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Let’s Talk About Death (Part 1)

So, did the title surprise you? Were you slightly put off? Upset, maybe? Well, this is deliberate. In today’s world death and dying have become such a taboo subject that we can hardly use the words in public! Certainly in Tobago where I live, people “pass” or “pass on” or are even “no longer with us”, but very few seem to die. I do not mean to trivialise such an important and emotive issue, but simply to draw attention to the sea change in our views on death over the past few decades, and the difficulty such a ‘hands off’ cultural mindset causes when trying to explore this topic.

As an Emergency Physician, I have spent my whole life around death and dying. Of course, my main job is to prevent this outcome in the majority of patients, and much of our training goes into this. But the fact that, despite this, all Emergency Physicians have a far closer relationship with death than many of our colleagues tells us that the situation is not as black and white as we might want to believe. So, let’s talk about death, confront our own views and ideas and see if we can rethink the role of death and dying in society and in our own lives.

Death, while distressing and sad, has always been understood as a normal part of life, by most cultures and societies. The uncertainty of what lies on the other side of this most momentous life event has led to the development of many philosophical views, and is a major driver of organised religion. Many of these religions offer “life after death” as a sort of carrot to encourage conformity on this side of the bridge. However, over the past few decades, death has slowly been transformed from a normal part of life to a taboo, spoken of in whispers, if at all. How did we get here? What should we do? There are no ‘right and wrong’ answers to these questions, but I will share my own thoughts, if only to get you to confront your views on life, death and dying.

As a population, our current views on death and dying have been heavily influenced by the medical profession, which has not always clothed itself in glory where this is concerned. Just a few decades ago, you were more likely to die in your own home, without the ‘benefit’ of cardiopulmonary resuscitation. However, over the decades, our advances in medical technology and resuscitation medicine has meant that a majority of people now die in hospital and will be subjected to CPR, whether this is appropriate or not. It seems as though advances in medical sciences have not been paralleled by appropriate developments in medical ethics. Worse yet, most doctors (apart from a few exceptions, such as Emergency Physicians, Palliative Care Specialists and Oncologists) find it difficult or impossible to discuss death with their patients in the cold light of day, and seem to think that this discussion is inappropriate in the heat of resuscitation. For most doctors and their patients, therefore, any discussions of and planning for death are truly taboo. How did we get here?

In fact a lot of the current thinking on death and dying has been driven by medical education which has for some time advocated the supremacy of life at all costs over the need to balance patient’s wishes, quality of life or other factors. While this is slowly changing, the overall philosophy of ‘life at all costs’ still holds sway in the medical profession and among patients. With this as a starting point, it can be very difficult to discuss death in any meaningful manner with patients and their relatives.

On top of this, medicine has been portrayed in the media and among some in the profession as omnipotent and infallible. Most lay people expect that, no matter what the ailment, medicine will cure it. With this mindset, there is no need to consider any other outcome, and certainly not death!

The present taboo around death goes beyond the medical profession. One of the things that confuses me is the position of organised religion on this topic. Many religions, including the majority of Christian denominations, take the view that life must be preserved at all costs. How does this square with the promise of life after death and an eternity in paradise? Surely if this is our final reward, then there should be no fear of death, and no reason to cling to life unnecessarily. Many religious leaders point out that “death is final” and when we allow people to die, we are “playing God”. However with the advances in medical practice, maybe the opposite is true. Given our current state of medical practice, we have technology can keep alive seriously ill people who would certainly have died in its absence. And to what end? Some of these people have no prospect of an independent or even sentient life given their illness or injuries, yet we keep them alive. In this context, who is playing God – those who would let nature take its course, or those who would engage the full force of technology to prevent this, despite no realistic end-game?

Finally, scientific advances have brought the possibility of eternal life that much closer to reality. With this in mind, the media, some scientific experts and some sections of the wider population have now clung to this as a “holy grail”. But why would we want to tie our existence to this stage of life for the rest of eternity? Is it that we truly believe that life on earth is so ideal that we never want to move on? Is it that we have no faith in what is to come after this life? Or are we so afraid to take the onward step out of this existence, that we are willing to trap ourselves in it forever?

 

When we seek to talk about death it is important to understand the environment in which we are having that discussion. In this blog, I’ve sought to show how difficult it is to talk about death and dying, while explaining how we got here. In the next blog, I want to share with you my own views on this issue, and get you thinking about your own position on this – I hope you will join me then!

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