Thinking Beyond Science

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-words as magic ciphers that may cause harm merely by being spoken aloud, can support a dying person 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 of death 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 with each other at a time when pretence and well-intentioned lies can separate us, wasting time that is very precious.

Not all dying is neat and well-prepared. Although the final moments of life follow a reasonably consistent pattern of waning consciousness and automatic breathing, the journey to that point may take a less predictable path. Possibly 25 percent of all deaths are sudden and unexpected, taking place too rapidly to allow time for any treatment. Yet even in such deaths there is often a known underlying condition, such as heart disease, or simply extreme age, that may make the timing of death unpredictable but that nevertheless foreshadows its approach.

The elderly expect death, and many try to talk to others about their hopes and wishes. But often they are rebuffed by the young, who cannot bear, or even contemplate, those thoughts that are the constant companions of the aged or the sick.

Telling children about death is important, yet uncomfortable. We want to protect them from sadness, but prepare them for life. Children’s ability to understand concepts like time, permanence, the persistence of unseen objects, and universality develops over the years, so what we say will be received and processed differently depending on the age of the child.

Some time around the age of seven, children become aware that death happens to everybody, and a little later, that it will even happen to them. This may lead to a period of anxiety and frequent requests for reassurance that immediate family members will not die. We addressed this during their childhood by explaining to our children that mummies and daddies don’t usually die until they are old and their children are grown-up. Of course, not every family has that good fortune, and specialist advice is available for families helping children to deal with death – see the Resources section at the end of this book for more information.

It can be daunting for a family to discuss bad news. Sometimes, if the bad news is broken only to the patient, or only to a family member, that individual can find themself with the burden of knowing a truth they dare not speak. This can lead to a whole conspiracy of silence that isolates people from each other at the very time they need to draw upon each other’s strength and support. It is possible to be lonely despite being surrounded by a loving family, as each person guards their secret knowledge for the love and protection of another.

When clinicians break bad news, they would do well to ensure that the right people are present to hear it, to reflect upon it and to support each other in dealing with it. This allows families to share their sadness or worry, and avoids locking anyone away in the Cage of Lonely Secrets. Such difficult conversations can be a challenge in a busy clinic or on a ward round, yet not to do so is a great disservice to the patient and their extended support network – as I had previously found out in an unforgettably shocking way.

The process of dying is recognisable. There are clear stages, a predictable sequence of events. In the generations of humanity before dying was hijacked into hospitals, the process was common knowledge and had been seen many times by anyone who lived into their thirties or forties. Most communities relied on local wise women to support patient and family during and after a death, much as they did (and still do) during and after a birth. The art of dying has become a forgotten wisdom, but every deathbed is an opportunity to restore that wisdom to those who will live, to benefit from it as they face other deaths in the future, including their own.

Sometimes our attention to the present detail prevents us from standing back to discover the pattern or meaning of what we are experiencing; sometimes our assumptions obscure other possible interpretations of the same information. The stoic philosophers asserted that it is not events themselves, but our responses to them that cause us happiness or heartache – at the prospect of the death of a beloved family member or friend, our upset may be mediated by our own sense of powerlessness or loss, or by the apparent distress of our loved one.

Source : With the End in Mind: Dying, Death, and Wisdom in an Age of Denial by Kathryn Mannix

Goodreads : https://www.goodreads.com/book/show/35099051-with-the-end-in-mind

Read Previous Article : https://thinkingbeyondscience.in/2025/02/17/coping-mechanisms-in-palliative-care-navigating-emotional-challenges/