Monday, September 17, 2007

Pursuing a rational death

I have been reading about death. It is something that interests me. I am not concerned with those unfortunates associated with a death – doe-eyed friends and relatives who might love you and even mentally put you in your coffin before you are ready to expire. Nor am I concerned with those who will grieve for you when you are gone. There is plenty of literature for such people, such as Kubler-Ross. Nor am I concerned with those suffering terrible pain who might welcome death, perhaps in the form of euthanasia, as a release.

Nor am I concerned with those who hold the religious view that we will go into a glorious afterlife. After all, I am an atheist.

No I am simply concerned for the fairly non-religious, intelligent person whose time is up and who knows it but who wants to live. Those who will cop it. To distinguish the particular situation I have in mind – trivially we all face the fact that eventually out time will be up – I want to suppose that an individual is told by a medical expert who has perfect foresight of their imminent demise that will occur in exactly one-hundred days. What is the individual’s best response to this information?

When the announcement of approaching death is made to lung cancer victims the first reaction is often denial – see Johnson (2001). It won’t be me! It can’t be me! This can be followed by anger that the person is being taken too soon or being taken unfairly. This might in turn be following by a period where the person bargains with God or physicians for more time. When the bargaining fails this might be followed by depression and sadness because bargaining has failed. Finally, the person might just accept that death will occur. Of course all these things might overlap and possibly repeat – it will not be a simple linear emotional experience. These five stages comprise the Kubler-Ross death-stages model.

Economists assume that rational agents maximise the (possibly discounted) aggregate value of joys over their lifetime which seems to me about as sensible a criterion as I have seen. This suggests that the move to passively accept the inevitability of death – rather than worrying about imminent death – is a rational way of dying. This is easier said than done in a society where the reality of death is a seldom discussed taboo. But accepting the inevitability of an inevitable death is a reality-based view of things and seems better than applying one’s energies to grieving about the prospects of dying.

Being quick to accept the reality of death might be thwarted by well-intentioned dishonesty from friends or doctors who themselves feel discomfit about a departure. This can be countered by pointing out the residual benefits of honesty in this situation for the residual optimiser.

Indeed, as the final stage of life approaches making sense of death might become an imperative one wishes to share with friends. It is an important experience and one seeks to understand it.

This will be difficult if friends and loved-ones have lower acceptance of death than you do. Again you can thwart this by stating – perhaps falsely – that you have had enough and want to die.

Talking to children is difficult since children may transform their love for you into anger on the grounds that you are leaving. Of course you need to affirm that you do love them and would not leave them if you had the choice. The dilemma here is a particular case of the general issue that many facing death need the permission of those they have left behind to die. A gesture of letting go by the family can, in fact, induce a welcome death.

Dying people often withdraw from the living as physical weakening occurs or because of changed spiritual or emotional needs. People sense that those who have died are seeking to communicate with them. They may also dream of those who have died.

Many facing death are curious about the process of death itself. I have observed the death of a dearly-loved one and it seemed to me unpleasant for the person dying. The person concerned drifted in and out of consciousness and seemed distressed. But those who have experienced near-death experiences do not remember great distress at this stage. It is an unknown.

Just before death – the ‘agonal’ (death rattle) stage – muscle spasms might occur with large gasps for breath, breathing that starts and stops, heaving of chest and shoulders, a single deep exhalation, various vocalisations and noisy breathing. All muscles relax – including the bladder and bowel – though waste will only be discharged if food has recently been eaten. And then that is it.

Accepting the inevitability of death by the person facing it and by those surrounding this person seems to me to provide the basis for a rational exit. You enjoy the time that is left and then when death approaches closely you experience what is a unique set of experiences.

I’d be interested if others think otherwise and am also interested in other non-religious discussions of this topic. The thoughts above are provisional and likely to be revised.


Steve said...

Well, that post is far from a cheery way to start the day! I hope this is not inspired by your own state of health...

I actually am not entirely sure of the point of the post. I didn't really think anyone (religious or not) would dispute that getting to the point of gentle acceptance is ideal; the issue is how do you get there.

Do you think people can overcome the early Kubler Ross stages by force of their rational mind alone? Because I expect that this is one area of experience, perhaps like falling in love, where the rational and emotional get all so mixed up it is not within anyone's control, even though that lack of control may be recognised on one level of your mind as irrational, or not how you would have wanted to respond.

That said, a simple recognition of the likely stages of the process presumably helps in a way, but it is still somewhat like a smart person with a psychosomatic illness: they may know it is a "phantom" pain, but it lingers nonetheless.

hc said...

No my health is fine. Agree on your second para and think your point is sound regarding limitations of rational mind.

Death seems to me a taboo I would like to explore. This is a first post - I might have another shot with your thoughts in mind.

hc said...

Steve, On thinking about your question. Why should thinking about death be a morbid thing? It happens to all of us. As a corollary why should be wait until we are 'threatened' by death to think about it? I am asking myself these questions as much as you.

I agree that the emotional side of things is powerful. But if you have a great fear of something can't you deal with this at least a little by recognising it, exposing it and discussing it?

Steve said...

Harry, it is hard for me to discuss this at any length without bringing religion at least partly into it, even though I know you don't want the discussion to go too far into that field.

However, I think it fair to say that Christianity has for most of its history been more than happy to have people constantly aware of death coming. (I remember one or two nuns when I was in primary school telling some fairly gruesome accidental death stories, with the clear purpose of reminding us to be good Catholics every day because you never know when your judgement is coming.)

The emphasis on this in catholicism has now gone, with (I suppose) people thinking that this was a morbid way of scaring people into good behaviour. But at least, I think, it did bring the reality of death to the forefront of people's minds perhaps in a much more regular way that non churching people experienced. My point is that I think it likely that the irreligious probably find it easier to avoid early consideration of death, and are more likely to label an interest in it as morbid.

On a related point, Phillip Adams likes to claim that the religious, including clergy, often have a crisis of faith when faced with their own death, and do not as a class necessarily handle it any better than the irreligious. I think his evidence is, however, purely anecdotal, and in fact I wonder whether there is proper research on this.

There was a show on Radio National's Health Report earlier this year in which an Australian palliative care doctor read extracts from his book about his experiences. I think that what he spoke about is very much along the lines of your interest. (He is Catholic though, although religion did not feature much in the interview.) I am sure you will be able to find it over at the ABC website.

hc said...

Steve, You are right - religion almost inevitably enters the discussion because religion is concerned with giving meaning to life in the face of death.

I was bought up a Christian and taught that hell was punishment for a bad life which later became liberalised to the idea that you just didn't get to go to heaven.

Every religious believer has crises of faith but if faith is an endogenous response to life's problems one might expect belief to become firmer if threatened with death. People might still experience fear but they might anyway.

Anonymous said...

Enemy Combatant aka Fuzzflash sez…

Harry, that’s a great piece of intellectually and emotionally honest writing. Saw E.K- Ross when she lectured at Sydney Town Hall in the early eighties and was mightily impressed with her dancing eyes, idyllic manner and her tales of “when the butterfly leaves the coccoon”.

My death, the only one I’m qualified to talk about, is my own. It doesn’t belong to any church or state or profession or trade. These organisations are riddled with high-powered control freaks who come on with with “loved one” platitudes and ALWAYS an eye for their slice of the action.

My partner and children know that I love them because I hug and kiss them at least twice a day and mean it: before leaving home in the morning and before we retire each night. Sometimes I say “I love you” and am never(or very rarely) denied the rejoinder. Mercifully serious blues are uncommon chez Fuzz. To love and be loved by them is more precious than platinum, or all the tea in China, as my dear old Granny used to say. Yes. Gold is where you find it.

My wishes are straight-forward. In the event of a debilitating accident or sudden illness(eg stroke, coma), if the lights are on and nobody’s home, switch off the machines that go beep...beep....beep. No ifs, no buts, just do it. If I can no longer get myself to the dunny or the kitchen, or down the road for a Johnny Raper and an espresso, a rave and a belly laugh, then that’s it. My call. Game over. So in the event of being permanently bed-ridden, having said my sayonaras, I shall procure a syringe and some H.K. No.4 and bang-bang Maxwell's silver hammer down myself.
When the time comes, if I can’t score smack, then nembutals and Chivas will do fine. My family know and respect my decision. Forget about hospitals and nursing homes and palliative fucking care and the long, slow ebb. We are the progeny of Great Apes, proud and free. We possess an aesthetic as well as a social sense, and we deserve to die actively, rather than cowering in fear and pain and at the mercy of strangers. Without the benefits of a first-world modern “lifestyle", most of us would have died before we got old anyway. "Why don't ya all f-f-f-fade away" was never an option.

Fear is used by churches (and some states) to persuade gullible people that there is a “correct” way to die (as well as live). As a fellow atheist, I’m not persuaded by their epistemological Ponzi schemes and like you H., am beyond their command.

There was a wonderful program on SBS or Auntie some years ago that compared the way that elderly people die in Palm Springs CA, in an Irish county village and in a teeming city in India. Next time you blog on death, Harry, I’d like to chime in with a few observations.

Every night before bed, I take a slash near the lemon tree, look up to the firmament and am awed by its splendour. Each morning, like the human beings in “Little Big Man” I smile, greet the day and confront my mortality with the thought,
“Today is a good day to die”.
Then I live and share it ‘twere my last.

No Fear!