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.