Opinion Articles

Debating the ‘good death’:  a long view

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‘Death had a thousand doors with which to let out life’ in Britain before the twentieth century. It was ubiquitous and immediate, taking place in the presence of family, friends and neighbours; and patterns for handling it impressed themselves on generations around the deathbed. Although the semi-public ritual of dying varied down the centuries, especially between Catholic and Protestant, it was, nonetheless, structured by prayers, scripture readings, usually a final communion. There was a formal leave-taking, a settling of accounts not only with neighbours but also with God, whether inwardly or through confession.

Modern death is different. It is sequestered in hospitals. Deathbeds are sparsely attended; the corpse is rarely viewed, the dead person remembered not dead but alive. These contrasts are a commonplace. But modern responses to death are an evolution of, not a departure from, earlier sentiments. Even when death was ever-present, churchmen worried that many postponed their own preparations and did not think enough on their own deaths. The very abundance of literature from the fifteenth to the nineteenth centuries about how to die well sprang from the need to teach the art; the profusion of macabre imagery in the middle ages bore witness to the need to shake people out of denial. The impulse to push death away is a deep one; modern cultural and medical conditions have simply realized more fully our ancestors’ ambitions.

Developments in palliative care and shifting cultural attitudes to pain in the late nineteenth and early twentieth centuries were elements in a cluster of changes which facilitated this. Suffering ceased to be a God-sent trial but a natural phenomenon that had to be managed - with increasing effectiveness - with opium and alcohol. The idea of pain as a thing to be endured with fortitude made sense to fewer people in a world equipped with more effective analgesic resources and so the ‘good death’ was re-invented. No longer did it require that one’s dying be lived, alert and responsive to ritual. It could be, might best be, a sedated slipping away. The unprepared death - once among the worst of deaths because it robbed the dying of a chance to make ready for God - could now be a good death too. Not only growing numbers of atheists and agnostics subscribed to such views. A shifting sense of salvation, more inclusive and superintended by a less vengeful, less punitive, God, smoothed a similar change of sensibilities among many who were religious.

At the same time, and more especially during the second half of the twentieth century, growing diversity of religious and irreligious views fractured the consensus about what to think about death and what to do around the dying. The twentieth-century ‘turn away’ from death arose from this disorientation and from something more. The century saw the extension of human control in many fields which impinged on the making and taking of life. Most saliently, medical advance made the prolongation of life possible. But scientific innovation and social change also altered the answers to related questions about contraception and abortion, suicide and capital punishment too. In the midst of that change the ultimate realities of the deathbed were resilient. This encouraged a silence, a sequestering of modern death, what some have called the twentieth-century taboo.

We might think that the taboo is now broken. As in the middle ages villagers gathered at the deathbed, so in our post-modern age a global - or at least a national - village can gather at a deathbed thanks to documentaries or internet clips that let us into the ends of lives. These deaths - immediate but also filmic, detached - are especially visible in the context of the debate about the right to die. And that this debate has become such a prominent way in which we talk about death - perhaps the means by which the taboo about death has been broken - is striking. For we are ready to talk about the right to die of those who no longer wish to live but we are less comfortable contemplating those who face death and fear to die. We do not talk about the terrors and existential anxieties of the deathbed and how these are to be managed in a ‘post-Christian’ culture.

There is a sense in which the debate about ‘the right to die’—vital as it is— is the debate about death that we are prepared to have. There might be other debates about dying – the psychologically as well as physically painful ways in which some people die – that we need to have too. The connection between these two things – what we want to talk about and what we do not want to talk about – might be agency, control, the idea that as we control and shape life, and hold death at bay for so long, we can elect to die at a moment of our choosing, when we are ready. And we talk about this in the languages of law and medicine, those most powerful tools for control in life, seeking to shrink what early modern men and women knew as the ‘King of Terrors’.

The people of the ‘premodern’ past are not alien. Some of their reflexes in the face of death are ours. And we have successfully postponed some of their fears, first by pushing death away, then by readmitting death to public debate but only on particular terms - that do not always do justice to the full range of problems around dying. The problem of deathbed anxiety was central as people in the past embarked on ‘the dark way unknown.’ There was language, spiritual language, in which that anxiety could be talked about. There was ritual which structured the responses of those who were dying and of those who were watching at moments when words failed. What replaces that language and those rituals in a world where many affirm a residual spirituality in the absence of formal belief? What happens to those who are not ready to die, perhaps even when life has run its course? How do we best manage their end? These are questions that care professionals are sensitive to but they seldom obtrude into public debate. Taking a long view of death might encourage us to ponder them once again.

Please note: Views expressed are those of the author.


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