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Last Updated: Wednesday, 21 February 2007, 11:34 GMT
Is it possible to have a good death?
Statue of angels

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".

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.

Richard and Kelly Taylor
Kelly has less than year to live
Recent 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.

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?

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

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."

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.

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

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.

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.

Dr Daniel Sokol is a medical ethicist at Keele University


Add your comments on this story, using the form below.

The Farmers' Union of Wales had it right: Live as if you'll die tomorrow, farm as if you'll live a thousand years. Merge short-term zest for life with an intention to continue... and when (for me as a Christian) the Lord calls my name, I'll come running. Until then, I'm going to enjoy this life to the full.
Megan, Cheshire

My father had terminal lung cancer. His body couldn't cope with the aggressive treatment and his heart failed. He was resuscitated only to spend his last few days struggling to breathe from blood in his lungs. He knew he was dying but medical intervention took over and his family was not able to spend those last precious days in the way we would have wanted. When my dog of 17yrs had a severe stroke, rather than a lingering death, confused and distressed, we were able to spend time with him to say our final goodbyes and he was put gently to sleep. I envied my dog because he had lived a good life and his exit was a great deal more dignified than my father's.
Karen Morris, Leigh on sea

I'm a strong Christian, but I have to say I've no idea how I want to die. It's still quite a daunting prospect! My mum died when I was very young and it's always been a concept that I've struggled with. Will I ever see her again? I am safe in the knowledge I will be with God, but it's still like climbing up a ladder to a extremely high diving board and then jumping off. You know that there is going to be this luscious envelopment when you land, but the leap and fall are still pretty scary.
Louisa, Salisbury

As someone who has attempted suicide on a number of occasions I have often considered the ramifications of life, death and dying in a "good way". Often life can be a difficult and agonising, be it due to physical or mental pain and anguish, and death can often be seen as a way off casting off of those bonds. A comfortable death is a right which should be available to all. I speak as someone who has been resuscitated, from being clinically dead, and despite having no intention of suicide now, I remain indifferent towards my resuscitation. Many people will perceive my attitude as selfish and unreasonable, however I will remind those people never to judge someone until you have walked a mile in their shoes. The most important thing about death is not dying in fear, with regrets or alone.
Joseph, Leicester

My great uncle was prepared and ready for his death. He passed away a few years ago in a hospital local to him, he knew the end was near and he was content with that. He liked all the young nurses and visitors and even remarked "I'm having a good death". He was cheerful and quietly slipped away after a few days. If only it could always be like that because those of us left behind even remember his passing with a smile.
Jill, Milton Keynes

There is a quitting mentality in this country that is now spreading to life and death itself. It goes along the lines of "If it's too hard, then give up." Is this really the right way to look at life, or anything else?
SK, London, UK

When the hospital doctor told me that my mother, aged 66 was dying I said she was to be made comfortable. I took their advice and did not put her on a ventilator. The alternative procedure they tried to assist her breathing did not work and my mum remained unconscious for about 11 hours before she finally died without any tubes at all in her. I do wonder if it WAS comfortable for her. She did not receive any fluids - did she die thirsty? She did not seem to be in pain. It was a quiet death, with me holding her hand and talking reassuringly. It seemed to me like a "good death" but I guess we can never really know what the dying person is feeling and thinking.
Pauline, Harrow

For many years I did military and anti-terrorist bomb disposal, and literally challenged death many times a day. I learned to live every moment as if it was my last, and I became unafraid of death itself. My life horizons expanded, and my wife and I became determined that we will help out others as much as we can. We want our deaths to mark a job well done, and our funerals to be celebrations, not mourning. We do not want to linger and suffer, we do not want our loved ones to have to fret over our demise, and we do not want our organs to be wasted because someone is afraid to pull the plug. God will decide when the time is right, and He will guide his servants to do his will. Morals and ethics and laws come from God, and who are we to go against nature?
John Taylor, Cambridge UK

I feel very strongly about this. I am 63, with five chronic medical conditions, one of which includes muscle wastage. All conditions are progressive. I shall have a "good death" because I shall choose when I terminate my physical existence. As to religious beliefs, I am "almost" a Buddhist, certainly a Spiritualist. I do not impose my views on others, who unfortunately, do not have the same common courtesy to do likewise. My life, my choice.
Freddy Whiting, Congresbury, Bristol

When I die, which I hope is of old age, I would like to be assisted into a lotus position, and left alone to meditate until I floated on to the next realm. In the ideal world, having reassured loved ones, I'd hope they would respect me enough to let me concentrate on the last act of life; death. We should introduce the subject in schools that helps young people get associated with the inevitability of death in a positive way that encourages us to live in a way that embraces death as a natural consequence of life. Funerals are a stark reminder of our collective attitude to death, they are typically sombre occasions.
Lisa, Wirral

My father died recently and the circumstances still bother me. I know he was afraid of going to sleep and never waking up - but that was before his short illness. In hospital he'd been put in on a breathing machine and an enforced coma, he never recovered. So he did in fact die in the way he was afraid of, but to others it was peaceful. I can't help wondering if he knew the risk he wouldn't wake up when he agreed to the procedure.
Christine, Milton Keynes

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

Nigel states that, as atheists, we must be "aimlessly drifting" through life. I like to think that I am motivated in this life to do the best I can for those around me just for the sake of it, and not in the hope of some after life that no one has any proof of. Lets hope the UK doesn't become a God state where morality is defined in religious terms, and people are incapable of separating law from belief.
Chris Wallace, Dumfries, Scotland

One well-known doctor recently commented that we need better palliative care rather than legalised euthanasia. Given the shortages of diamorphine for cancer sufferers, I think that this should be addressed before we start to consider intervening to end life. After all, what most people want is to avoid pain. If we can address that then perhaps the desire for euthanasia will be reduced.
Matt, Hants

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

How I can heed Catherine's point. I nearly died from kidney failure two years ago. I have nearly made a full recovery, but I think it is a real shame that I hadn't lived my life to the full then as much as I do since. Most times it really does depend what is wrong with you whether you are worth saving, and indeed whether YOU want to go on.
Jill Jackson, Brighton

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

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