Let’s talk about a good death — Lee Poh Wah

OCT 30 — A little-known fact is that each day, some 150,000 deaths occur throughout the world. Anthropologist Geoffrey Gorer rightfully calls it "the pornography of death".

In his essay Death, Grief and Mourning, he argues that death has replaced sex as the unmentionable topic in polite society today: A century ago, sex was not discussed, whereas death was treated openly. Today, the opposite is true.

We generally accept that progress is an inexorable straight line forward. In medicine, so many killer diseases of the past — from bubonic plague to malaria and tuberculosis — have been curbed, while life-threatening incidents such as premature births have been transformed into innocuous events.

Yet, such progress has not stopped us from regressing in Ars Moriendi, the art of dying. Dying used to be a shared social event by the sick and their family and friends, and death was celebrated with an elaborate ritual. Increasingly now, people die alone, in an alien and sterile environment such as a hospital. Funerals are tolerated as an inconvenient truth.

Today, the dying process is seldom seen or heard. As a result, many no longer know what to expect or how to behave. When confronted by death, we either feel awkward or avert our gaze.

The change in social mores has been compounded by modern medical technologies which allow us to delay death, but often at the expense of quality of life. We can think, for example, of the terminally ill who may live extra weeks by suffering cure-at-all-cost chemotherapy and its torturous side effects. Or of heart patients who survive a heart attack only to endure chronic ailments or dementia.

By making dying a lingering process, we have introduced, in many cases, the spectre of depression. Physical pain exacerbates psychological pain, and vice versa, so that the dying process turns into a downward spiral of deepening distress and despair.

For society, dying as a long drawn-out affair has created a web of complexity involving policy, law, ethics and economics. Family and caregivers have to juggle their respect for the wishes of the person with their judgment of what the right thing to do is.

Policy makers and doctors have to parcel out limited resources. Who, for instance, should have priority to a life-extending treatment?

The way we die has changed over time, but the fear and fascination death exercises over the human mind remains a constant.

All life fears its end. Ernest Becker, of Denial of Death fame, goes so far as to argue that the terror of death lies at the very root of human behaviour; what drives us is not, as Sigmund Freud would have it, unconscious sexual desire but a desperate effort to deny our mortality, to control the overwhelming anxiety provoked by the knowledge of our biological destiny.

To this could be added the present-day trend of giving in to our hedonistic tendencies. Anything that does not give pleasure is bad, and if it cannot be eliminated, at least it should be hidden away.

But it is not possible to run from death. It is, after all, the only certain event in our lives. A much better strategy is to befriend this stranger.

Like any phobia, the fear of death and dying can be alleviated when we are familiar with what it is, when we can talk openly about it, when we are prepared, and when we have the power to make it a better experience for ourselves and loved ones.

The way forward is to talk about death in a climate of honesty, in order to "normalise" it. In the same way that we prepare for puberty, marriage, parenthood and ageing, we need to ask awkward questions about death and dying. And we need to be given frank answers. Talking about death could change the way we live, simply because it will help us sort out our emotions and relationships.

In addition, we should facilitate the ideal physical circumstances for a good death. For the sick, there is a world of difference between dying in pain and in comfort — alone, or in the company of loved ones. For the living, there is also a world of difference between seeing a dying person look inhuman in a hospital with tubes sticking out of him, and finding him dignified and peaceful in his own bed.

In spite of all the goodwill in the world, the families of the dying are often at a loss. They have no idea of how to help, or what to do. They feel powerless and frightened in the face of death. They need the help of palliative care, a holistic approach which supports not only the dying but their families by focusing on their quality of life; prioritising the treatment of the pain without neglecting the psychosocial and spiritual aspects.

The palliative care team of doctors, nurses and social workers takes the sting out of death by providing the family and caregiver with viable alternatives regarding medical treatment, nursing care and emotional support. They can prompt and facilitate the right decisions at the right time, taking into account the wishes of the dying, and of the family. Through their expertise and understanding, they help to minimise the physical suffering, while providing a spiritual balm.

Theirs is such a humane and compassionate approach, I happily extol it as one of Britain's best exports. I would go so far as to advocate palliative care as a human right, given that it relieves man from the torture of untreated pain. It is a social innovation that deserves a Nobel Peace Prize for giving peace of mind and body at the moment when we need it most.

Properly handled, life in the shadow of death can be richer than life in the sun. While our bodies become weaker, the spirit can grow stronger. I have seen terminally ill patients who are genuinely happy and capable of making their demise a joy-filled inspiration to those around them.

True wisdom comes from knowing that while death may be inevitable, dying is not the problem. The real problems are our refusal to die which often leads to a conspiracy to do anything to avoid it; our fear of death and our ignorance of the dying process, which create unnecessary suffering, anxiety and a feeling of helplessness.

But all these can be overcome. Palliative care for one, when delivered well, shows us that a good death is not as impossible as it seems. — Today

* Lee Poh Wah is the CEO of Lien Foundation, a Singapore philanthropic house noted for its model of radical philanthropy.

* This is the personal opinion of the writer or publication, and does not necessarily represent the views of The Malaysian Insider.

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