Dying to Know Day a national call to action to remove taboos around death

by GERALDINE CARDOZO

Death 'fans' Clive Salzer, Gypsy Artemis and Anthea Paterson planning events around Dying

Death ‘fans’ Clive Salzer, Gypsy Artemis and Anthea Paterson planning events around Dying to Know Day on the Central Coast.

For Umina retirees Anthea Paterson and Clive Salzer, life has never been better since facing up to death.

The couple, who call themselves “death fans” say they had a life-changing experience after attending an end-of-life course.

“Both our mothers are 94 and approaching death, so we went along to an end of life course to try and prepare ourselves for what is to come,” Mr Salzer said.

“While it was very emotional, the experience has changed our outlook on life and death completely.”

The pair are now part of the Central Coast End of Life Collective, which is associated with the Groundswell Project – the group behind Dying to Know Day.

“This is a national day of action challenging the taboo of death and bringing to life conversations around death, dying and bereavement,” Central Coast organiser Gypsy Artemis said.

Making a will is an important part in dealing with the inevitability of death.

Making a will is an important part in dealing with the inevitability of death.

“To me, Dying to Know Day is about saying things you may wish you’d never left unsaid.”

Ms Artemis, formerly known as Kim Ryder, said her fascination with “society’s last taboo” was sparked after a near-death experience in 1997.

“This changed my outlook on life forever and then my mum was diagnosed with terminal cancer and died in 2008. This was my first first-hand experience with death and I started thinking about how we, as a society, don’t deal with death very well.”

For Mrs Paterson, talking about death has helped her deal with grief associated with the death of her father.

“It’s not a morbid thing, this is about exploring death to enhance life,” she said.

ORGANISE YOUR OWN FUNERAL

Find out information about how to organise your own funeral, alternatives to cremation, how to make a will and advanced care plan at Dying to Know events next week. For details visit www.dyingtoknowday.org.

 
Complete Article HERE!

WRITE YOUR OWN OBITUARY

I have an interesting exercise for you.

I want you to write your own obituary. Just like you would want it to appear after your death. You can be as creative as you like.

Obituary

Try to remember that this is just an exercise, okay? A wise man once said that we are unable to manage what we cannot measure. And this is an opportunity for you to take measure of who and what you are. Give it some thought. As the saying goes: Things that are difficult for us will tell us more about ourselves than the things we do with ease.

Take some time over the next week or so to review examples of obituaries and death notices…they’re in all the newspapers and online. Now write your own obituary. You died today. What would you like to say about yourself and your death? Model it upon the ones you researched or be creative and design your own. Remember, this is just a snapshot of who you are at this moment. It would be interesting to compare this obituary with the one that you might write at the next year or when it is truly needed.

“Life doesn’t cease to be funny when people die any more than it ceases to be serious when people laugh.”
— George Bernard Shaw

Excerpts From World Class Obituaries:

Ronnie loved spur-of-the-moment trips in luxury cars to Vegas with his friends. We would also like to thank the people who issued his credit cards.

 

Allison studied cooking to prevent recurrences of memorable culinary disasters and fend off resulting “blond” jokes.

 

When you remember Brett, remember he was more than a great set of biceps; he was also an incredible set of pecs.

 

She is remembered for her endless capacity to love, her romantic ideals, her wit, her sense of humor, her homemaking and her ability to accessorize.

 

Jenette is probably shrieking from the other side now that her true age has been published.

 

Handsome and tailored to a fault, he somehow still managed to wear too much jewelry.

 

William, the proud owner of an outrageous giant poodle named Orbit, could often be found in his red pumps on Bernal Hill or high in the Sierras.

 

Here’s to short skirts, tall hairdos, seamed stockings, and bad attitudes!

 

He lived in San Francisco according to the Gospel of Mame and believed implicitly in the virtues of room service and frequent flyer miles.

 

Ron loved collecting ‘50’s memorabilia as well as dining out and drinking Merlot and driving his treasured 1961 Cadillac — sometimes unfortunately in that order!

 

She lived by the words of Alice Roosevelt: “If you haven’t anything nice to say about someone, come sit next to me.

 

Weary of reading obituaries noting someone’s courageous battle with death, Mike wanted it known that he died as a result of being stubborn, refusing to follow doctors’ orders and raising hell for more than six decades. He enjoyed booze, guns, cars, and younger women until the day he died. So many of his childhood friends that weren’t killed in Vietnam went on to become criminals, prostitutes and/or Democrats. He asks that you stop by and re-tell the stories he can no longer tell. As the Celebration will contain adult material we respectfully ask that no children under 18 attend.

Aid In Dying, Part 2

“If you expect heroics from the people who attend you, even if it doesn’t include hastening your death, you’d be well advised to treat your attendants as heroes. Mutual respect and consideration, honor and compassion should be the hallmarks of your relationship with them.”

 

(We pick up our discussion where we left off last time. Part 1 is HERE.)

One of the most predictable questions I get when I present on the topic of aid in dying is; how do I go about finding someone who will be willing to help me? And I always answer the same way; the only way to know is by asking.

AidinDyingphoto_mediumI suggest that anyone looking for help with their end of life choices begin by interviewing those they love, to see who may have psychological, emotional, or moral reservations about assisting them in this fashion. I suggest that you never ask anyone to violate his/her ethical code regardless of how much you need help.

Once you find the person(s) you are looking for, I suggest that you check in with this person regularly to see if their level of commitment remains high, and excuse anyone who may have developed the least reservation about helping you as the time approaches. I suggest that you keep the number of people involved to the smallest number possible. One or two people at the most is my recommendation. Confidentiality and coordination of effort is essential and a large group make that virtually impossible.

At this point in the presentation I share two stories of very different death scenes to make my point. I was invited to consult on both occasions.

Jeffery was dying of AIDS. He and Alex, his lover of nearly twenty years, were preparing for his imminent death. Jeffery had a fear that he was beginning to slide into dementia, which was his worst nightmare. He wanted to short-circuit this final indignity and wanted to know if I would help them plan a strategy for proactively ending his life. I told them that I would be happy to offer them whatever information I had.street drugs

On this first visit with them I tried to assess the situation; to get a feel for the level of commitment that each person was bringing to this endeavor. There was no doubt about it, Jeffery was actively dying, his doctor confirmed the dementia diagnosis, and so time was of the essence.

I asked, “Have you guys done your homework?”

“If you mean, have we squirreled away enough medications to do the trick, the answer is no. We never gave this eventuality a thought until recently and now there’s not enough time to do that.”

“Will your doctor assist you with a prescription for a lethal dose of, let’s say, a barbiturate?”

“Doubt it. We’ve never talked to her about this. I don’t even know where she stands on the issue.”

“Well, then, how were you going to make this happen?”

“We were thinking about using street drugs, you know, coke and heroin. I also have some oral morphine left over from a friend who died last year.”

the_end_life_by_liquifiedsoul-d3fuz2nThat’s it? That’s your plan? What if you mess up on the dosage or something else goes wrong? I’ve seen it happen. You could be in worse shape than you are now and still be alive. Do you have a Plan B?”

Jeffery responded; “Alex and I talked about it some and Alex promised that he wouldn’t let me suffer.”

“But what does that mean? Alex, do you know what it is you are promising?”

The three of us talked for hours about their half-baked scheme. I tried to get them to see how implausible their plan was and how serious the consequences would be if there was a miscalculation. They would have none of it. Their love for each other and Alex’s blind commitment to Jeffery to preserve him from any more suffering was all there was to know. Alex would be as resourceful as necessary, even if it meant he had to suffocate Jeffery in the end.

Ten days later I was invited to their home again. I didn’t realize it at first, but earlier that day they had set their plan in motion. Alex had scored some cocaine, freebased it, and watched as Jeffery shot up. Both of these guys had had a long history with intravenous drug use so all of this was familiar territory. Unfortunately, Jeffery’s history with drug use complicated matters considerably. He had built up a tolerance to the drug and even though he was nothing more than skin and bones, the dose was not lethal. This is the situation as I found it. Jeffery was comatose and appeared near death, and Alex was at his wit’s end.

“He’s been like that for hours. I thought for sure he’d be dead by now. I think we’ve screwed up. What am I gonna do now?”

“I’m afraid I can’t advise you. I can only help you weigh your options.”

As I saw it, Alex had two options. He could call the paramedics and have them try to revive Jeffery with all the trauma that would involve, or he could honor the commitment he made to Jeffery and complete the plan they rehearsed.

Then there was Earl and his wife Christina. Earl was in the final stages of lung cancer. He was a hard, difficult man, plagued angerby many personal demons. Even when he was well, people used to say that he was an acquired taste, and if you ask me, that was being generous. The sicker he got, the more difficult he became. He alienated just about everyone – his sons, his friends, even the people from hospice. No one could tolerate his fury. In the end there was only Christina.

Some weeks before he died, Earl demanded that Christina call me over for a visit. I wasn’t inclined to accept the summons because I hated to see how he treated her, but Christina sounded so defeated on the phone that I relented and made plans to stop by the following day. Nothing had changed in the eight months since my last visit. Despite being a mere shadow of his former self, Earl was as abusive as ever. How had Christina been able to stand it all this time, I wondered.

“I want to die! I want this to be over now. I can’t get decent care. All these fuckin’ doctors and nurses make me sick. They don’t know what they’re doing.”

“He doesn’t mean that, Richard,” Christina interjected. “He gets good care.”

“Pipe down! I’m doing the talking. What do you know about it anyway? She don’t know nothin’ about what it’s like for me. Listen, Richard, I want to die. I want to end it right now, but I need help. I’m sick of this.”

“What kind of help do you need?” I asked.

“I read Final Exit, you know. I know how to do it. I got all these pills I can take.” Earl pointed to the cache of pill bottles in the nightstand drawer. “But I don’t want any slip-ups. I need someone to help me with the plastic bag at the right time, and she won’t help me.” He nodded in the direction of his long-suffering wife.

keep-calm-and-do-your-homework-100It was true. Christina absolutely refused to help. When I asked her why, she could only sheepishly shrug her shoulders. There was clearly much more to this than what was on the surface.

Earl then turned his attention to me. “You got to help me. You’re the only one left.”

“Earl, I won’t and can’t. It’s not that your request is out of line. It’s because I’m a stranger here. In all the years that we’ve known each other, you’ve never once invited even the most casual of friendships to form between us. You’ve always kept me out. You can’t ask me to overlook that now. You’re asking me to participate in one of the most intimate experiences two people can have in life and, I’m afraid, there just isn’t any foundation for that here. I’m sorry.”

“You’re a fuckin’ coward, just like everybody else. So you can just get the hell out and leave me alone. Damn you all!”

I hated to leave Christina alone with him, but I did as he demanded. Christina showed me to the door.

“Why won’t you help him?” I asked, when she and I were alone. “It would be the end of your misery.”

“That’s exactly why I won’t. After all these years, I couldn’t be sure whether helping him die would be an act of compassion, which would end his suffering, or an act of violence, which would end mine.”

These two scenarios provide a blueprint of what not to do if you are seriously considering having someone assist you to die. If you expect heroics from the people who attend you, even if it doesn’t include hastening your death, you’d be well advised to treat your attendants as heroes. Mutual respect and consideration, honor and compassion should be the hallmarks of your relationship with them.

You also have to have a well-thought out plan. And a “Plan B.” There’s no substitute for meticulous attention to detail. Who, what, when, where, and how. Do your homework!

Staring death in the face

By Chen Ximeng

As Song Hua (pseudonym) lay in her open casket, nearly a dozen people dressed in black stood above the 34-year-old shedding tears and paying heartfelt tributes. Incense burned from an altar flanked by wreaths as moving music played in the small, candlelit chapel in downtown Beijing. But this wasn’t any ordinary memorial service. After all, Song wasn’t actually dead. Inner Light Group

“I really wanted to experience what it feels like to die,” said Song, whose faux funeral was attended by 10 “mourners” playing the roles of family members, friends and colleagues.

Death might be a certainty in life, but it is a major taboo in Chinese culture. Visiting ancestors’ tombs for Qingming Festival, which falls on April 5, used to be the closest most people were comfortable with getting to death, but now a growing number of people are participating in educational activities that help them to develop a rational understanding of death.

Try before you die

Song’s fake wake last month was organized by the Inner Light Group (ILG), a Dongcheng district-based counseling agency that has provided the service to around a dozen people since last year. Each wake costs 100 yuan ($16.11) and runs for two hours.

Faux funerals have been popular in Japan and South Korea since 2010, but they are still relatively new in China. They give people like Song, whose battle with depression had caused her to contemplate suicide, a glimpse of the impact their deaths might have on loved ones while reminding them of their own mortality.

“I couldn’t accept myself and wanted to end it all. I knew it was wrong, but I felt trapped in an abyss of grief and despair. I thought, ‘Why not leave the world?'” said Song.

Before Song’s faux funeral, she was required to give a farewell letter to her “relatives” played by ILG members. She was then draped in a white sheet and laid in her casket at the center of the 30-square-meter chapel before the agency’s 45-year-old founder and mock celebrant, Jia Dao, told the somber audience of Song’s death by suicide.

“I lay face-up in the casket as my ‘parents,’ ‘siblings’ and ‘colleagues’ circled me,” explained Song.

Everything seemed to be progressing like any normal funeral until a ‘colleague’ who had apparently returned from abroad to attend Song’s ‘funeral’ held her hand and sobbed about being left heartbroken.

Upon hearing his words, Song was stirred from her motionless state and tears rolled from the corners of her closed eyes.

“Their words were so sincere and warm that it connected deeply with my heart. Since then, I haven’t thought about suicide once. I can now accept death naturally,” said Song.

Ashes to ashes

For those who want to take their near-death experience a step further from a funeral, the Life and Death Experience Center in Shanghai might be the best option. Visitors can write their own will and epitaph, as well as nominate organs they wish to donate.

The experience culminates inside a 4D “crematory” that shows the living what the dead never see, hear or smell: roaring flames turning skin, hair and bones to ash.

The center, which has attracted more than 400,000 yuan from over 200 investors since July 2013, is slated to open later this year.

Ding Rui, one of the center’s co-founders, was inspired to create the grisly tourist attraction after climbing into a real crematory himself in November 2011 while working as a trainer for volunteers at Hand in Hand, a Shanghai-based NGO that provides palliative care.

“When I was inside the crematory, I felt breathless for a moment and very close to death,” recalled Ding.

A 'mourner' holds the hand

Although Ding knew he was safe, staring at flame vents positioned above his head and at his sides was an unnerving experience.

“Being inside [the crematory] strengthened my resolve to open the center to teach people about death. I wanted to simulate the vivid feeling of being cremated and also experiencing rebirth,” said Ding.

Dying to experience the other side

His time spent caring for people nearing the end of their lives led Ding to realize problems with Chinese being “unable to openly talk about death.”

“After taking care of more and more dying patients, I found that people’s fear of death is infectious like a virus,” said Ding, adding that his biggest concern from experience in palliative care was seeing how few people – from the elderly to their family members – struggled to directly face death.

No one lives forever, but sometimes people can be uncomfortable at being reminded they are mere mortals.

“The deep impact of Chinese culture is a major reason why few people are comfortable talking about death,” said Wang Zuoji, deputy director of the Beijing Folklore Committee and a member of the capital’s non-tangible cultural heritage committee.

In Chinese culture, the number four is considered unlucky because its pronunciation in Putonghua is close to “die.” Similarly, a clock is never given as a gift because it sounds similar to the word for “end.” Even the sight of chopsticks placed upright in a bowl of rice can cause superstitious Chinese to shudder due to its resemblance to incense.

“Some customs and taboos have no scientific reasoning, existing only to reject anything related to death or bad luck,” said Wang.

Preserving dignity at the end

Grim Reaper imitator

Ding said he shared a feeling of powerlessness with those he cared for in palliative care, noting that medical apparatus used to extend people’s lives often came at the cost of individuals’ dignity.

“People dying don’t have the right to decide matters relating to their death, which are instead handled by relatives often influenced by others’ opinions,” said Ding.

Most people spare no effort to give their loved ones the best medical care possible, even if it means extending their life for a short time only. Life-support machines and medical ventilators are often used to keep alive patients unable to talk or move out of bed.

In a society that values filial piety, many relatives don’t dare assist or speed up a parent’s death. Despite a December 2013 survey by Shanghai Jiao Tong University finding that more than two-thirds of Chinese have an open, tolerant attitude towards euthanasia, the practice is banned under Chinese law and there are no signs it could be legalized any time soon.

“In some regards, palliative care doesn’t work in educating people about death,” said Ding.

“We want to put it in the spotlight by letting people experience the closest thing to it. Death education is important because no one knows when their number is up.”

Learning about death

Wang Yifang, a professor at Peking University’s Health Science Center, recalled how one of his colleagues learned after teaching a class in 2009 that his father was terminally ill. Accepting fate gave both father and son peace of mind.

“My colleague shunned technology and medical care that would extend his father’s life, choosing instead to provide palliative care at home. His father died graciously,” said Wang Yifang.

Since 2009, Wang Yifang has taught a course about life and death that helps students come to grips with an issue avoided most of their young lives.

“My course provides theory-based education, while death simulation is a more radical version of interactive education,” said Wang Yifang.

Approaches to death education vary in China. It currently isn’t included in curriculums of schools, with opinions among experts divided over whether it should be added.

Medical students in Taiwan are required to lie in a coffin and read farewell letters, while students at a high school in Hainan Province visit funeral parlors to inspect how ashes are stored after cremation.

Chen Yue, a counselor at the Sunshine Psychological Counseling Corporation in Beijing, has taught a class since February about death education.

Attendance is low, however, with even some fellow counselors unable to sit through classes due to the grim nature of its subject.

“Parents need to take the initiative in teaching their children about death. The subject of death is horrible, but neglecting it makes it even more terrifying to children,” said Chen.

“China has a long way to go in death education, which can not be achieved in the span of one or two generations. People need to dramatically change their perception of death, but this can only be done little by little.”

Complete Article HERE!

Sherwin B. Nuland, ‘How We Die’ Author, Dies at 83

By DENISE GELLENE

Dr. Sherwin B. Nuland, a surgeon and author who drew on more than 35 years in medicine and a childhood buffeted by illness in writing “How We Die,” an award-winning book that sought to dispel the notion of death with dignity and fueled a national conversation about end-of-life decisions, died on Monday at his home in Hamden, Conn. He was 83.

The cause was prostate cancer, his daughter Amelia Nuland said.Sherwin Nuland

To Dr. Nuland, death was messy and frequently humiliating, and he believed that seeking the good death was pointless and an exercise in self-deception. He maintained that only an uncommon few, through a lucky confluence of circumstances, reached life’s end before the destructiveness of dying eroded their humanity.

“I have not seen much dignity in the process by which we die,” he wrote. “The quest to achieve true dignity fails when our bodies fail.”

In “How We Die, ” published in 1994, Dr. Nuland described in frank detail the processes by which life succumbs to violence, disease or old age. Arriving amid an intense moral and legal debate over physician-assisted suicide — perhaps the ultimate manifestation of the concept of a dignified death — the book tapped into a deep national desire to understand the nature of dying, which, as Dr. Nuland observed, increasingly took place behind the walls of the modern hospital. It won a National Book Award.

Dr. Nuland wrote that his intention was to demythologize death, making it more familiar and therefore less frightening, so that the dying might approach decisions regarding their care with greater knowledge and more reasonable expectations. The issue has only intensified since the book was published, and has been discussed and debated in the medical world, on campuses, in the news media and among politicians and government officials engaged in health care policy.

“The final disease that nature inflicts on us will determine the atmosphere in which we take our leave of life,” he wrote, “but our own choices should be allowed, insofar as possible, to be the decisive factor in the manner of our going.”

Beyond its descriptions of ruptured embolisms, spreading metastases and bodily functions run amok, “How We Die” was a criticism of a medical profession that saw death as an enemy to be engaged, frequently beyond the point of futility.

In chiding physicians, Dr. Nuland pointed the finger at himself, confessing that on more than one occasion he persuaded dying patients to accept aggressive treatments that intensified their suffering and robbed them of an easier death. One of those patients was his brother, Harvey, an accountant who died of colon cancer in 1990 after receiving an experimental treatment with no reasonable chance of success.

Looking back on that episode, Dr. Nuland wrote that he had mistakenly tried to give his brother hope, failing to acknowledge that disease, not death, was the true nemesis.

He was born Shepsel Ber Nudelman on Dec. 8, 1930, in the Bronx, the son of Orthodox Jews who had emigrated from Russia. (He adopted the first and middle names Sherwin Bernard when he went to kindergarten.) His childhood was spent in a tiny South Bronx apartment with his parents, his older brother, his maternal grandmother and a maiden aunt, in an atmosphere permeated with sickness and death.

A brother died before Dr. Nuland was born, and at age 3, he was hospitalized for diphtheria. His mother, the emotional center of his family, died of colon cancer when he was 11. In his memoir, “Lost in America” (2003), he recalled with striking vividness the bad smells and bloody pads that came from his mother’s room.

Dr. Nuland’s adolescent years were dominated by his father, Meyer Nudelman, a garment worker who was incapacitated by chronic illness, physical infirmities and his resistance to a new way of life. He terrified the family with his explosive rages, never learned to read or write English — Yiddish was the predominant language at home — and could not walk more than a short distance without his son’s help.

Dr. Nuland regarded him with fear and shame, emotions that would take a deep psychological toll later in his life.

While still in high school, Dr. Nuland and his older brother changed their names from Nudelman, separating themselves from a weak, angry man who, Dr. Nuland wrote, represented “everything I so desperately wanted to be rid of.” They chose a name first adopted by a cousin, Willie Nuland, a physician who looked after the boys’ parents when they were ill, and whose compassion and competence pointed Dr. Nuland toward his career.

Dr. Nuland received his bachelor’s degree from New York University in 1951 and went on to study medicine at Yale, attracted by its distance — geographically and culturally — from the old-world Jewishness in which he grew up. Reading about spinal cord diseases as a medical student, Dr. Nuland discovered that his father’s crippling illness was tertiary, or chronic, syphilis. Dr. Nuland felt anger, and then pity. “I now had some perception of the tragedy of his life,” he wrote in his memoir.

Dr. Nuland received his medical degree from Yale in 1955. Electing to specialize in surgery, he set his sights on becoming chief surgical resident at Yale-New Haven Hospital, entering a Darwinian competition for a position seldom occupied by Jews. In 1958, Dr. Nuland won the coveted appointment. Four days later, his father died of complications of syphilis. Mr. Nudelman never knew the source of what led to his father’s death.

“I think that one time, before he was married, Meyer Nudelman was very unlucky,” Dr. Nuland said in a 2003 interview with The New York Times.

Mr. Nudelman’s death fulfilled Dr. Nuland’s wish to escape his father, but instead of liberation, he felt intense guilt and shame. Plagued by feelings of unworthiness, he felt himself becoming his father, assuming Mr. Nudelman’s hunched shoulders and shuffling gait.

By his early 40s, his depression had become so severe that he was institutionalized for more than a year. Senior psychiatrists recommended a lobotomy, but they were overruled by the young resident psychiatrist who had been assigned to his case, who insisted on electroshock therapy. By early 1974, it was clear that the treatment had been a success, and as Dr. Nuland recovered, according to his memoir, he started to make peace with his father and, perhaps, himself.

Dr. Nuland’s first marriage ended in divorce. In 1977, he married Sarah Peterson, an actress and director. Besides his wife, survivors include two children from his first marriage, Victoria Jane Nuland, the assistant secretary of state for European and Eurasian affairs, and Andrew; two children from his second marriage, Amelia and William; and four grandchildren.

From 1962 until 1991, he was a clinical professor of surgery at Yale, where he also taught bioethics and medical history. He was a surgeon at Yale-New Haven from 1962 to 1992, when he retired to write full time.

Dr. Nuland’s books include “Doctors: The Biography of Medicine” (1988), “The Wisdom of the Body” (1997), “The Doctors’ Plague” (2003) and “The Uncertain Art” (2008). He was a contributing editor to The American Scholar and The New Republic.

“How We Die,” which won the National Book Award for nonfiction in 1994 and was a finalist for the Pulitzer Prize in nonfiction in 1995, has sold more than 500,000 copies worldwide. In its concluding chapter, Dr. Nuland confessed that he, like many of his readers, desired a death without suffering “surrounded by the people and the things I love,” though he hastened to add that his odds were slim. This brought him to a final question.

“And so, if the classic image of dying with dignity must be modified or even discarded,” he wrote, “what is to be salvaged of our hope for the final memories we leave to those who love us? The dignity we seek in dying must be found in the dignity with which we have lived our lives.”

Complete Article HERE!

The History of Christian Death Rites

by FREDERICK S. PAXTON

In the world in which Christianity emerged, death was a private affair. Except when struck down on the battlefield or by accident, people died in the company of family and friends. There were no physicians or religious personnel present. Ancient physicians generally removed themselves when cases became hopeless, and priests and priestesses served their gods rather than ordinary people. Contact with a corpse caused ritual impurity and hence ritual activity underworld ferrymanaround the deathbed was minimal. A relative might bestow a final kiss or attempt to catch a dying person’s last breath. The living closed the eyes and mouth of the deceased, perhaps placing a coin for the underworld ferryman on the tongue or eyelids. They then washed the corpse, anointed it with scented oil and herbs, and dressed it, sometimes in clothing befitting the social status of the deceased, sometimes in a shroud. A procession accompanied the body to the necropolis outside the city walls. There it was laid to rest, or cremated and given an urn burial, in a family plot that often contained a structure to house the dead. Upon returning from the funeral, the family purified themselves and the house through rituals of fire and water.

Beyond such more or less shared features, funeral rites, as well as forms of burial and commemoration, varied as much as the people and the ecology of the region in which Christianity developed and spread. Cremation was the most common mode of disposal in the Roman Empire, but older patterns of corpse burial persisted in many areas, especially in Egypt and the Middle East. Christianity arose among Jews, who buried their dead, and the death, burial, and resurrection of Jesus were its defining events. Although Christians practiced inhumation (corpse burial) from the earliest times, they were not, as often assumed, responsible for the gradual disappearance of cremation in the Roman Empire during the second and third centuries, for common practice was already changing before Christianity became a major cultural force. However, Christianity was, in this case, in sync with wider patterns of cultural change. Hope ofsalvation and attention to the fate of the body and the soul after death were more or less common features of all the major religious movements of the age, including the Hellenistic mysteries, Christianity, Rabbinic Judaism, Manichaeanism, and Mahayana Buddhism, which was preached as far west as Alexandria.

Early Christian Responses to Death and Dying

In spite of the centrality of death in the theology and spiritual anthropology of early Christians, they were slow to develop specifically Christian responses to death and dying. The most immediate change was that Christians handled the bodies of the dead without fear of pollution. The purification of baptism was permanent, unless marred by mortal sin, and the corpse of a Christian prefigured the transformed body that would be resurrected into eternal life at the end of time. The Christian living had less need than their neighbors to appease their dead, who were themselves less likely to return as unhappy ghosts. Non-Christians noted the joyous mood at Christian funerals and the ease of the participants in the presence of the dead. They observed how Christians gave decent burials to even the poorest of the poor. Normal Roman practice was to dump them in large pits away from the well-kept family tombs lining the roads outside the city walls.

catacombs

The span of a Christian biography stretched from death and rebirth in baptism, to what was called the “second death,” to final resurrection. In a sense, then, baptism was the first Christian death ritual. In the fourth century Bishop Ambrose of Milan (374–397) taught that the baptismal font was like a tomb because baptism was a ritual of death and resurrection. Bishop Ambrose also urged baptized Christians to look forward to death with joy, for physical death was just a way station on the road to paradise. Some of his younger contemporaries, like Augustine of Hippo, held a different view. Baptism did not guarantee salvation, preached Augustine; only God could do that. The proper response to death ought to be fear—of both human sinfulness and God’s inscrutable judgment.

This more anxious attitude toward death demanded a pastoral response from the clergy, which came in the form of communion as viaticum (provisions for a journey), originally granted to penitents by the first ecumenical council at Nicea (325), and extended to all Christians in the fifth and sixth centuries. There is, however, evidence that another type of deathbed communion was regularly practiced as early as the fourth century, if not before. The psalms, prayers, and symbolic representations in the old Roman death ritual discussed by the historian Frederick Paxton are in perfect accord with the triumphant theology of Ambrose of Milan and the Imperial Church. The rite does not refer to deathbed communion as viaticum, but as “a defender and advocate at the resurrection of the just” (Paxton 1990, p. 39). Nor does it present the bread and wine as provisions for the soul’s journey to the otherworld, but as a sign of its membership in the community of the saved, to be rendered at the last judgment. Thanks, in part, to the preservation and transmission of this Roman ritual, the Augustinian point of view did not sweep all before it and older patterns of triumphant death persisted.

However difficult the contemplation (or moment) of death became, the living continually invented new ways of aiding the passage of souls and maintaining community with the dead. In one of the most important developments of the age, Christians began to revere the remains of those who had suffered martyrdom under Roman persecution. As Peter Brown has shown, the rise of the cult of the saints is a precise measure of the changing relationship between the living and the dead in late antiquity and the early medieval West. The saints formed a special group, present to both the living and the dead and mediating between and among them. The faithful looked to them as friends and patrons, and as advocates at earthly and heavenly courts. Moreover, the shrines of the saints brought

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people to live and worship in the cemeteries outside the city walls. Eventually, the dead even appeared inside the walls, first as saints’ relics, and then in the bodies of those who wished to be buried near them. Ancient prohibitions against intramural burials slowly lost their force. In the second half of the first millennium, graves began to cluster around both urban and rural churches. Essentiallycomplete by the year 1000, this process configured the landscape of Western Christendom in ways that survive until the present day. The living and the dead formed a single community and shared a common space. The dead, as Patrick Geary has put it, became simply another “age group” in medieval society.

Emergence of a Completely Developed Death Ritual in the Medieval Latin Church

However close the living and dead might be, it was still necessary to pass from one group to the other, and early medieval Christians were no less inventive in facilitating that passage. The centuries from 500 to 1000 saw the emergence of a fully developed ritual process around death, burial, and the incorporation of souls into the otherworld that became a standard for Christian Europeans until the Reformation, and for Catholics until the very near present. The multitude of Christian kingdoms that emerged in the West as the Roman Empire declined fostered the development of local churches. In the sixth, seventh, and eighth centuries, these churches developed distinctive ritual responses to death and dying. In southern Gaul, Bishop Caesarius of Arles (503–543) urged the sick to seek ritual anointing from priests rather than magicians and folk healers and authored some of the most enduring of the prayers that accompanied death and burial in medieval Christianity. Pope Gregory the Great (590–604) first promoted the practice of offering the mass as an aid to souls in the afterlife, thus establishing the basis for a system of suffrages for the dead. In seventh-century Spain, the Visigothic Church developed an elaborate rite of deathbed penance. This ritual, which purified and transformed the body and soul of the dying, was so powerful that anyone who subsequently recovered was required to retire into a monastery for life. Under the influence of Mosaic law, Irish priests avoided contact with corpses. Perhaps as a consequence, they transformed the practice of anointing the sick into a rite of preparation for death, laying the groundwork for the sacrament of extreme unction. In the eighth century, Irish and Anglo-Saxon missionary monks began to contract with one another for prayers and masses after death.

All of these developments came into contact in the later eighth and ninth centuries under the Carolingian kings and emperors, especially Charlemagne (769–814), but also his father Pepin and his son Louis. Together they unified western Europe more

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successfully around shared rituals than common political structures. The rhetoric of their reforms favored Roman traditions, and they succeeded in making the Mass and certain elements of clerical and monastic culture, like chant, conform to Roman practice whether real or imagined. When it came to death and dying, however, Rome provided only one piece of the Carolingian ritual synthesis: the old Roman death ritual. Whether or not it was in use in Rome at the time, its triumphant psalmody and salvation theology struck a chord in a church supported by powerful and pious men who saw themselves as heirs to the kings of Israel and the Christian emperors of Rome. Other elements of their rituals had other sources. Carolingian rituals were deeply penitential, not just because of Augustine, but also because, in the rough-and-tumble world of the eighth and ninth centuries, even monks and priests were anxious about making it into heaven. Although reformers, following Caesarius of Arles, promoted the anointing of the sick on the grounds that there was no scriptural basis for anointing the dying, deathbed anointing came into general use, often via Irish texts and traditions. Carolingian rituals also drew liberally on the prayers of Caesarius of Arles and other fathers of the old Gallican and Visigothic churches.

The ritual experts of the Carolingian age did not just adapt older rites and provide a setting for their synthesis, however; they made their own contributions as well. In his classic 1908 study on ritual, the anthropologist Arnold van Gennep was surprised by the lack of elaboration of the first phase of death rites in the ethnographic reports he studied. People generally ritualized burial and commemoration, but gave little attention to the dying. Unlike other rites of passage, few rituals prepared people for death. Familiarity with European Christian traditions may be the source of van Gennep’s surprise, for well-developed preliminal rites are one of their most characteristic features. Around the year 800 certain clerical communities introduced a ritual for the death agony. To aid the dying through the struggle of the soul’s exit from the body, the community chanted the names of the denizens of paradise. Rhythmically calling on the Trinity, Mary, the angels, the prophets and patriarchs, the martyrs and confessors, and all living holy men and women, they wove a web of sung prayer to aid the soul’s passing. This practice quickly became part of a common tradition that also included rites of penance, absolution, anointing, and communion, each of which helped cut the ties that bound the dying to this world, ritually preparing them for entry into paradise.

LazarusLike most human groups, Christians had always used rites of transition to allay the dangers of the liminal period after death before the corpse was safely buried and the soul set on its journey to the otherworld. The same was true of post-liminal rites of incorporation, which accompanied the body into the earth, the soul into the otherworld, and the mourners back into normal society. But medieval Christians placed the ritual commemoration of the dead at the very center of social life. Between 760 and 762, a group of churchmen at the Carolingian royal villa of Attigny committed themselves to mutual commemoration after death. Not long afterward, monastic congregations began to make similar arrangements with other houses and with members of secular society. They also began to record the names of participants in books, which grew to include as many as 40,000 entries. When alms for the poor were added to the psalms and masses sung for the dead, the final piece was in place in a complex system of exchange that became one of the fundamental features of medieval Latin Christendom. Cloistered men and women, themselves “dead to this world,” mediated these exchanges. They accepted gifts to the poor (among whom they included themselves) in exchange for prayers for the souls of the givers and their dead relatives. They may have acted more out of anxiety than out of confidence in the face of death, as the scholar Arno Borst has argued, but whatever their motivations, their actions, like the actions of the saints, helped bind together the community of the living and the dead.

The Carolingian reformers hoped to create community through shared ritual, but communities shaped ritual as much as ritual shaped communities, and the synthesis that resulted from their activities reflected not just their official stance but all the myriad traditions of the local churches that flowed into their vast realm. By the end of the ninth century a ritual process had emerged that blended the triumphant psalmody of the old Roman rites with the concern for penance and purification of the early medieval world. A rite of passage that coordinated and accompanied every stage of the transition from this community to the next, it perfectly complemented the social and architectural landscape. Taken up by the reform movements of the tenth and eleventh centuries, this ritual complex reached its most developed form at the Burgundian monastery of Cluny. At Cluny, the desire to have the whole community present at the death of each of its members was so great that infirmary servants were specially trained to recognize the signs of approaching death.

The Modern Ageextreme-unction

Christian death rituals changed in the transition to modernity, historians like Philippe Ariès and David Stannard have detailed in their various works. But while Protestants stripped away many of their characteristic features, Catholics kept them essentially the same, at least until the Second Vatican Council (1962–1965). Like the Carolingian reformers, the fathers of Vatican II moved to restrict ritual anointing to the sick, but they may be no more successful in the long run, for the symbolic power of anointing as a rite of preparation for death seems hard to resist. And while the secularization of society since the 1700s has eroded the influence of Christian death rites in Western culture, nothing has quite taken their place. Modern science and medicine have taught humankind a great deal about death, and about how to treat the sick and the dying, but they have been unable to give death the kind of meaning that it had for medieval Christians. For many people living in the twenty-first century death is a wall against which the self is obliterated. For medieval Christians it was a membrane linking two communities and two worlds. In particular, Christian rites of preparation for death offered the dying the solace of ritual and community at the most difficult moment in their lives.

Reconnecting with the Past

The Chalice of ReposeThe Chalice of Repose Project at St. Patrick Hospital in Missoula, Montana, is applying ancient knowledge to twenty-first-century end-of-life care. Inspired in part by the medieval death rituals of Cluny, the Chalice Project trains professional music thanatologists to serve the physical, emotional, and spiritual needs of the dying with sung prayer. With harp and voice, these “contemplative musicians” ease the pain of death with sacred music—for the dying, but also for their families and friends and for the nurses and doctors who care for them. While anchored in the Catholic tradition, music thanatologists seek to make each death a blessed event regardless of the religious background of the dying person. Working with palliative physicians and nurses, they offer prescriptive music as an alternative therapy in end-of-life care. The Chalice of Repose is a model of how the past can infuse the present with new possibilities.

Complete Article HERE!

The Good Life (and death)

“Let’s take a fresh look at our mortality, and let’s do so in an interactive and positive way. Let’s celebrate the concept that living well and dying well are one and the same thing. I’m not talking about adjusting deathbed pillows so that, as we die, we can strike heroic poses for the edification of onlookers. I’m talking about achieving a good death in the context of real dying–with all its unpredictability, disfigurement, pain, and sorrow.”

 

I presented a workshop to a group of seniors, at a senior center, north of Seattle awhile back. The workshop was titled, Managing Our Mortality. I like that title; if for no other reason than it doesn’t seem to spook folks into thinking doom and gloom as they consider the end of their life. Fact is, and this is a real curious thing, for most people the concept of their mortality is easier to handle than the concept of their death. Even though, let’s face it, they basically are one and the same thing. Such is the power of euphemisms.

At any rate, I began my presentation with some preliminary thoughts on the concept of living a good death. This is another favorite topic of mine. See an earlier posting of mine, Is Death The Enemy?  I am of the mind that a good life and a good death are one and the same thing, but this is a real hard sell for someone who is enjoying one’s life (especially one’s golden years) and who is not yet ready to go push up daises.

live in such a wayAll these workshops begin with a proclamation. “Let’s take a fresh look at our mortality, and let’s do so in an interactive and positive way. Let’s celebrate the concept that living well and dying well are one and the same thing. I’m not talking about adjusting deathbed pillows so that, as we die, we can strike heroic poses for the edification of onlookers. I’m talking about achieving a good death in the context of real dying–with all its unpredictability, disfigurement, pain, and sorrow.”

While I was saying this I was watching the body language of those gathered to hear me speak. I know this is a critical moment in the presentation. A swift rise in the anxiety level of just a few participants can be contagious to the whole group. I notice that there was a modest amount of lip pursing, clearing of throats, shifting in their seats, and crossing of arms. This signaled that some were ill at ease, but I thought I was ok with the majority so I pressed on. But just to be sure, I casually added that I deliver this very same message regardless of my audience—college kids, soccer moms, healing and helping professionals, what have you. This seemed to settle down my audience a bit. I guess they were reassured that I wasn’t singling them out for a special dose of reality just because they were of a certain age.

I was just about to move on to my next point when a nicely dressed woman with carefully coiffed platinum-colored hair meekly raised her hand with a question. I called on her. She said; “I don’t understand the concept of a good death. There’s nothing ‘good’ about death. Death is the end. I’m really enjoying my retirement, I’m involved with all sorts of creative things I never had time for when I was working and raising my family. I don’t relish the thought of all this coming to an end any time soon.”

There was a lot of nodding of heads in agreement. A man, further back in the room, who appeared to be well into his 70’s, stood up, with the aid of his cane, in anticipation that I would call on him. I pointed to him and asked, “Do you have a question?” “Yes I do! Actually it’s more of a statement.” I said, “Please continue.” “Well, seems to me that dying is hard enough. All this talk of a ‘good death’ sounds like you are layering on an expectation that we do it correctly. I take exception to that.”

Again, there’s more nodding of heads. And then there was a fair amount of whispered chatter too.

I could tell the anxiety level in the group was beginning to peak. Perhaps I misjudged my audience. I thought they were with me, but at least some of them were either resisting or confused by the concept of a good death. So I decide to circle back to see if I could head off their growing concern.

I addressed the man in the back of the room who was still standing and leaning slightly on his cane. “I think there has been some misunderstanding. When I use the term a ‘good death,’ I don’t mean to suggest that there’s a ‘proper’ way of dying. As you suggest, sir, dying is hard enough all by itself, I certainly don’t want to add performance anxiety to the mix. Is anyone else getting the impression that I’m talking about a ‘correct way’ to die?”

Some of the participants tentatively raise their hands.dying well

I quickly took stock of the situation. If a few people were bold enough to raise their hands, others must have been feeling the same way but were too timid to acknowledge it. I decided to approach this in different way. I asked; “If we were talking about living the good life, would any of you feel as if you needed to conform to some arbitrary notion of what the ‘good life’ is?” Most everyone shook their head. “I thought not! So why then, did you make that leap when I mentioned the concept of a ‘good death’?”

This stumped my audience.

I went on to say; “One of the reasons death is such a hot button issue for most of us is because we’ve isolated death way over at the extreme end of our life. I think that’s a mistake. For one thing, it makes death stick out like a sore thumb, when actually it is part and parcel of life. Death is embedded in life. Nothing is alive that will not die. In fact, more things die than will ever have a real life. Consider the infant that is stillborn. For that child birth and death occurred at the same moment. But just because you and I lived beyond that crucial period in our lives, doesn’t me we were in the clear, so to speak.

If the truth were told, the first breath we took once outside our mother’s womb set us on a trajectory toward the inevitable end of our life. And each of us is old enough to have witnessed the death of many people, some older and some younger; if not personally then by proxy. We’ve all seen the carnage of war, the ravages of disease, and we’ve known sudden and accidental death too. So, to my mind, every breath, between our first and our last, is both our living and our dying. That’s why I say that living well and dying well are one and the same thing.”

I let that settle for a bit before I continued.

“There’s a secret I want to pass on to you. It’ll seem pretty simple and self-evident once you’ve embraced it. And the secret is: we must learn to integrate death into life. Once we do that, death stops being this freakish, scary thing over there waiting for its chance to pounce. Death is actually beside us all along. No, that’s not right! Death is not beside us; it’s in us! We are our death in the same way we are our life.

When we live the ‘good life,’ however we choose to define that, we are also living our ‘good death.’ And that’s what I want to address today. If we want to insure that our death, in as much as we have control over it, be good and wise, then we have to be proactive. Just as we have been proactive in living our ‘good life,’ in as much as we have control over that.”

Before I moved on to my next topic I had one final thing to say about a good death. “If we fear death then, on some fundamental level, we fear ourselves. And nothing good, least of all a good life, will ever come of that.”