Some of the questions in life can be downright scary. Take death, for instance! We know it’s going to happen yet we do so little about it. When the time comes, sometimes everything happens in a rush.
For this Blog post, I have taken three uplifting but intensely practical inputs. Firstly is a TED talk by an emergency medical technician called Matthew O’Reilly. He identifies three common scenarios he sees when attending someone in the last moments of life. Secondly is a re-blog from my friend Derek Humphry’s mailing list where he recalls the transformative attitude of a dying woman as recounted by philosopher John Hardwig. Finally is a story from our recent Exit workshop that maybe pulls these together.
First, here’s the TED talk, called, “Am I dying?” The honest answer.
(apologies to our readers who found a large blank space here! … we weren’t aware that video embedding isn’t allowed on wordpress blogs without a $99 subscription, so they were deleted after a day or so — do please just follow the link above — it’s only five minutes but has great emotional and practical impact)
Matthew looks at common crises that persons face inside and how he answers the question, “Am I going to die?” But he goes deeper. He finds out what people are really looking for. He tells them the truth, and listens to what is important when someone knows that they are dying. They found inner peace and acceptance. But the reactions vary. 1) It’s about forgiveness, knowing that their life was good. Or (2) a need for remembrance, and in this a sense of eternity. Or (3) “The dying need to know that their life had meaning,” he says, and how that one always moves him the most.
Next, here is an example of someone with more than a few minutes, someone who knows they are dying and wants to act on the sort of realisations that Matthew mentions: she wants to do good for others and make her life count in that way.
Brittany Maynard’s ordeal is now over. On Nov. 1, the 29-year old with terminal brain cancer, who became the face of a movement to allow dying patients to choose when to end their lives, used the pills provided by her Oregon physician and died. Compassion and Choices, the nonprofit Maynard worked with, reported that “she died as she intended -peacefully in her bedroom, in the arms of her loved ones.”
I would trade quite a few more days (especially days spent with searing pain or doped into semi-consciousness in an effort to manage symptoms) for the ability to say my goodbyes and die like that. We all know by now that the best death is not the one that can be postponed the longest.
The most striking thing about Maynard was the way she transformed herself so quickly, with an essay, from just another person into a warrior with a mission. But this is in keeping with the way many terminally ill people behave. They often spend their remaining days trying to improve the lot of those who will suffer similar illnesses in the future. Some, like Maynard, campaign for policy changes. Some offer themselves as subjects for medical experimentation, knowing full well that any findings will not help them. Some participate in support groups for those with similar medical prognoses.
“I didn’t launch this campaign because I wanted attention; in fact, it’s hard for me to process it all. I did this because I want to see a world where everyone has access to death with dignity, as I have had. My journey is easier because of this choice,” Maynard wrote on Oct. 9. In that way, she gave meaning to her final days in a way that a series of purely self-centered decisions never could have.
Discussions about physician-assisted suicide – and Maynard’s death – almost inevitably focus on what’s good for the terminally ill patient. But not every patient takes such a self-centered approach. A self-centered life, focused on personal gratification, aggrandizement and comfort, may or may not be good for the one living it. But a self-centered death is not. If all we care about is ourselves, everything we care about will perish in our death. That is unbearable.
Those who see themselves as connected to something bigger and more enduring than themselves, however, can die in a context of meaning and purpose. For some, religion provides this connection. But religion doesn’t always work. Many cannot summon the necessary theological convictions, especially on demand. And some kinds of religion fail at the end of life. A Christian oncologist told me that she deals with many patients who die filled with rage against God.
For others, a sense of connection comes from family, a deeply felt affinity with the natural world, or commitment to some ongoing endeavor such as art, science or efforts on behalf of disadvantaged kids. This approach clearly spoke to Maynard, who wrote that she worried she’d soon be unable to recognize her husband; her family moved with her to Oregon so she could die there.
For those who live a life of connection, when illness threatens to sever the connections, it is time to go. But the survivors go on, burdened or blessed with the memory of the death of their loved one. For them, the death is never the end of the story. And a death in the family – especially a long, drawn-out dying process – can be much worse for the survivors than it was for the deceased. This is part of the reason Maynard gave for opting against hospice care: “I probably would have suffered in hospice care for weeks or even months. And my family would have had to watch that. I did not want this nightmare scenario for my family.” She was looking outside herself.
The evaluation of Maynard’s death and of physician-assisted suicide more generally, must not be exclusively focused on the dying person. That would be to revert to the self-centered, unconnected perspective. Those of us with deep attachments to family and loved ones are all charged with carefully weighing what each of our alternatives probably would mean for our loved ones, with helping them to understand whatever choice we make, and with preparing them, as best we can, to go on to live happy, fulfilled lives without us.
How do these things all relate to each other in a practical way?
Some while ago, we looked at peer-reviewed research on the way we can choose to influence our state of mind when facing death. Matthew has described the needs, but not all of us will have Matthew to talk us through or be in Maynard’s position. For the first time in a face-to-face situation, confronted with a fairly hard-nosed audience unwilling to swallow any psychobabble, we introduced one of the several techniques. Called LKM, it is used by persons of any religion or none and, like mindfulness meditation, involves meta-cognition (the psychological ability we have to ‘think about our thinking’). There are two stages, one is to feel good (and forgiving) about oneself and the second is to feel good about everyone else.
The first of these, feeling good about oneself, one’s life, can be particular hard at a moment when it is all about to go away. I sometimes go through this stage with people by asking them to think of someone who loves or has loved them unconditionally. Imagine that person is glancing at you from the other side of a screen as they write about you. Imagine you can look over their shoulder. Look at all of the wonderful things they are writing about you. Make peace in this way and value the goodness of your life; and then, only now, turn to your feelings towards others.
This second part involves holding that feeling now built up inside oneself, a feeling and knowledge gained from a sense of unconditional love, and extending the feeling to others. Starting with those close to you, feeling love for them and extending forgiveness for anything that has happened in the past. Then extend it to carers, associates or people you barely know. Lastly, to anyone who wished you harm or that was your enemy.
While this sounds a wonderful exercise, I have not introduced it merely to suggest we should all love each other! – even if you think that should be the case (and of course, maybe it is). But the issue we are tackling here is our own inner state of mind at the time of death. If you want a good death, whether by your own hand at a time of your choosing, whether by going to Dignitas, whether by letting ‘nature’ take its course, or it could even include a road accident (going back to the first story in this blog) then you might want to spend a moment deciding how you will handle it.
A close and very elderly friend recently said to me the other day that, with severely declining health, continuing to live a little longer became acceptable on realising contributions to the needy she can make. She probably has her ‘Exit’ kit to hand, but she is practicing her mental attitude in a wholly fulfilling way.
Sometimes learning how we want to die can inspire us to enjoy the way we really want to live our lives (first!) EXit wishes all its readers a good life, and (quite literally) a good death, and a good dying.
n.b. This is a more upbeat approach than our previous, rather graphic blog, but there is maybe a common theme running through them which we have touched on in a practical way in our ‘last moments’ essay (find it at the very foot of the ExitEuthanasia Blog).