The thought of dying is one that most people push aside, at least until it seems imminent (to ourselves or someone close to us). The mission of Exit can be described as taking away the fear of death. A large part of that, and since Exit was formed in 1980, is to research the reliable means of taking things into one’s own hands if all else fails. It is an area where our research, quietly, still leads the world. It can provide the most peaceful of available exits to those that need to use it one day, or reassurance and courage for an unknown future for those with many years still to live. Stop, and think about it for a minute…
(Merely thinking about death is not harmful, in spite of superstition.) Take a calm look at the issues and how you feel about them, might handle them; then stand up, do something else, put the radio on or clap your hands: thinking about for a few minutes is not the same as dwelling on it.
Control of pain and symptoms
There are various other fears associated with death. Most can be dealt with simply with knowledge. Most (but not all) terminal pain can be relieved. This does not mean that in every (or in your case) case it will be relieved, and it is worth bearing in mind that making a loud fuss (if you pain is not being controlled) may be the best way of getting the attention you urgently require. I have a friend who explains very calmly, with a typical English stiff upper lip, that the pain he is in is “really rather considerable.” I advised him instead to let it show in his face a bit that he is in excruciating pain (it produced a more satisfactory and immediate answer).
Then there are symptoms that might occur in the time leading up to death and which people can fear. Perhaps you have seen someone struggling for breath for instance? Breathing difficulties can in most cases be lessened these days with careful medication (such as benzodiazepines) and good nursing care to ensure fresh air and a posture that makes breathing easier. If you are looking after someone at home, these things can be researched easily or advice obtained from such experts as (in the UK), Macmillan Nurses. These people are expert in the most modern methods of pain and symptom control but not sympathetic towards euthanasia or self-euthanasia, so one has to be careful to respect that. Different experts for different challenges. If you try to discuss euthanasia with a medical person in a country where it is illegal for a doctor to help you then you put him or her in a very difficult position and quite unfairly. It is probably be worse for you and for the doctor to do so (they have legal obligations, after all, and “quietly giving someone some pills” is much harder these days due to the paperwork and checks on almost every move a doctor makes).
Self-euthanasia and assisted suicide
Exit is the source of expertise for self-deliverance, or self-euthanasia. Many people think, “Oh, that’s good, I’ll just phone up if I am near to death.” As many readers of this Blog will know, it doesn’t work quite like that. Self-euthanasia is fairly straightforward but mostly when it is researched in advance so the person, while reasonably fit and mentally competent, can absorb the necessary knowledge in advance of the time, if and when that time comes, and one decides for oneself that is needed. The law does not allow an emergency ‘help line’. We provide the best knowledge available worldwide in our books, our members’ magazine, and in our very occasional workshops. Until the law is changed and you can approach your doctor for the help you need, there is no perfect solution: we simply look at this area as responsibly as humanly possible. (For those considering Dignitas, Switzerland, again, do not think that it is just a case of a phone call: get in touch with them well before such emergencies arise.) There is no ‘on demand’ service anywhere in the world at this time.
Think about tomorrow today
The key to all of this is planning. Planning for your future, planning for a good death, whether that good death will be a ‘natural’ one, aided by doctors, sudden, or by your own hand. The strange thing about this is that the grief and fears associated with death are a challenge, quite literally, for every single person on this planet. If you lose a loved one, or if your own death is approaching, it seems like the most momentous thing (and in a way, it is), and yet it is a more commonplace and universal event than anything else consciously encountered in this life. There is no “if” one is close to death. One day you and I will will be close to death. No-one has ever escaped that. So a little planning can go away.
“I have everything under control, but I am still uneasy.”
A few years ago, we realised that, even if pain and symptoms are controlled, and even if you are capable and confident of making a self-euthanasia, some people still feel worried or afraid of the final moment, that second and the seconds and minutes leading up to it where everything, consciousness, outside world, ability to do things, say things, experience through the senses, and even to have any thoughts, all will cease, finally and forever. (We are not denying or affirming any life-after-death scenarios but that is generally a slightly different matter to the ending of the here-and-now.)
Having a calm state of mind is a good start to most challenges: but how to achieve it? Fear is a neurochemical reaction that plays an important role in some circumstances but is redundant in others. When an animal or human feels threatened, fear or anxiety may stimulate appropriate and largely automatic responses such as fight or flight. It can occur whether the fear is reasonable or not (We have all probably known a child fearing the bogey-man, or a bullied child being more fearful generally.) Some fear responses are learned and can be unlearned. (An alternative psychological view is that fear at the moment of death is natural and one should just accept it.)
Some years ago I was camping solo in the desert for several days and nights. I had arranged with my guide that he would come back at a certain time, on a certain day, to fish me out. I was already very dehydrated, having slightly misjudged the water I would require, and when he didn’t arrive, my first reaction was slight panic. I decided to test some of the meditative techniques I had long researched, several of which have been used in peer-reviewed studies in hospitals and elsewhere. It was all pretty logical (once I reminded myself to be logical!) First, sitting quite still, I slow my breathing, focussing my mind on my higher aspirations (rather than the external ’emergency’ outside). I listen to the sound of my breath, enjoying the purity of the air as it enters and fills my lungs, the movement of my diaphragm, up, down, not thinking of anything else, my attention solely on the rise and fall, my breathing deeper, slower.
That first stage is very simple. Our thought patterns are closely linked to our breathing and usually agitation, excitement and so on will cause a change in breathing patterns. This simply reverses the process. Sitting very still also minimises outside distractions.
The next (but not the last) stage is to actively produce a positive state of mind. To do this, I first think of someone who loves me unconditionally (if you cannot think of someone who loves you unconditionally, then you imagine someone). I imagine I am sitting in bright room, warm and comfortable, with a chair and table. In front of me is a diary and I have been writing my life story. Then I imagine that the person that loves me unconditionally is looking in, watching me through a small window. Part of me then moves and imagines I am standing next to them, looking at me writing the diary, and I can hear them gently saying all the many wonderful things they feel and know about me. Returning to the desk, I write these things in my diary.
The purpose of the above stage is to feel good about yourself, to feel conscious of yourself as a wonderful individual, and to feel loved. It is not difficult: but is best done methodically, as just described. It should not be rushed. It has the effect of a good conversation, and releases oxytocin, making one feel good about oneself and ready to feel good about others.
The next step is to produce a feeling of being centred. So far, it has all been about oneself, not the distractions or tendencies of the mind to be swept up by that which is external to the mind, whether one’s physical state, the people around us, or the myriad cares of the world. The following stage allows us to take a pro-active stance and expand the positivity now felt to all things whatsoever.
In the desert, I chose north, east, west and south and performed the exercise four times, concentrating on one direction at a time.* Some people might prefer to think of an expanding circle. I focussed on the positive feeling of love produced from the last stage. I imagined this expanding and embracing others. (If this is difficult for you, imagine it as a warm, golden light which you radiate from the heart.) Firstly, I expand it to the people with whom I have a good emotional bond, the people I love; then to people who are simply colleagues or people I don’t have strong feelings towards one way or the other, and also then people I have never met; finally I expand it to embrace enemies, people I maybe don’t like for some reason or who maybe have some issues with me.
Conflicting emotions can reignite fear, anxiousness, feelings of ‘things left undone’ and so on; the final stage described above takes control of the process to counter all external input with a sense of non-conditional goodwill. It stops one being pulled in one particular direction while at the same time feeling expansive towards all living persons. It associates the positive emotion and neurochemicals in a continuum towards all possible sensory input.
These basic methods of controlling one’s own mind were first brought to the West by a gentleman called Allan Bennett, an analytic chemist and scientist who applied his scientific mind to the meditative practices of Buddhism; today they can be found in many palliative care programs. In essence they are neither religious nor non-religious and can be adapted to personal preference. There are versions for Christians and Atheists, Buddhists and Agnostics. In essence it is simply the application of certain psychological principles to direct one’s mind to a state of inner calm (neuroscientists describe it in fancier terms of course). It has also been used effectively for carers.
I have included a few references of related interest for those maybe inclined to investigate further how all this works. There are many more in the Epilogue to Five Last Acts – The Exit Path where the subject is treated more broadly and a variety of approaches examined. Having recognised that the fear response is redundant and inappropriate at a time when death is inevitable, we simply reprogramme our mind’s outlook, step by step, producing the neurotransmitters that enable a more productive management. Many of the sensory inputs near death may not be the most conducive to a peaceful moment (hospital wards, emotional relatives) but cannot in all situations be avoided. The process is one to allow us to take control of one’s outlook. As Viktor Frank pointed in his famous book, there is always choice, and the last choice is to choose one’s state of mind.
(The author got out of the desert. The calmness produced by the practice lead to a new ‘Plan B’ that would enable a successful exit from the wilderness. As he was about to execute it, his guide eventually arrived, rather late, but nevertheless very welcome.)
Five Last Acts – The Exit Path (this is the new, considerably expanded edition, just released: for reviews of the earlier edition please see here)
Viktor Frankl’s Man’s Search for Meaning (famed neurologist, psychologist and Holocaust survivor)
Dignitas (Swiss assisted suicide group)
The biology of fear- and anxiety-related behaviors (by Thierry Steimer, complete text)
Neuroanatomical and neurochemical basis of conditioned fear (M Fendt & M Fanselow)
Neurochemistry of Positive Conversations (lay article, full text)
Loving-kindness meditation: a tool to improve healthcare provider compassion, resilience, and patient care (Seppala et al.)
Loving-Kindness Meditation for Chronic Low Back Pain Results From a Pilot Trial (Carson et al.)
Mindfulness for Cancer and Terminal Illness (Carlson, L. Note: mindfulness meditation is more closely related to the first stage described above.)
When it All comes to an end (a free download from this Blog)