip has melted into a wobbling lower one.” Is modern grief incontinent? http://bit.ly/hXrfKA

Click on ‘Progressive Conservatism Project’ at the Demos website and you’ll get this: ‘That page could not be found’ !!!

“The great thing about being old is that you don’t give a bugger about people’s opinions anymore.” Dolly Frankel.

Very good booklet here from cancer.net spelling out for terminal patients their end-of-life options - http://bit.ly/fflu8r

“E’body wants a good death but not a moment too soon, but they don’t have the language to ask for it.” http://bit.ly/g3JWCW

“I knew something was terribly wrong with my marriage when I planned my husband’s funeral.” Great first line! http://bit.ly/eDVnEY

“Webcast funerals are dehumanizing – the necessity of human contact requires the physical presence of mourners.”http://bit.ly/eUYVQT

A classic illustration of the systemic incapability of corporate FDs to provide a good service - http://wapo.st/gh1pMf

Would the sale of Bretby crematorium amount to ‘privatising death’? Well, it’s a good question - http://bit.ly/ekH9jp

’26 babies buried together in a wooden box along with unidentified limbs and bones.’ They do this in the US. Shame!!http://huff.to/gaBdyu

Teacher makes her final journey in her VW camper van. Touching story, this - http://bit.ly/faIUHh

‘So recently directing medical care, now we are awkward bystanders.’ Hugely humane doctor’s response to death -http://nyti.ms/hbx8iC

RIP trolling. New to me (but maybe not to you) - http://bit.ly/hf2ikY

What’s responsible reportage and what’s voyeuristic grief porn?http://bit.ly/hIehDs

Mourning glory – the Banshee. Real or myth? Good stuff here -http://bit.ly/gY7nH4

The family is dead? 368 direct descendants at funeral of L’pool matriarch – 17 lims followed the hearse - http://bit.ly/hq6rMz

A funeral at a rugby ground. Great venue, great sendoff -http://bit.ly/gBs9F1

2 biggest comps you can pay an FD: You look nothing like an undertaker; this place is nothing like a funeral home -http://bit.ly/eKUEVm

Some very touching condolence messages on this online memorial site - http://bit.ly/e68jq3

Interesting reflections by ASD folk on weddings and funerals -http://bit.ly/eJyc8d

Great story here + pics: the funeral of racehorse Man o’ War, embalmed (23 gals) and casketed - http://bit.ly/idcYp0

StNeotsFunerals Andrew Hickson

by GoodFunerals

Our new Funeral Price Estimator is up and running online. Open and honest and proud of it.http://www.kingfisherfunerals.co.uk/costs.html

US undertaker offers end-of-life workshops. I like this.http://bit.ly/erO8zM

Love this irresistible free offer from the Neptune Society -http://bit.ly/i86PaI

‘After my sister died I went through her computer and deleted everything questionable so my parents wouldn’t find it.’http://bit.ly/fgqYzN

Online memorial site of the day: last-memories.com. Great twinkly backgrounds. And it’s free! http://bit.ly/fC1V7y

Oh dear, SCI in the doo-doo again. Are these big corps systemically inept? http://bit.ly/fPq7mh

Good piece in the HuffPo here on end-of-life planning -http://huff.to/gqZDUF

DIY suicide causes horrible death, claims EXIT. Time to legalise? http://bit.ly/ffDoI1

Oz police shut the pubs when there’s an Aborigine funeral in town. Racist? http://bit.ly/eIrtbE

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…

I enjoyed this piece by David Nobbs, creator of Reginald Perrin, in yesterday’s Observer. Here are some extracts.

My mother died on 7 August 1995. I didn’t realise, that day, my life had changed … My mother died, as she had lived, unselfishly. After she’d died, my wife Susan and I were just in time for Sunday lunch at my aunt’s. That may sound frivolous, but it was so typical of her I actually believe that some unconscious influence was at work.

She had lived about as happily as it was possible to live in the 20th century, for almost 95 years. She had been ill and in hospital only for the last two weeks. At times, during those two weeks, she had been restless and disturbed, but that Sunday morning she became more and more peaceful. Her breathing began to get slower. She had worried for Wales, and I had no doubt this contributed heavily to her worry lines, but now all those lines disappeared – her face became smooth and she looked young again. Her breathing faded and slowed so imperceptibly it was hard to recognise the moment she actually died.

I can honestly say, on reflection, that witnessing her death took away from me all fear of my death. (Not of my wife’s death. I fear loss dreadfully.)

That doesn’t mean I welcome the ravages of old age. I fight against them. In my 70s I have taken on a fitness trainer and last month I began to tweet! I hope that I will not die in great pain or in an old people’s home. But I no longer fear the moment when I will cease to exist

But the most important thing that happened to me in the wake of my mother’s death wasn’t the strengthening of my feelings against religion. It was the strengthening of my feelings for disbelief. I believe that there are just as many of the “Christian virtues” to be found among the faithless as the faithful…

Loss of faith. It sounds so negative. I didn’t lose faith. I gained faith. Faith in people. I am proud to describe myself as a humanist.

This growing conviction has had quite an effect on my writing – on the novels, at least. I am sometimes described as a comic novelist, but I describe myself simply as a novelist. I write about life, and in life I see much humour and much tragedy, and that is what I write about.

An irony of all this is that if my mother could hear me, could read this, she would be very distressed and would be horrified to think that her death had led me down this road. Well, there it is, it’s what has happened and luckily I believe (know?) that she can’t.

Read the entire article here.

David Nobbs talks about how he is dealing with ‘the ravages of old age.’ I guess that, as we embark on an era when, for most of us, we’ve never had it so old, there will be more and more writers dealing with if and how ageing can be made endurable as physical debility advances and we are deserted by all interest in sex and shopping. A book which has been well reviewed is Jane Miller’s Crazy Age: Thoughts on Being Old. There’s article by her in the Guardian here. The social problems thrown up by an ageing population will become more and more apparent in the next 20 years and I suppose the answers to them are, for the time being, unthinkable. But not for very much longer.

Over on BBC Radio 4 tonight at 8pm there’s a challenging-sounding if uncheerful-sounding  programme, Exit Strategy, by Jenny Cuffe about assisted dying and self-deliverance. “The debate over whether we should legalise assisted suicide is not going away. But whilst we flounder over the grey areas of the British legal system, a radical Australian doctor has found a loophole. Because physically helping someone to die is illegal, he is providing information to paying participants on how to die peacefully and painlessly kill themselves … Talking with geriatricians, psychologists, campaigners and elderly people she explores society’s last great taboo: death. She asks why so many people approaching old age are scared of dying. Are they being failed by our care system? Are advances in medicine extending quantity but not quality of life? Or is even discussing assisted suicide for the elderly symptomatic of an ageist society that undervalues the old? Should the ‘I want’ generation be able to make the choice of when we die and have the right to plan our own Exit Strategy?” If you miss it, you can always catch it on the Listen Again.