We are all going to do it at some point in our lives, but popular conceptions can be far from reality.
Characters in soap operas, for instance, tend not only die quickly but mostly from unusual causes. In reality, most people, especially over the age of 35, die after a long period of illness. Often this means long-term care. A hospital bed costs around £435 a day and a hospice bed, while hard to calculate, about twice that in real terms. While most people would prefer to die at home, it is often either not possible because of the illness, or not possible because of lack of community support.
For readers concerned to have control over the timing of their death at their choosing, this complicates matters considerably. A helium tank might be fine and dandy – but not if you cannot get out of your hospital bed and find it impractical to be discharged. Of the leading textbooks on self-deliverance, only Five Last Acts II covers emergency methods that can potentially be used in a hospital or nursing home.
Palliative care is perhaps most advanced for various types of cancer (which form, in total, the second biggest cause of death). Heart disease is the biggest killer, for which palliative care is far less well developed. Most people seem to be ill for several years before they die. And when it is known that their illness is going to be fatal, there is still usually a relatively long period during which we are wondering how to come to terms with their loss.
Many of us will not be so fit mentally or physically in the time leading to unavoidable death. Coping with day-to-day life will present new and very serious challenges. We might have a struggle arranging care, or paying for things (one man was told to report to the Job Centre or lose his benefits, even though he was terminally ill in a hospice). We might feel very confident during good health, a living will in one hand, and a stash of helium or fatal drugs in a secret place should push come to shove. But what if we end up with round-the-clock care in an institution? What if our mental faculties are not up to speed in preparing a lethal ‘exit’ cocktail?
We tend not to think about such taboo subjects. If we do contemplate dying, the image portrayed by television dramas seems more helpful to get us through the basic idea that we don’t live forever. But is it really different from any other major aspect of life? A sensible approach is to be aware of the various possibilities and an idea of what is involved. Considering your options doesn’t make you ill or speed up the inevitable.
What we die of (easy visual chart from the Guardian newspaper)
‘Come to the JobCentre or lose your disability allowance’ terminally ill man told
How We Die: Reflections of Life’s Final Chapter (book by Sherwin Nuland)
Chronic Terminal Illness, When Do You Say Goodbye? (article)
Trajectories of eventual fatal chronic illness (graph)
Trajectories of Illness Across Time (article)
Leading causes of death in England and Wales (statistics chart)
Mortality statistics (Open University)
Death rates of characters in soap operas (British Medical Journal)
Top 10 Occurrences before and after death (warning: slightly graphic!)
Hospice care costs (quoted in legal report)
Who will look after me if I have advanced cancer? (Macmillan support page)
End of life care in different settings (Marie Curie Cancer Care)
200,000 people a year should die at home, not in hospital (Demos Think Tank)
(And just to finish on a brighter note!)
“Take advantage of five before five — your life before your death, your health before illness, your free time before your preoccupation, your youth before your old age, and your wealth before poverty (i.e. preparing for the Hereafter).”
[Ahmad & Bayhaqi]