For most of my life, talking about death and dying has been taboo.
Death has always been scary. For centuries, humans have tried to mitigate that fear with ghost stories, with goblins and skeleton costumes on Halloween and the popularity of vampires in books and film, all of which have in common the possibility of some form of continued consciousness of self after death.
Just recently, the taboo against death talk has begun to loosen and it appears to me to be connected, in part, with the realization that for the foreseeable future there are going to be a whole lot more old people, in relation to the entire population, than has ever been seen on earth.
That means growing numbers who are concerned with and want to know more about how to control their deaths.
Death cafes, a bit shocking only a couple of years ago, now commonly attract people to neighborly discussions of dying without too much flinching from anyone.
My favorite mortician, Caitlin Doughty, not only keeps a popular blog titled The Order of the Good Death which demystifies all deathly things, her Ask A Mortician videos on YouTube are as much a hoot as informative.
Ms. Doughty, who is wont to say such things as, “Maybe we need to look and say, 'Wow, let's look at this beautiful, natural corpse,'” published a popular book in 2014, Smoke Gets in Your Eyes and Other Lessons from the Crematory that is fascinating, sometimes morbid and funny too.
I credit her continued efforts to explain the history, facts and details of dying and its aftermath with going a long way toward removing our taboo about speaking of death.
This all came to mind a few days ago when The American Journal of Geriatric Psychiatry in its April issue released a study titled Defining a Good Death (Successful Dying).
(My first thought was what in the world such an awful phrase as “successful dying” means. As opposed to what – unsuccessful dying? And what would that mean - sitting up after being pronounced dead and saying, “Sorry, just kidding”?)
Back to the report, the study is actually a review of 36 previous studies. Stakeholders in these studies included patients, family members and healthcare providers. Eleven core themes of good death were identified by the researchers:
• preferences for a specific dying process
• pain-free status
• emotional well-being
• life completion
• treatment preferences
• quality of life
• relationship with the health care provider
A couple of these themes are obvious but how some of the others play into a “good death” is hard to know because I am working from the abstract and not from the study itself which is behind an expensive firewall.
The newswise website report tells us that lead researcher, Dilip Jeste, said the bottom line of their study is “ask the patient.”
(I understand that death is a touchy issue but I think I must be allowed to insert my response here: “Duh.” Jeste continues:
“Usually, patients know what they want or need and there is relief in talking about it. It gives them a sense of control.
“I hope these findings spur greater conversation across the spectrum. It may be possible to develop formal rating scales and protocols that will prompt greater discussion and better outcomes. You can make it possible to have a good death by talking about it sometime before.”
The doctor's heart seems to be in the right place but “formal rating scales and protocols” hardly sound like the care and thoughtfulness anyone wants when working out end-of-life issues.
Over the next couple of months, I'll be discussing some practical information about end-of-life decisions that can help any of us to have a “good death” but anyone as old as most of us at this blog knows perfectly well how much can go wrong as the end approaches.
One kind of control is physician-assisted suicide. Four states currently allow what is also called “death with dignity” under very strict rules and California, later this year, is likely to join Oregon, Washington, Vermont and Montana with such a law.
Many people oppose this kind of legal suicide as a slippery slope that can lead to pressure on people, the old in particular, I suppose, to hurry along their journey to whatever comes next.
Recently, a TGB reader emailed to tell me of attending a talk at a senior center by a state employee who first discussed the importance of such end-of-life documents as advance directives and then, apparently, described in some detail the experience of dying by physician-assisted suicide.
Further, the speaker implied, according to the reader email, this is to the good because such a death would save the state money. Dear god. Has the id of Donald Trump already devolved onto the petty bureaucracy of state government?
Unlike the person who wrote to me, I welcome death with dignity laws and I even think the rules are too strict (a good conversation to have here another time). But the idea that anyone would suggest that a person end his/her life to save the government some money is disgusting and dangerous. Worse so coming from a state employee.
I'm not sure this incident actually goes well with the main discussion above about what are successful or unsuccessful deaths, but it's a good lead-in to a clip from the 1973 science fiction movie, Soylent Green I've been wanting to show you for awhile.
You remember that movie, don't you? It became notorious for what soylent green is revealed at the end to be. If you don't know, go find the movie or read the Wikipedia entry. I wouldn't want to be the spoiler.
The clip was sent to me by my blog/internet friend, John Michael Spinelli, a long-time independent reporter in Ohio who also contributes to the Plunderbund political blog that focuses on Ohio and national politics (hint: he knows a lot about John Kasich some of which you can read here).
John and I had been emailing about death with dignity laws when he included a link to this Soylent Green clip titled, “Levi Goes Home,” in which Edward G. Robinson (in his last film role) goes, as John explained in his email, “to the futuristic service center that caters to people ready to say goodbye.”
There are a lot of links above to a variety of websites about death and dying and end of life issues that I hope you will find useful or worth your time in other ways. And I know we are all eager to read what you have to say in the comments about good and bad deaths, physician-assisted suicide and related issues.