A good death

by Christina on November 5, 2011

“The art of living well and the art of dying well are one.” ~Epicurus

Ever since I’ve known him, my dad has been focused on living a full, productive, and meaningful life. As he grows older he’s beginning to think more about dying, and how to achieve a full and meaningful death.

He recently read a book called Dying Well (and recommended it so strongly that he bought and shipped me a copy).

He then wrote this piece about it… it’s excellent!

A Good Death—And How To Achieve It.

Chris Palmer

Is it possible to create a good death? Or is someone simply lucky if he or she dies well? These are the fascinating questions Dr. Ira Byock, a professor at Dartmouth Medical School, raises in his important 1997 book, Dying Well: Peace and Possibilities at the End of Life.

Both my parents have died (four years apart), and neither experienced what Byock would call a good death. None of us in the family—neither my parents, nor their three sons, nor their eleven grandchildren—experienced increased closeness, expressed much gratitude or affection, or offered much in the way of tender goodbyes. In retrospect, I fear that my parents felt lonely and frightened as they were dying.

This sad experience has led me to think about whether it’s possible to prevent the kind of suffering my parents experienced—in short, to die better. Can someone create meaning and purpose out of the dying process?

Byock says a good death includes expressing love (for example, saying I love you), accepting love, thanking loved ones, expressing appreciation, forgiving, apologizing, and saying goodbye.

The goal is to find peace and satisfaction by completing and resolving the issues that deeply matter. Of course, there is no need to wait until the last year of your life to do these things.

But let’s get real for a moment. Dying isn’t pretty. An implacable and ravaging illness can undermine your sense of who you are. Your very identity, what gives your life purpose and meaning, can wither and bring on feelings of profound despair.

When deteriorating, you are no longer all those things—father or mother, husband or wife, nurturer, initiator, organizer, caregiver, resource, breadwinner—that once defined you as a person. You are no longer living as you did at your peak. All the “work” that used to give your life meaning has disappeared.

In dying, you become a different person. The strong, independent, loving person you once were painfully fades away and the memories of you in peak health grow faint. You can no longer fulfill your responsibilities and in fact have become a burden to those you love. Sickness and senility leave you a far less appealing and attractive person.

In the face of losing your responsibilities, roles, and abilities, is it still possible for you to have mastery in some sense as you weaken inexorably and slip towards death? How do you avoid feelings of helplessness, humiliation, fear, and despair? These are the issues that Byock’s book grapples with. He argues persuasively that a dying person and his or her family can take many steps to achieve a good death.

One of them is not to let doctors do what they’ve been taught to do in medical school. Doctors are taught to give patients aggressive life-prolonging treatments and to keep them alive by whatever means possible. This makes no sense if the only thing accomplished is to delay death by a few days accompanied by intense pain, suffering, and even trauma (to say nothing of the incredible expense). What is the point of allowing a semi-conscious, terminally ill patient to linger? We don’t treat our dogs this inhumanely. Each of us has a right to choose a good death.

Good deaths can also be prevented by failing to control pain, especially when it is agonizing and explosive. I’d rather be sedated than be in unbearable pain or have my family see me in such pain. I know there is a fine line between sedation for the treatment of extreme terminal pain and euthanasia. Byock points out in his book that the line between ensuring comfort and hastening death—between refusing unwanted medical intervention and euthanasia—is a fine one.

For some, a good death means assisted suicide, but, says Byock, better efforts by doctors at relieving pain might make discussions of assisted suicide or euthanasia less necessary.

A good death is fundamentally about a person experiencing something that has meaning and value. Is it possible to transform the experience of dying into a process which includes peace and serenity? The question may seem absurd when most of us associate dying with emotional anguish and extreme misery, exacerbated by the morbid prospect of annihilation and leaving projects unfinished. Still, it’s a question worth asking and Ira Byock provides a great service by provoking his readers to reflect on how it might be possible.

This coming March, Dr. Byock will publish a new book called The Best Care Possible. I will be the first in line to buy it.

{ 4 comments… read them below or add one }

Melissa November 6, 2011 at 8:17 pm

That was amazing, poignant and well written. Tell your Dad thank you. Makes me think about how I treat people and behave while I am alive.

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Lizzie November 7, 2011 at 10:47 pm

i’ve read that book!!

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John November 10, 2011 at 3:30 pm

How involved we are with life choices that effect our today, tomorrow, and maybe next week,, well, ok this being early November we think about the holidays, maybe dream or even plan for our vacation next summer,,, and seem to play, often un-artfully, with longer term choices of college, marriage, baby birth, divorce, jobs, etc., but it seems the latter are always a reflection of what we see around us – friends getting married, having babies, etc. The idea of our death being real is very remote when we are “young”, maybe becoming more real when we reach something like 50 and can consider that we only get to live the amount of time we have already lived. Yet, giving some time to understanding death more can bring greater meaning into our present lives, no matter what age,, and both our time of time and experience of it can ‘very much’ be altered by what we do right now.
My first thoughts are to see death as 3 parts: 1. The time up to our deaths, which as your dad shares, can be greatly enhanced by manifesting the joy of family and community ways that we might know in our current life – the length of this time that we live may be significantly lengthened by astute study of your other blog topics, namely healthier medicine and better nutrition, and yoga seems to help a lot too, and 2. The process of death that is shared in the Tibetan Book of the Dead about that time when we are declared deceased but yet there is continuation of our electromagnetic energies that perhaps on some level define our consciousness, and where perhaps, many years of yoga and meditation might help bring a significantly enhanced experience, although we have not yet evolved a keen understanding of how this works, it would not be surprising if it strongly related to the functioning level of our physical and emotional selves, which in turn might also be progressed through some serious yoga, and finally 3. The time after our bodies have finally dissipated (some Zen monks have had their bodies maintained through their practices for a significant amount of time beyond normal after death), and here we will only ever be left with a complete unknowingness, perhaps replaced with a belief, but still with no certain experiential understanding of how it fully is after this point. So preparing for this last stage is really a preparation for being in this uncomfortable state of uncertainty, which is what yoga physically prepares us for as we twist and contort daily in our asana poses. Somehow we find repeated joy in bringing repeated discomfort into our bodies, and do see the physical, emotional, and psychological benefits. Vipasana is similar to yoga in that it is very uncomfortable to sit and think of nothing for long periods of time and while continually reminding our wandering minds to stop thinking and then to stop thinking about ‘stop thinking’, etc.
And ‘we all get to choose’, weather to ignore death until 50 years from now and see what is to be done with our lives about it then, or to commit seriously to daily yoga and meditation or another chosen path of evolvement, and of course anything in between, ‘we all get to choose’ so it could be viewed that there is some inferred responsibility for us to make a choice. And even though I don’t understand so much about death, intuitively there doesn’t seem to be much that comes close to yoga and good nutrition for the possibility of supporting a long, healthy life,, and perhaps a much better dying and death journey … Much appreciation to your dad for his beautiful writing too!

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Chris Palmer November 11, 2011 at 2:24 am

Dear Melissa, Lizzie, and John,
I appreciated your lovely comments! Thank you!
Best, Chris

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