These days we humans have a very strange relationship with death.
Death used to be an everyday part of life. Child mortality rates were very high and adult mortality rates were not much less. Most people died before the age of forty and a great many of those perished before even reaching puberty. Bacterial infections and viruses and everyday mishaps all carried people off, while the rest went on with their lives and hoped their supplications to whatever invisible deities they believed in would magically keep them safe.
Because nothing else could.
As a by-product of the Industrial Revolution and sinful Capitalism, the 20th century changed everything. Antibiotics cut death rates by orders of magnitude. Vaccination programs likewise caused the mortality rate to plummet. Better health and safety awareness slashed workplace accidents and slowly a similar mentality began to reduce household accidents likewise. Eventually cigarettes were priced out of the common pocket and so lung cancer and emphysema deaths began to decline. A parent living in 1970 would expect all of their children to live to adulthood; an expectation never before possible in human history.
Meanwhile we moved death into remote hospital wards. Today the average US citizen fondly imagines they will have a TV death: peacefully lying in bed at home surrounded by loving friends and family. In reality 94% of US citizens will die alone, confused, and afraid in an anonymous hospital bed. Most will die after long protracted illnesses in which all the marvels of modern medical technology will be employed to ensure their pointless suffering continues for as long as possible.
The situation isn’t much better in some European countries, though for the most part Europeans have a more healthy acceptance of one’s ultimate fate and avoid the horrors of the US medical system, which is designed to maximize hospital and doctor revenues rather than to provide suitable palliative care. And there is no equivalent of the Lancaster Protocol in the USA for the absurd reason that giving morphine to a dying person to alleviate their unbearable pain would be to risk the patient becoming… a morphine addict.
So I think it’s long overdue that we face up to the Great Unspoken and accept that each one of us is, not merely conceptually or abstractly but actually and ineluctably, going to die.
For every single person reading these words there will come a last second of life after which death will supervene. And while many choose to run away and hide under the metaphorical blanket of childish myths about souls and heavens and happy hunting grounds, the reality is that we cease to exist. Just as we weren’t here before a sperm and an egg fused and we incubated for 9 months, so we aren’t here after we cease to struggle against the second law of thermodynamics. Entropy always wins, and death is merely one example of how it does so.
As we’re all going to die, it makes sense to think about taking responsibility for our demise because we are expected to take responsibility for everything else we do. Instead of playing make-believe and acting as though it won’t happen, we can use the inevitability of death to focus our lives.
A great many people seem to sleepwalk through existence, unaware of how precious every second is. If we really understand the fact we’re going to die, we may be more inclined to treasure the moments we have and be less inclined to under-value other people’s lives. We may be more inclined to try to make a positive difference with the fleeting moments we have been granted by random chance, rather than passively drift along as little more than flotsam.
And as health care systems everywhere are under impossible stress because demand is infinite but resources are always finite, a more coherent approach to death could remove much shameful wastefulness as is seen in the USA where 50% of one’s total lifetime health care costs will be incurred in the last 18 months of life: an 18 months mostly spent in abject misery.
I personally believe that instead of surrendering agency with regards to our own death we should accept it as just another responsibility.
Of course, some deaths don’t fit themselves to our convenience. Some will be killed by accidents, some by illnesses that strike regardless of the lifestyle choices one has made. Life will always be to some degree unpredictable. That does not, however, invalidate the proposition that for most people death is in fact very predictable indeed. Actuaries have been doing so with significant accuracy for over a century and doctors can look at certain indicators and be very confident about the approximate time period in which death will supervene.
So let’s look at the facts of death.
Do we really, truly, want to play let’s-pretend until we end up, as 94% of people do, alone and in pain and confused and afraid, in an anonymous hospital ward in which we’re nothing more than a transient nuisance for medical personnel who’ve seen thousands before us die and will see thousands more after we’ve gasped our last agonizing terrified breath?
Sure, you’ll always find someone who claims their Auntie Edna died peacefully in her sleep without experiencing any distress at all in the preceding months, but 99% of the time these claims are just mental shampoo employed by the teller to avoid facing up to the facts of what really happened.
There is a peculiar reticence to talk about managed death. Suicide is the last big taboo.
Most legal systems take the absurd position of criminalizing suicide. One can imagine the dialog in a courtroom after someone who’s attempt has failed is tried, found guilty by an outraged jury, and then sentenced by an outraged judge:
Judge: “Mister Robert Stanley D’Arcy Peebles, you have been found guilty of the heinous crime of attempting to end your own life by means of suicide. This Court therefore has no choice but to sentence you to death.”
There are two principle types of suicide. The one we do talk about sometimes, sotto voce, is when someone who has reached the end of their ability to deal with endless pain takes the only option remaining to them. Most people then tell themselves fairy-tales like, “If only she’d asked for help,” or “If only he’d taken his medications.”
The desire to pretend death can be avoided is very strong. We fabricate nonsense in order to avoid having to think about our own inevitable death.
There are people who suffer from terrible persistent depression that robs them of their ability to feel joy while crushing them under a blanket of despair. Depression can utterly rob a person of their sense of self, until they regard themselves as nothing more than a burden — a burden suffering unbearable agony. Those who have the fortitude to persist with life despite being tormented in this way are few and far between. For anyone who wants to try to understand what real dark unrelenting depression is, Kitty Hannah Eden here on Medium has written many excellent articles and her personal fortitude is astonishing. Many lack her inner resources and it is no wonder that many choose to end their pain in the only way they know how. One should feel tremendous compassion for those who choose this path, for they were suffering beyond our ability to comprehend.
But an increasing number of suicides aren’t driven by despair but rather by calm rationality.
A significant number of intelligent well-informed people rightly regard the modern way of death as an abomination and opt to end their own lives in order to spare themselves and those who love them the unnecessary horrors of a long-drawn-out gradual decomposition as doctors and nurses perform their obsessive and totally pointless actions. Sherwin Nuland’s How We Die is an excellent book for those who want to understand how we arrived at the ghastly modern mode of death and why an increasing number of brave people are sensibly opting out.
Although the law is always far too slow to change, and although many people remain in denial about the inevitability of death, my own belief is that we need to return to an acceptance of death as the inevitable consequence of being alive.
Being alive is an astonishing gift. A different sperm at a different moment would have resulted in an entirely different person. Each of us is a product of chance. We get a few moments of semi-consciousness in which we can discover the richness of the world we live in and, hopefully, contribute in some way to things being a little better today than they were yesterday. What better way to honor this gift than to treat the end of life with the dignity and grace it deserves, instead of shutting it away in a hospital and pretending death is a sad consequence of not-quite-enough medical intervention?
At the age of eight I realized with absolute clarity that no matter how many years and months and weeks and days and hours and minutes and seconds that lay ahead of me, a final second would arrive and after that my existence would be over. This realization has motivated me my entire life: I’ve grasped opportunities, taken chances, and whenever possible tried to help others and make some positive contribution while I can.
When the quality of my life has reached the threshold I predetermined a long time ago, I shall with a certain serenity do what is necessary to end my life. I shall have the opportunity to tell those I care about how much they have meant to me; my affairs shall be in order. I shall choose a place that gives me great pleasure and where my demise will inconvenience no one.
And then, in the gap between one second and the next, I shall cease to exist. By taking responsibility for my own death I shall spare those I love the pain of watching me slowly disintegrate under the well-meaning but absurd ministrations of healthcare professionals. I shall spare myself the horrors that our modern way of death practically guarantees.
It is better to leave a little early than to hesitate a moment too late. And so I shall die, alone and content, looking back on a rich and full life, knowing that I have spared those I care for and have likewise spared myself. I shall die as I’ve lived: without illusions, without false hopes, and without regrets. No intelligent person wants to die, but accepting that we must die and deciding to do it as well as possible seems to me the only coherent option.
Mine shall be a satisfactory demise.