We need to talk about death

 

‘In this world nothing can be said to be certain, except death and taxes’. So wrote Benjamin Franklin in 1789, ironically only one year before his own passing. The topic of mortality is one that has become especially pertinent topic during the coronavirus pandemic, and it does not generally sit well in a society so determined to avoid the subject. The general feeling is that life is good and death is bad, and must be prevented no matter what. We cannot believe our friends and family will not live forever, because life without them is too jarring a thought for us to contend with. Back in the day we would have seen death and lived with it in a way we no longer feel able to do so. The wonders of modern healthcare are of course an improvement on this, but is it possible we have lost something in the process?

Keeping someone alive at all costs is not always the kindest thing to do, in fact in some situations it is nothing short of cruel. Terminal illness, the losses that become more and more frequent, and the difficulties of old age are for many the signals of acceptance that their time left is short. Yet this does not have to be a painful realisation. Dying old is not a tragedy – by that I don’t mean it is not a sad event. It is the natural end to a life well lived, it is indeed simply an inevitability. We should be grateful that our elderly loved ones had the opportunity to spend several decades with us, rather than seeking to extend their time to its absolute maximum. What purpose does that serve? If we were being honest it is a selfish one, an idea generated by fear of the unknown rather than a genuine respect for what it means to lead a good life. We have the right to grieve when we lose someone dear, they in turn have the right to feel uncertain or anxious about the end, but a dignified and comfortable death is a gift rather than a curse.

Reaching old age is a privilege, and it should be treated as such. A recent scandal following the coronavirus outbreak was the order given to 1 in 10 care homes to impose a blanket Do Not Resuscitate (DNR) order on residents, without the families necessarily being aware of this. There are of course questions to be asked here, especially as to why this was applicable to all care home residents including the cognitively impaired. However, there is something to be said for not giving CPR to more elderly patients. It is rare for anyone to survive CPR - in fact only 10-20% of people recover sufficiently to leave hospital, and that figure drops to less than 5% when the patient is old and extremely sick. Plus we must bear in mind the quality of life that person will experience having gone through such a procedure. Pounding on the chest can cause serious internal injuries, and the older someone is the less likely they are to recover from the effects of a cardiac arrest. Leaving someone to die when intervention is possible at first appears callous and even sadistic, but what reason is there to keep someone alive in that situation? What are we waiting for? Happiness does not come with quantity, but rather with quality. It is often not possible for us to choose how we go, and it is hard to imagine that being plugged into every hospital machine, with no power or control over what happens to you is a desirable fate. 

Yet it is rare that anyone in our society will admit to this. Even when the terminally ill express their wish to be left to die in peace and comfort, there are families who will fight against this. They forget that the first duty of doctors, nurses and other hospital workers is to the patient and what they believe to be in their best interests. And this is the way it should be. Treatment is available where appropriate, yet it is not an infallible solution. In our efforts to conquer the world we fail to realise that no matter how many life-saving treatments we develop or earth-shattering bombs we use to wipe out entire populations, the power of life and death will remain largely out of our hands. Years ago we would have seen death and lived with it in a way we thankfully no longer have to - is this why we now struggle so much to process it? One thing we should remember is the time we have with each other is precious, no matter how long that is and we should treasure it in the best way we possibly can. Respect for quality of life must play a role in that, and respect for the wishes of the individual. Fight when you must fight, and show dignity when you have no other choice, and let that be the strength that we all must draw on. Because death is scary and painful, but it can also be a relief at a time when life is no longer a happy and comfortable place. Grief and loss is a difficult yet fundamental part of the human experience but at least it is a shared experience - whatever happens we will always have each to lean on.