A Good Death?
In recent years there has been some shift away from the preoccupation with the spiritual and existential experience of death and dying towards bodily deterioration and its psychological and social implications. As we live longer, more and more of us endure decades of low level, chronic ill-health, often followed by prolonged terminal illness, from which we may be “rescued” time and time again by sophisticated medical interventions.
The classic “good death” is about the experience of acceptance and awareness – a kind of epiphany – in the final hours of life.
However, Sherwin B. Nuland, in a pioneering critique, warned that “the comfort and peace, and especially the conscious serenity, of final lingering days on earth have been vastly overestimated by many commentators; we are not well served by being lulled into unjustified expectations.”
A survey by Karlis Osis of over 35,000 observations by doctors and nurses, concluded that only 10% of patients were even conscious in the hour before death. Of these only one in twenty (0.5% of the total) showed any signs of elation.
We may surmise that many of them may in fact have rejoiced at no more than a merciful release from prolonged suffering.
Thus, few of us are likely to enjoy the privilege of the “good death”. It is true that within certain limits we can prepare for how we shall die, and hence influence our experience of dying, but these limits are narrowly set by the nature of whatever kind of physical deterioration eventually afflicts us.
We are most likely to die in a coma or under heavy sedation. Long before that, the person who we recognisably are, to ourselves and to our friends and relations, may have become distorted almost beyond recognition.
It is true that advances and wider use of palliative treatment has led to more pain effective control. But this has in turn brought to the fore other afflictions which patients find frightening and depressing.
There may be a crisis of identity: no longer able to recognise oneself, reinforced by the evident difficulty that the nearest and dearest may have in treating you as the person they once knew and loved. Also, there is the frightening lack of bodily control and ability to sustain dignity when reduced to helplessness by vomiting, incontinence, and the like.
There is now a growing awareness of the very diverse ways in which people evolve through terminal illness and approach their deaths.
Researchers have claimed that as the hospice movement has grown, what were the creative and flexible perspectives of the founders have tended to become institutionalised stereotypes, in both training and care.
The good death, they claim, has become a bench mark, even an “ideology”, against which patients can be measured, as also the stages through which they are supposed to pass in getting to it. Those, for example, who remain in denial may be considered the awkward and unsatisfactory ones, who subtly threaten the equanimity of the staff by not doing what they are supposed to do and not dying by the book. This can amount to a discriminatory lack of respect for some patients’ autonomy, and has provoked calls for greater concern for that autonomy.
The above critique suggests that there may be a something of a contemporary Western Buddhist ideology of death, an idealisation which has tended to obscure the diverse realities of dying.
The following testimony from Frank Ostaseski, administrator of the 1992 San Francisco Zen Hospice Project, is worth bearing in mind:
“However many dying people I have known, this person is dying for the first time and I don’t know what they need: everyone has different needs. You must hold your previous experience of dying patients very lightly, so if they prove incorrect for this person you can shift very quickly.”
In the light of the above I believe it is now time for a shift away from the final hours of the “good death” to an emphasis on the good life.
How we have lived is more important than how we die, over which we may very well have little or no control.
More particularly, whatever our dying lot turns out to be, we can as from now prepare ourselves by the practice of bare awareness. Through this we can make the experience of our terminal afflictions more manageable and endurable, and can longer sustain our personal integrity.
In dropping all illusion and evasion, this can indeed be a time of insight and transformation, and in this sense a true culmination of the life we have lived.
Thus, in her excellent book, Making Friends with Death, Judith Lief advises:
“When death occurs, our old strategies no longer apply, so we are disorientated and frightened. How can we work with this? How can we better prepare ourselves to deal with death?
The best preparation is working with our state of mind now rather than thinking about exotic things we might do later when we are looking death in the eyes. It is better to learn to relate to death now, when we still have the strength and ability … People have different paths and different teachers and different traditions – but whatever our tradition is, it is not going to help us very much if we don’t actually apply it. The point is: do it now; don’t wait.”
Lief advises working with the many smaller “deaths” we encounter day by day, year by year, ranging from losing a favourite pen to losing someone we love, from missing a train to receiving a fateful diagnosis – all the many shocks and losses of life. Such an awareness practice prepares for facing the greatest of the self’s losses – of itself, of its life.
Source: Based on Jones, Ken. Ageing: The Great Adventure (A Buddhist Guide). Published by The Buddhist Hospice Trust.
https://buddhisthospice.org.uk/books/
This 32-page pamphlet by Ken Jones shows how to make a work of art of ageing and dying, as the greatest adventure of our lives. It also draws attention to the snares and delusions, and has some controversial and down-to-earth things to say about dying. It ends with a celebration of old age. Although written from a Buddhist standpoint, it aims to be accessible and helpful to people of all spiritual beliefs and none.
Cultivating a Personal Awareness of Death
The teachings presented in this book are rooted in the cultivation of an ongoing personal awareness of death.
We are on a journey that begins with our birth and ends with our death. At each moment of that journey, we confront the boundary of life and death. We are constantly in transition.
At the moment of death, theoretical understanding is of limited use. Many of our ideas are untested and merely reflect our fears and confusion. As we try to avoid pain, we only increase our suffering. We need a different approach.
Instead of avoiding the reality of death, we need to look into it and examine our own fixed ideas and preconceptions.
Having done so, we could look freshly at our immediate experience through meditation, or mindfulness practice.
Mindfulness practice is a way to drop our preconceptions and reconnect with our immediate moment-to-moment experience of life and death.
With that as our ground, we can begin to explore our relationship to death in a systematic way by means of the traditional practice: contemplating the reality of death.
Through that powerful combination—mindfulness practice and the contemplation of death—we can change how we relate to death and enhance our appreciation of life. We can begin to make friends with our own death.
(Judith L. Lief, Making Friends with Death: A Buddhist Guide to Encountering Mortality)