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| Is it possible to have a good death? | Is it possible to have a good death? |
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| Death is something we will all face - and some, like terminally ill Kelly Taylor, want the same medical advances that enable us to live longer to allow us some control over when the end will come. Medical ethicist Daniel Sokol asks what a "good' death entails. | Death is something we will all face - and some, like terminally ill Kelly Taylor, want the same medical advances that enable us to live longer to allow us some control over when the end will come. Medical ethicist Daniel Sokol asks what a "good' death entails. |
| A few years ago, I was sitting on a hospital ethics committee reviewing the case of a woman who had just died from cancer. After the chairman read out the interminable list of treatments and procedures she had undergone, a consultant commented "it's difficult to die in this hospital". | A few years ago, I was sitting on a hospital ethics committee reviewing the case of a woman who had just died from cancer. After the chairman read out the interminable list of treatments and procedures she had undergone, a consultant commented "it's difficult to die in this hospital". |
| In our increasingly secular society, death is a formidable enemy. No heaven, no rebirth, no nirvana. Even for some who believe in an afterlife, such as Orthodox Jews, there is a duty to do everything to stay alive. Life is too precious a gift to abandon without a fight. | In our increasingly secular society, death is a formidable enemy. No heaven, no rebirth, no nirvana. Even for some who believe in an afterlife, such as Orthodox Jews, there is a duty to do everything to stay alive. Life is too precious a gift to abandon without a fight. |
| Kelly has less than year to liveRecent advances in medical technology, such as ventilators, feeding tubes and dialysis, have given us a glimmer of hope. The downside is that, although we can postpone death, we cannot always guarantee the quality of those extra weeks or months. | Kelly has less than year to liveRecent advances in medical technology, such as ventilators, feeding tubes and dialysis, have given us a glimmer of hope. The downside is that, although we can postpone death, we cannot always guarantee the quality of those extra weeks or months. |
| Feeding tubes can be uncomfortable - so much so that some patients try to pull them out - and many patients are alive but unconscious. With hi-tech support, therapeutically eager medical staff - and an ingrained fear of death - the glimmer of hope can turn into a blinding light. We may fail to see the burdens of a medically prolonged life outweigh the benefits. | Feeding tubes can be uncomfortable - so much so that some patients try to pull them out - and many patients are alive but unconscious. With hi-tech support, therapeutically eager medical staff - and an ingrained fear of death - the glimmer of hope can turn into a blinding light. We may fail to see the burdens of a medically prolonged life outweigh the benefits. |
| A fitting end | A fitting end |
| When people talk of a good death, they really mean dying well. Death is a state of non-existence which follows dying. Philosophers have traditionally been more interested in death than dying. Is death actually bad? If so, why? | When people talk of a good death, they really mean dying well. Death is a state of non-existence which follows dying. Philosophers have traditionally been more interested in death than dying. Is death actually bad? If so, why? |
| Epicurus, the ancient Greek philosopher, argued that death cannot possibly be bad since there is no subject to experience the badness. It might be bad for friends, family and society, but not for us since we no longer exist. | Epicurus, the ancient Greek philosopher, argued that death cannot possibly be bad since there is no subject to experience the badness. It might be bad for friends, family and society, but not for us since we no longer exist. |
| I am in constant pain, suffer from breathlessness and have bed sores. I do not want to have to leave the UK in order to die Kelly Taylor Kelly's legal battle Generally, we want to die in a way which isn't too frightening, painful and unsightly. Most of the time, medicine can satisfy these wishes. | I am in constant pain, suffer from breathlessness and have bed sores. I do not want to have to leave the UK in order to die Kelly Taylor Kelly's legal battle Generally, we want to die in a way which isn't too frightening, painful and unsightly. Most of the time, medicine can satisfy these wishes. |
| For those of us who want to die surrounded by family, doctors will kindly keep us on life-support until they arrive. As Jonathan Gavrin, a professor of anaesthesia, says: "The last moments of someone's life often are the indelible images that persist in the minds of loved ones." | For those of us who want to die surrounded by family, doctors will kindly keep us on life-support until they arrive. As Jonathan Gavrin, a professor of anaesthesia, says: "The last moments of someone's life often are the indelible images that persist in the minds of loved ones." |
| We want our final moments to fit, as far as possible, with our conception of who we are as individuals. A bad death, to use a crude analogy, is like being forced to wear a shirt you detest. | We want our final moments to fit, as far as possible, with our conception of who we are as individuals. A bad death, to use a crude analogy, is like being forced to wear a shirt you detest. |
| The shirt might be fine for someone else, but you don't think fluorescent orange suits you ("it's just not me"). There is a clash between your idea of style and the shirt. | The shirt might be fine for someone else, but you don't think fluorescent orange suits you ("it's just not me"). There is a clash between your idea of style and the shirt. |
| This, perhaps, is what it means to die with dignity. It is dying in a way which most closely matches your perception of yourself and your life story. This could explain why so many people are attracted by physician-assisted suicide and euthanasia (a term derived from the Greek for "good death"). The controlled manner of death provides what they believe is the most suitable ending to their life narrative. | This, perhaps, is what it means to die with dignity. It is dying in a way which most closely matches your perception of yourself and your life story. This could explain why so many people are attracted by physician-assisted suicide and euthanasia (a term derived from the Greek for "good death"). The controlled manner of death provides what they believe is the most suitable ending to their life narrative. |
| Subjective | Subjective |
| But a good death is not an objective reality. There are many good deaths. | But a good death is not an objective reality. There are many good deaths. |
| In a hospital corridor in the United States, I once met a lady pushing a harp on wheels - she called herself a music thanatologist. Her job was to ease people into death through music. For some patients, no doubt avid music-lovers, dying to music was part of their conception of a good death. | In a hospital corridor in the United States, I once met a lady pushing a harp on wheels - she called herself a music thanatologist. Her job was to ease people into death through music. For some patients, no doubt avid music-lovers, dying to music was part of their conception of a good death. |
| If conscious, we can tell doctors our views on dying well. Since we may be unconscious at decision time, we can either write an advance directive detailing our values and preferences, or appoint an advocate who could advise the medical team on what we would want in the circumstances. | If conscious, we can tell doctors our views on dying well. Since we may be unconscious at decision time, we can either write an advance directive detailing our values and preferences, or appoint an advocate who could advise the medical team on what we would want in the circumstances. |
| I am undecided about how aggressively I want to be treated when near the end. Certainly not as much as that poor lady who died of cancer. I am tempted to leave this difficult decision to some wise and unfortunate relative. Of one thing, however, I am certain: no orange shirt on the death bed. | I am undecided about how aggressively I want to be treated when near the end. Certainly not as much as that poor lady who died of cancer. I am tempted to leave this difficult decision to some wise and unfortunate relative. Of one thing, however, I am certain: no orange shirt on the death bed. |
| Dr Daniel Sokol is a medical ethicist at Keele University | Dr Daniel Sokol is a medical ethicist at Keele University |
| Add your comments on this story, using the form below. | Add your comments on this story, using the form below. |
| People should have the right to death if that is what they really want. After all, what is life? It isn't just a weak pulse while you are on a hospital bed stuffed with tubes. Once the quality of life deteriorates so much with no hope of recovery then there is no point in prolonging the inevitable and the suffering. Perhaps they should market euthanasia as an "organic end" - one where nature takes it course rather than being pumped full of synthetic drugs.Simon Ward, Watford, UK | |
| You assume that we are all part of this "secular" society. Not so. I for one am a Roman Catholic, who certainly believes that my life will take on new meaning and existence when I die, by going to God and the eternal happiness that we are promised by him. We read in the press of Roman Catholics shortly to outnumber Protestants in the UK, due to the influx of migrants. There's talk of reuniting the Church of England with the Church of Rome. I would argue that this heralds the start of the conversion of England back to God in a big way, and a move away from secular society, and the aimless drifting that brings to peoples lives.Nigel Brown, London England | |
| I once read a comment about this from a hospice nurse that I have never forgotten, mainly because it seems so simple yet few of us will ever take heed of it - that one should be prepared to die at a moment's notice so live each moment as if it were your last. Those who are at peace with themselves and the world have a good death, those who are angry or harbour resentments about life do not.Catherine, Northumberland | |
| My father signed a do not resuscitate order and as we watched him die over an eight-hour period from complications from lung cancer, it seemed to me he had his doubts. He specified his wishes when he was feeling good, but was he not allowed to change his mind was the question that kept running through my mind.Candace, New Jersey, US | |
| When I read of the death of Ian Richardson, I commented to my partner that his had been a "good death". What I meant at the time was that he hadn't had a protracted illness or pain, that he died peacefully in his sleep and that although his family had no warning of his death, they didn't have the heartache of caring for him as he neared the end. In my opinion, no matter how much it pains the family of a seriously or terminally ill person, their wishes must be the most important. If they have no hope of a cure and are in pain for no good reason, we should assist them to slip away at a time when they can be surrounded with their families and without a long period of waiting in agony for the inevitable. A good death is like a good life. All unnecessary pain should be avoided.Heather, Wolverhampton | |