Growing in the midst of death

IF you had a choice, how would you like to die suddenly, without warning, knowing nothing of the moment at which the light is…

IF you had a choice, how would you like to die suddenly, without warning, knowing nothing of the moment at which the light is switched off? Or slowly, in full awareness, able therefore to take" account of the coming event?

Fortunately, this is not a question that needs to trouble any of us since no one knows the time, nor the day when the bell will toll. What we do know, however, is that present day medical science can prolong life to the extent that more people are now living longer who are ill, disabled or incapacitated in some way. In other words, an increasing number of people are dying more slowly and it is the slow death and its implications that sociologist Michael Young, assisted by Lesley Cullen, deals with in his book The Good Death.

Just as there is no such thing as simply a baby, but rather a baby and (at least) its mother, so patients have their doctor, their family and their carer - and it is this grouping that Michael Young sees as the bedrock of a community which can support the person approaching death while, at the same time, gaining something from that death.

"The person who dies in peace, with acceptance rather than bitterness," he writes, "bestows a gift upon the survivors which lasts for them, and can quiet en their own, fears."

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One of the people he interviewed for his book was 51 year old Dermot Donoghue, an Irishman living in London. Brought up in an institution, educated by the Christian Brothers and forced into economic exile, Dermot lead a solitary and lonely existence until, incapacitated by his illness, he was taken into a hospice. Once there, his life brightened in a way it had never done before. People fussed around him, brought him his meals, placed his chair in a sunny window alcove where he could read his newspaper.

A hospice nurse rang Dermot's long lost sister in the US. She arrived on the next plane and stayed with him for the last two months of his life - probably the happiest he had known - while they both tried to make up for all the years of separation.

When Dermot died, his sister had his body flown back to Ireland. The period of his dying had been a time of reconciliation for them both.

For those who fear the pain sometimes associated with a lingering death, Michael Young has a thesis to offer which challenges, to some degree, the idea of the total opiate offered by some hospices. "Some people need to experience pain in order to assess how much they can tolerate," he told me from his office on London. "It's a way of testing themselves for what may lie ahead." The practice of numbing the pain entirely takes away from a patient one of the few freedoms still open to them - the freedom to control at least a part of their lives.

And if terminally ill people are to exercise that control, then what he calls the "doctors undemocratic right to silence" must be challenged so that patients can make informed choices. People should be told what their options are, he maintains, rather than having treatments or operations imposed upon them - with no alternatives offered.

Michael Young is no stranger to death. His second wife, the writer and broadcaster Sasha Moorsom, died in London of cancer in 1993. Her illness had not been helped by hospital closures and other cutbacks in the National Health Service, an extra cross to bear for her husband, a lifelong socialist. He mourned her death greatly and his observations on the importance of grieving are of particular relevance to any culture which has become separated from its folk death traditions.

Funeral services are often rushed through, the formal name of the dead person often used instead of the one by which he or she might have been known among family and friends and, worst of all, there is little if any continuity between the dead and the living. It is this last, he says, which is one of the greatest wastes, for the "perpetual fund of goodwill which death can generate" is something that will always be there as long as humankind survives.

"The failing of the collective arrangements we now make is that we draw so parsimoniously on the fund and fail so often to top it up." This is a fault of the system, he told me, rather than of individual clerics: "But if only more clergymen protested about that system. After all, they do get paid - for doing very little."

Not that he emphasises the strength of any particular religion or indeed of religion at all. What he is seeking to do, in this book, is to look at the opportunities for those facing a lingering death, to work towards an acceptance of what is the greatest mystery of all - and what may lie beyond it, for the mourners left behind.

His own belief is that lives may end but life goes on, regenerated by those associated with the dead person and he quotes Richard Dawkins to support this thesis: "The genes are the immortals ... we, the individual survival machines in the world, can expect to live a few more decades but the genes have an expectation of life that must be measured not in decades but in thousands and millions of years.

This is a remarkable book which draws on the wisdom of, among others, Christ, Buddha, David Hume and Socrates - as well as of the people in the book - in order to humanise what, for many people, might be seen as a terrifying and draining ordeal. His statement that death is not the end of everything may be challenged by those who believe other wise, while at the same time it can be examined by those - secular or religious - who see life and death as a continuum.

He himself takes his beliefs from a variety of sources: "My mother was from what used to be called Kingstown and though Irish, she tended towards the Quakers and later Hinduism, trying to reconcile that with Christianity." His daughter, Sophie, was a member of a Buddhist order for 12 years but disrobed around the time her mother, Sasha died: she is currently training to be a hospice nurse. Michael Young is 80 and, having mourned his wife, last year married Dorit Uhlemann, a 37 year old German: their baby daughter - his sixth child - is now three months old.