1.4.12 Bad deaths
What about the other end of the spectrum? What constitutes a bad death? Is there less contention about what constitutes a bad death? Extreme pain and discomfort, humiliating dependence and being a burden are obvious, but what about being alone? Many people say they fear dying alone but there are others who would prefer it. Sudden, unexpected deaths are clearly bad for those left behind but are they also bad for those who die in such circumstances? Sudden unexpected deaths used to be considered bad deaths because there was no opportunity to prepare or atone for past sins, but now many people would choose to die in this way.
Cartwright et al. (1973) identified groups of people who they considered were more likely to experience a bad death than others. Among them were elderly people living alone and young people with a terminal illness.
Two such deaths that they describe in their work seem clear candidates for the epithet ‘bad death’.
A man of 84 was said by his landlord never to be ill – ‘He lived at the top of two flights and was never even out of breath. I woke up in the morning at 5.30. I didn’t see him the night before and for some reason I felt uneasy about him but there was no reason. It so happens that another person living in rooms here heard a bump about 8.30 the previous night but thought nothing of it. About nine in the morning I got my nephew to go up and see if the old man was all right and found him dead on the floor’ (cause of death on the death certificate given as purulent bronchitis and old age).
(Cartwright et al., 1973, p. 40)
The second was a grandmother’s account of the death of a 17-year-old boy who died of cancer.
He didn’t want his pals in the end. They used to come and talk about what they were doing outside. He just couldn’t stand it. He died at home, five weeks after being discharged from hospital.
(Cartwright et al., 1973, p. 62)
In an article called ‘Not going gently’ an East End GP, David Widgery, describes very graphically the adverse effects of socio-economic deprivation on the quality of dying, particularly in the following passage.
[H]ow death is observed, the respect or otherwise human bodies are afforded, surely marks a measure of our degree of civilisation. In one week the local paper reported four East End deaths which were last exits of horror and neglect. A hospital porter in his fifties lay in a filthy local pond because ‘the locals thought it was a bag of rubbish’. A Stepney pensioner was found dead only after a neighbour complained of a smell coming from his door. A Poplar widower hanged himself with a tie and a Hoxton man died alone of hypothermia after falling in his bedroom. Earlier in 1990, a 91-year-old demented man lay dead in the grounds of Hackney Hospital for three weeks before discovery. A 67-year-old Clapton man drowned in a pool of roadside water that had developed when sewers had become blocked with mud and litter. During the 1989 flu epidemic, some of the Borough of Hackney’s old people’s homes were reported as being damp and draughty with a shortage of towels and sheets, intermittent hot water, dirty toilets and uncarpeted floors.
(Widgery, 1993, p. 19)
Few would argue that these constitute very bad deaths but defining precisely what constitutes a good or bad death is fraught with difficulty. However, if we are committed to improving the quality of dying, then we need to find some yardstick.