With the End in Mind

What would happen if we ever ‘found a cure’ for death? Immortality seems in many ways an uninviting option. It is the fact that every day counts us down that makes each one such a gift. There are only two days with fewer than twenty-four hours in each lifetime, sitting like bookends astride our lives: one is celebrated every year, yet it is the other that makes us see living as precious.

It has become taboo to mention dying. This has been a gradual transition, and since we have lost familiarity with the process, we are now also losing the vocabulary that describes it. Euphemisms like ‘passed’ or ‘lost’ have replaced ‘died’ and ‘dead’. Illness has become a ‘battle’, and sick people, treatments and outcomes are described in metaphors of warfare. No matter that a life was well-lived, that an individual was contented with their achievements and satisfied by their lifetime’s tally of rich experiences: at the end of their life they will be described as having ‘lost their battle’, rather than simply having died.

Reclaiming the language of illness and dying enables us to have simple, unambiguous conversations about death. Allowing each other to discuss dying, rather than treating the D-word as magic ciphers that may cause harm merely by being spoken aloud, can support a dying in anticipating the last part of their living, in planning ahead in order to prepare their loved ones for bereavement, and can bring the notion as the thing that happens at the end of every life back into the realm of the normal. Open discussion reduces superstition and fear, and allows us to be honest each other at a time when pretence and well-intentioned lies can separate us, wasting time that is very precious.

Working in the reality of day-to-day dying, many of us in palliative care roles are exasperated by the trenchant black-and-white opinions of the campaigners for either view [life/care and death/euthanasia], when we know that the reality is neither white nor black, but a completely individual, ever-shifting shade of grey for each person. The missing perspective on both sides of the debate is the reality of human dying, the unexpectedly gentle progression towards death that most of us will experience, whatever the trials of the preceding terminal illness.

Looking beyond the immediate situation offers us all a richer perspective, and enables the dying to focus on what is most important to them, whatever other ideas the rest of us might have.