Living with death and dying
Living with death and dying

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Living with death and dying

1.4 The quality of dying

1.4.1 Choices in dying

An enormous diversity exists in the way people view and approach death and dying. This diversity continues to be evident when people are faced with the knowledge that their own death is approaching. There is no standard, correct or even best way of dying. Yet there is a concept of a ‘good death’ which will be addressed in this section. As a course team we are somewhat ambivalent about the usefulness of the phrase, but we retain it largely as a reminder that there are important issues to be borne in mind relating to the quality of dying. We all feel the urge to improve the quality of dying and recognise that this involves allowing people the opportunity to die in a way that is acceptable to them and is consistent with the people they are.

It is worth noting that there can be tensions between different views of what constitutes a good death, because it is not just the person who is dying who is affected: other people also share the experience. It may be inevitable, therefore, that some sort of negotiation and compromise need to take place in how individual deaths are managed. Bearing that in mind, we aim to relate the analysis of ‘a good death’ to individual needs.

Most of us give little thought to the manner in which we would like to die (perhaps because most of us would not like to die). The following activity is designed to encourage such reflection and discussion. It is not meant to be taken too seriously and may, if you wish, be omitted.

Activity 6

Consider the following statements about what might constitute a good death. What would you most like for yourself? What are the top three priorities? If you are in a group, explore together why you chose the answers you did.

  • I want to die in my own home

  • I want to die in a hospice cared for by people who understand how to make me comfortable

  • I want to have someone religious with me at the moment of death, praying for me

  • I would hate to be on public view and want to have privacy

  • I want to die quickly

  • I want the opportunity to say good-bye to my family

  • I would hate to live to be very old

  • I want to live to a good age, as long as I have my faculties

  • I want to die in my sleep and know nothing about it

  • I don't want to die in pain

  • I want to die in solitude

  • I want to be ready when the time comes

  • I want to be with other people on an open ward, and not hidden away

  • I want to be very alert, even if this means being in some pain

  • I want to be ready and accept death when it comes

  • I want to be able to die as the person I am and be accepted for that, even if I’m angry, or in denial

  • I don’t want anyone religious around, nor do I want any religious ideas expressed

  • I want to be able to plan my own funeral.

Discussion

Were you surprised by what you wanted for yourself? Perhaps the activity felt rather unreal because, as one of our course testers commented, ‘it would all depend how I was feeling physically, what I was dying from, and whether my life was going well or not at the time I heard I was dying.’ In a way, you don’t know ahead of a situation exactly how you will respond and what you will want.

Tom Scott, the former administrator of Strathcarron Hospice, identified the companions he would like to have with him when he died. Since writing this, he has died and we hope his death was as he wished.

If I try to imagine myself with just a few months I think I can describe the kind of people I would like as my closest companions.

  • People who will somehow be there when I need them without making their presence felt all the time.

  • People who by the way they are will give me space and time, who will not crowd in on me, or try to move my thoughts onto other things because they find my thoughts difficult to take.

  • People who are safe to be with and with whom it is safe to be myself.

  • People who will tolerate my moods and tears and who will have the wisdom to know when to leave me in my moods and when to rescue me from them.

  • People who will let me take the lead, choose the path, set the pace when I can and who will lead me when I need to be led.

  • Someone most special with whom to say ‘Goodbye’ and ‘I love you’.

But there are other people whose particular knowledge and skills I may need and want. They may come in and out of my life to do practical things like a doctor or a nurse, a bank manager to discuss financial matters, a solicitor to help in the making of a will. So there will be personal companions and practical companions, and sometimes companions who are both.

(Scott, 1990, p. 29)

We cannot anticipate exactly how those close to you will respond and what kind of support they will be able to offer. We can, however, learn a great deal by looking at the responses, actions and decisions made by others as they approach their death.

The following responses come from care staff working in residential homes for older people. They are of mixed age, background and professional experiences. The exercise was part of an awareness raising session, in which staff were asked to consider the manner of their death.

  • I want someone to sit with me, quietly.

  • First and foremost I don’t want to die in pain, and I want my family to be with me.

  • I’d like to feel at peace and have someone I know and trust with me.

  • I want someone to sit with me and read to me.

  • I hope I’m prepared, both spiritually and emotionally, and that I’m somewhere safe and warm.

  • I’d like someone to take over the things that really matter to me now, like putting on my make-up, doing my hair and plucking my facial hairs.

  • I don’t want a minister of religion present when I die, but I do want someone to read the bible to me as I am dying.

  • It’s really important to have privacy and I want someone to do that for me, keeping strangers away and making sure my body is covered.

  • I should hate to have a crowd at the bedside waiting for me to die. I want to be with someone who loves me.

You may have noticed that no one put suicide on their list, although you may possibly have thought about doing so. The term ‘suicide’ is a contested one, which carries strong moral connotations. It is important to recognise that making a choice to kill oneself is understood differently in different contexts and reflects varying degrees of stigma. The traditional Christian-Platonic view tells us clearly that since we do not own our own life we do not have the right to take it. How we view suicide has changed over time, and our judgements are framed by the historical and cultural contexts in which they are made. Perhaps many people would be sympathetic about the suicide of someone dying from a seriously debilitating illness, and not judge this as morally wrong. Likewise, some deaths are viewed as heroic, particularly those constructed as acts of self-sacrifice. It is probably less easy to view suicide sympathetically when someone is in good health and does not appear to be in a situation that is unresolvable. There are ethical issues surrounding assisted suicide and euthanasia but at the moment it is worth noting that ‘assisted’ deaths are thought desirable by some people and totally abhorrent by others and that there are many cultural, social and personal factors which influence these judgements. But when we talk about the choices that we make about the way in which we die, we need to recognise that we may want to be in complete control of that choice, and it could be argued that deciding the time and manner of one’s own death is the only way to do that.

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