A Good Death

I knew a man once who said, “Death smiles at us all. All a man can do is smile back.”

Maximus Decimus Meridius in Gladiator

On 7th July 2005, my parents were in London on a bit of a break.  They got up that morning and my mother drew back the curtains.  Dad got up and went in to the bathroom.  As they each went about their business (more so in my Dad’s case) they heard a loud bang, an explosion, and saw smoke drift past the window.  A bomb had just been detonated on a bus in Tavistock Square, contributing the deaths of more than 50 people with hundreds more injured.

Apparently, at the moment of the explosion, Dad had just sat on the toilet.  This may well have been fortunate for him, but apparently the explosion was so loud that his first thought was actually that he didn’t want to die on the bog.

My Dad has always had a funny view of death.  I remember when I was still living with the parents and he would say that he enjoyed food and would rather die fat and happy than emulate two of the regular joggers he knew who happened to die of heart attacks.  Then something happened that made him perhaps realise how close he was to that particular death and he changed his diet and started getting more exercise himself.

Dr Dilip Jeste, of the University of California San Diego School of Medicine did a study in to what people believe constitutes a good death.  His team came up with 11 core themes:

  • Preferences for a specific dying process
  • Pain-free status
  • Religiosity/spirituality
  • Emotional well-being
  • Life completion
  • Treatment preferences
  • Dignity
  • Family
  • Quality of life
  • Relationship with the health care provider
  • Other

Now, I haven’t read the whole study because $31.50 feels like a lot of money for what I would get from it.   However, does it not feel like the most obvious results that one would get from such a study?  Is it not obvious that people want to leave this earth on their own terms having done everything they want and surrounded by loved ones? (Incidentally, I also love that one of 11 “core themes” was that wonderful catch all “Other”!)

What the study did show was that participants who were firmly in the group of those expecting imminent death put more importance on religious/spiritual resolve in their dying than the family member stakeholders, who were more interested in dignity and satisfaction with the life that’s just been lived.  Again, it makes a lot of sense that when you are expecting to die you contemplate what’s going to happen next to a greater degree than those you are leaving behind.

Of course, not many of us actually get to choose how we die, or have much control over other factors such as life completion, quality of life, or level of pain during illness, but the researchers say that just knowing what a person who’s dying values most – and what those around them value – will make the whole inevitable process that much better. Just “ask the patient,” says Jeste.

I remember when Roy Castle was first diagnosed with cancer and someone asked him what it was like to know that he only had 3 months (I think it was) to live.  He said that it was great news, because the interviewer didn’t know how long they had left!

Another recent study by The University of Tsukuba showed that cancer patients who had been given between two and eight weeks to live survived 36 days at home, but only 29 in hospital.  This highlights the effect and therefore the requirement for people to be happy in life to have a good death.

Irrespective of how long you have left or how you want to go, what would you need to do today that means that if tomorrow never comes, you would be happy anyway?  How would you live, rather than just survive?

If tomorrow never comes
Will she know how much I loved her
Did I try in every way to show her every day
That she’s my only one
And if my time on earth were through
And she must face this world without me
Is the love I gave her in the past
Gonna be enough to last
If tomorrow never comes

So tell that someone that you love
Just what you’re thinking of
If tomorrow never comes

If Tomorrow Never Comes by Ronan Keating


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