What is a good death? And how can we prepare for the end of life?
After realising how completely unprepared she and her family had been for the experience of companioning a loved one who is dying, Margaret Rice decided to go in search of the information she couldn’t find when she most needed it. She now regularly shares her insights at good-grief.com.au and recently released a book. Here we share a brief extract from her new book ‘A Good Death: A compassionate and practical guide to prepare for the end of life’.
Someyears ago, I sat at my mother’s bedside as she lay dying. My siblings and I were all well-educated people, but I realised we knew nothing about the experience that we as a family were just about to confront.
We had many questions.
Can we predict when someone is likely to die? (Is that even a fair question?) Is there a process that we’ll be able to recognise, a set of events, a particular order of events? And just exactly what will happean? How do we work with the medical experts? How do we deal with the non-medical issues that will come up? Is morphine used to nudge death along or is this just a myth? How does the idea of assisted death fit in with personal, lived experiences?
These questions, some of them seemingly minor, have a very big impact on the dying person and their family and friends, and how they will manage their fears. Having a little information can help a lot. But as my mother lay dying, such questions felt too simple for the busy experts, too biological for counsellors and too broad for the doctors and nurses grappling with her immediate situation.
But as my mother lay dying, such questions felt too simple for the busy experts, too biological for counsellors and too broad for the doctors and nurses grappling with her immediate situation.
I wished I’d been a little bit more curious before her life reached this particular phase, this time of ending.
We were typical of many people today, facing the death of someone really close for the first time as adults in their late forties and early fifties, although I was later to meet people who hadn’t had a close experience of death until they were even older. You’re reading a gentle, practical guide to dying.
We live in a culture that is often described as ‘death denying’. Youthfulness is idolised; the elderly are neglected. But we don’t have to be this way. Let’s take a step in a different direction, towards understanding what we’ll face, so that we can help others around us die a better death. In turn, the knowledge we gain and the experiences we have will help us when our own time comes.
Once upon a time, our involvement with death was much more immediate. When our great-grandmothers were children they watched and listened when a death occurred, little observers of their household’s dramas and rituals, an experience that was often repeated. They learned unconsciously.
They grew up knowing what it is to have someone they love die, to grieve them, mourn them, then bury them – all from their own or another family member’s house. But theirs was the last generation to grow up with such a close knowledge of death, before it was outsourced.
Today in a thousand different ways we are lucky this has changed. Infant mortality rates have dropped, death from infectious diseases is low and, at least for affluent people in the West, we are pushing death from old age right back. So now it is reasonable for many people to expect to live beyond 80, and increasing numbers are reaching a century. But of course, death is always present. Some will die early from cancers, accidents and a range of chronic illnesses.
So we have to do two things at once. Prepare as though we will live to be 100, and also prepare as though we won’t, since we don’t know for sure which of these two ends we will have. This means changing from denying death ourselves to acknowledging in a more practical way than most of us currently do, that we will die. We don’t want to be morbid and obsessed with death, but we need to know how to meet it.
So we have to do two things at once. Prepare as though we will live to be 100, and also prepare as though we won’t.
When Mum was dying she asked, ‘Why?’ And that catapulted me into interviews and reflections, in an attempt to learn more. So after Mum’s death I started listening to and gathering the everyday stories of people who had experienced the death of someone they love. I’m a journalist and a grandmother. I like to mix sleuthing to find answers to difficult questions with enjoying the company of people – including little ones – and a good cup
Shortly after I started work on this task, my brother Julian’s sudden and unexpected death in a motorcycle accident drew me further into an exploration of grief and how we manage this terrible thing called death. Interviews soothed me, kept me going, as I struggled with my double load of grief. The stories I heard were profoundly moving – but also full of clues to what people need today.
After further research, I realised that themes were emerging. I talked to experts and did a lot of reading, which I then distilled. But I noticed that some of the most helpful information came from those who were giving simple support to their own communities. This tells us something important – what we learn from experts and outsiders, we can feel confident about adapting and changing to suit ourselves and our own people. As you use this guide, keep that in mind.
We can regain the sense generations of our ancestors had, that they could help each other, those close by, to make a good death, at least in those circumstances where death didn’t occur suddenly and violently, say as the result of an accident. And even in those circumstances, we can learn to be more effective.
Death is awful. We should never get used to it. We should keep looking for cures for cancers and defying other diseases. We should keep making our drivers safer and challenging the acceptability of war. We should keep doggedly searching for ways to lead people into a rich life, so that suicidal ideas are never shaped. We don’t have to romanticise death – and I certainly don’t want to.
We don’t have to romanticise death – and I certainly don’t want to.
I’ve distilled my experiences and thoughts into eleven practical steps, corresponding to the eleven chapters in this book. You can work with these steps, then build on them to make the experience of death better.
First, we learn how to accompany someone who is dying, rather than being afraid of them and their death. Second, we learn about the non-physical side to death, including spiritual (but not necessarily religious) experiences that transform a human life into something extraordinary.
Third, we learn how to eliminate pain, because pain can prevent a good death. Fourth, we learn what death looks like, so we are able to face the death of those we love without being afraid of what we do not know.
Fifth, we learn the ‘housework’ required after death – what’s needed and what’s not, so we can let go of the person honourably. Sixth, we develop the skills, particularly the social ones, to help when a death is unexpected.
Seventh, we learn how to say goodbye. We strip away dross, to say our own authentic goodbye – so we discard and recycle, sometimes going back to the ancient, sometimes moving away from it. Eighth, we find new ways to reach out when grief strikes – for the sake of others and also for ourselves.
Ninth, we plan ahead, taking what we’ve learnt and applying practical steps, to help ourselves and to help others. Tenth, we visualise, well before we need to, where we want to die so that this becomes reality.
Eleventh, we learn to talk about how we will die, because using words will show others what we want and also dispel fear – our fear and that of others.
Images and Text from A Good Death by Margaret Rice,
Murdoch Books RRP ‘$29.99.