Understanding Death

Our genetic destiny is clear; from the moment we are born, we will one day die. We don’t know at what age, or whether it will be by natural means or by an outside agency, but it will happen. To some, that might feel somewhat depressing; we will some day cease to exist, just like we didn’t exist for all the previous millennia before our birth. But however we react to that ultimate terminal day, it will still happen; the only thing we can control over the process is how we react to it.

Since humanity became conscious of life having an fixed date of expiration, we have sought to understand why we die. We don’t understand that, nor do we understand what happens after death. It might be lovely for some to imagine that we float on clouds and commune with our predeceased loved ones – but we simply don’t know. No-one does.

There is so much variation in how death is perceived and dealt with around the world. The Tana Torajen community in Indonesia believes that relationships with the deceased continue after their biological death. Bodies often remain with their family at home until the funeral, and life continues around – and including – the body; Torajen believe that the spirit remains close by, and the body is often preserved to remain with the family long after the funeral is done.

Does that give you a sense of fulfillment? Or perhaps a visceral chill up your spine? To the Torajen, it’s entirely normal; children are fully comfortable with these bodies – to them, the dead are “sick”. In the west, we undoubtedly feel nervous and uncomfortable at that norm; I certainly wouldn’t want to visit my nan and granddad in the back bedroom instead of the garden of rest where they are both interred.

Language is so important when we think about death, and here in the west, we are often uncomfortable about being too direct; we will say, “They passed away”; “They’ve gone onto a better place”; “We lost them.” To say, “They died”, is often felt too blunt; it makes us uncomfortable, or we worry it will make others uncomfortable.

We also vary our language depending on who we talk to; we will often say something a lot more careful and soft to a vulnerable person than a co-worker, for example. Humour can feature heavily in our conversations, but it’s rare to just say, “They died.” It can be hard to know what to say when we learn of someone’s death; there are accepted phrase for these situations that we mostly fall back on, and it’s sad that we can’t find a more meaningful way of expressing our empathy and which doesn’t make anyone uncomfortable.

What does a good death look like? The hospice movement has led the way in presenting death as potentially peaceful, gentle, and planned (and talked about more openly). Hospice care usually starts when medical intervention ends, and allows for a sense of finality when staff guide people through the process of that final ending.

It’s often easier for us in the west to accept death if the people has lived to old age, has put all their affairs in order, and their wishes have been respected – i.e. they have had family and friends around them and they died with dignity. On the occasions that happens, there is often a peaceful acceptance from those around them – perhaps because we are pattern-seeking animals, and we like the thought of a peaceful, logical end to a life well-lived.

But life is not always logical, and we can’t expect death to be logical either. We do not always die at a great old age; children and fit people die when they don’t deserve to. On that same scale, no-one “deserves” to, but everyone dies nonetheless, and it’s difficult to come to terms with anything that’s untimely and unfair. When we feel like we don’t have control – control of the time of death, how we die, and how it feels when we get close to the end – it becomes more difficult to discuss.

There is, as well, another aspect to death; assisted dying. A contentious issue, most certainly, and one which inflames strong opinions on both sides of the argument. I fully support assisted dying (properly regulated), but understand that it gives many others a lot of misgivings – even if I don’t respect that point of view.

It’s not currently something that people can access in the UK. In some countries, it is perfectly legal – Switzerland and the Netherlands, for example – and is offered alongside end-of-life care.

An argument against it is that, if end-of-life care was better, people would then not want assisted dying; their pain and other symptoms, psychological and social included, would be managed. A fair point, but with two corrollories; end-of-life care is not perfect and cannot ever hope to be. Some people will be stripped of their dignity and self-respect as illnesses robs them of their independence; people also have the right, when they are fully compis mentis, to have a say in when their life ends.

Others argue that even with such care, some people will want to choose when and how they die. There was some research done in 1995, 2000, and 2006, all of which suggested that people wanting assisted dying or euthanasia actually increased among those in hospices. That poses the question of why. The main suggestions have been; the greater openness of expression encouraged in hospices, the distress of witnessing other people’s deaths and wanting to avoid a similar experience, and the wish to remain physically independent and ‘in control’. In countries where assisted dying is legal, there is some evidence to suggest that not everyone who requests it follows through with the act.

Those against assisted dying worry that the act won’t be voluntary or, if people change their minds, that won’t be catered for – that doctors will make them go through the process no matter what. But there are a number of legal safeguards in countries where assisted dying is legal, and they seem to be sufficient to prevent unlawful killings.

There are actually a number of different terms under the assisted dying “umbrella”, if you will. Being such a contentious subject (it really creates a huge amount of passion whenever it is discussed), it’s important to know the different terms;

Assisted Dying: Someone who is dying, or has a terminal illness, is helped to die by someone else – and that death is earlier than it would be if the illness took them away (and done in a different way – with particular drugs, for example).

Assisted Suicide: The person who dies commits the act themselves, but is helped by someone else (by getting the drugs, for example). The person who dies may or may not have a terminal disease before they die.

Euthanasia: Someone – or a team of people – bring about a person’s death because he / she / they believe that it’s in the person’s best interests. The means of death (drugs, for example) are administered by someone other than the dying / suffering person. The word euthanasia comes from the Greek term meaning “good death”.

Involuntary Euthanasia: Euthanasia performed on a person capable of giving consent, but doesn’t give it – either because they weren’t asked or because they don’t want to die.

Voluntary Euthanasia: Euthanasia performed on a person who has consented to it.

Passive Euthanisa: When someone dies because of an omission – for example, by letting someone die or withdrawing / withholding treatment (switching off a machine that is keeping a person alive, so that they die of their disease).

Assisted dying is seen by those in favour (me included) as an ethically-responsible course; it stops painful and prolonged deaths. Every person has the right to choose the method and manner of their own death, as long as they are in a stable frame of mind.

Should we all have the right to an assisted death? There are some situations where a dying person might conclude that theirs is a life ‘worth not living’. Arguably, only the person who is living that life can decide on its value to them, but they might not be able to end their life without assistance from someone else, or they might be afraid of surviving the suicide attempt and ending up worse off. Relatives, friends, or doctors might be asked for help to do the deed.

But anyone who helps someone end their own life in the UK run a serious risk of being prosecuted. That said, the court have some discretion as to whether the case is judged. Under the Suicide Act 1961, anyone who “aids, abets, counsels, or procures the suicide of another, or an attempt by another to commit suicide” has commited an offence and, if convicted, can be sentenced to up to 14 years in prison. People assisting a suicide can also be charged with attempted murder under certain circumstances.

So often, we find ourselves fearing death, unable to voice our thoughts about this final act of our lives. We grieve at the loss of people dear to us, and we wonder what happens to them – and to us – after we draw our last breath. Death is so often feared that it’s hard to imagine a shift in the zeitgeist.

Religion offers us a possible answer. Devised as they were in the infancy of our species, religion was both our first and our worst attempt at explaining so many things; what happens after death being one of them. It is sad that we are so far along in our evolution and yet reliant on wish-thinking to hope that people we love are still out there in the ether, and that we will be reunited with them in heaven, hell, or somewhere else entirely. Sad because we simply don’t have any evidence suggesting that we have some part of our body – our soul – able to survive physical death and floating up or down to its next life.

This kind of view gives up a sense of temporary reassurance about our future; “our consciousness is not going to die ever.” We will always be ourselves, and we will never miss out on anything every again. But of course, we don’t know that; it’s possible that we cease to exist when our bodies die. It’s a painful and frightening thought, but one we have to be open to – not because we want it to be true, but because it might well be. Wish-thinking doesn’t change our uncertainty of the situation, or indeed the truth; that can only be assessed through scientific endeavour and an open mind.

And what if the truth ends up being that nothing happens to us after death? Then we must deal with the stark reality that offers; it is not pretty nor is it necessarily desirable, but if it is the truth. then so be it. The taboos we hold around death are not always very healthy; in the west, we are often discouraged from talking openly about an ending that we will all, one day, experience. Perhaps if we did more of that, we might find a way to stop fearing it quite so much.

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