Category: Philosophy of Dying

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Death as a Design Challenge

Last year Elaine Fong’s mother used the Washington Death with Dignity Act. Elaine shared the experience of helping her mother fulfill her end-of-life wishes in a TEDx San Francisco presentation in October 2017.

Elaine told us, “Our family is grateful to have given our mom a peaceful death and to fulfill her end of life wishes in this way. I wanted to share the experience we had with the world, because I understand how important it is to have this honest conversation, and because it was her wish to help others be brave too. Her life would have ended painfully if it were not for this policy and the work you all have done.”

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Mortals Anonymous:

Inside the Cafés Where People Go to Talk About Dying

By Lexi Pandell

We sat in a circle, clutching paper cups full of steaming coffee and tea. First, I said my name. “Hi, I’m Lexi.” What came next wasn’t an admission of addiction, but a statement about what I feared most about death. “I fear the unknown,” I began, but paused. That didn’t quite sum it up. My voice tight from nerves, I added, “Nothingness. Losing everything I’ve ever known. The whole thing, really.”

This is life at Death Café, an event where strangers gather to snack and chat about shuffling off this mortal coil. It sounds (literally) morbid, but in this Age of Anxiety, as people grapple with climate change, threats of violence, and political and economic instability, death lingers on many people’s minds. A fear of dying is at the root of all those stressful issues and, as Sheldon Solomon put it when speaking to The Atlantic in 2015, those things are “all malignant manifestations of death anxiety running amok.” It’s cyclical: Anxiety spiral, fear of death, bad decisions, rinse, repeat. Despite this, people rarely talk about their own mortality. Death Cafés strive to break that taboo.

That moniker—Death Café—is both the name of the organization that came up with a format for these death-discussion groups and the term for the meetings themselves. The gatherings can be hosted anywhere—community centers, living rooms, hospices, or regular old coffee shops. I attended one in a funeral home. They cost nothing to attend and, as the official website reads, “in the Death Café there are no hierarchies. We all meet simply as people who are going to die.” Though some attendees may have lost loved ones, it’s not a place for bereavement or grief counseling. It’s also not the place to attempt to convert anyone to a religion. Rather, it’s intended as an open, salon-style conversation. The experiences I’ve had varied wildly: At one of them, two people claimed to have seen ghosts. Another veered toward practical discussions of funeral and estate planning. I’ve met people who’ve had near-death experiences, who are terminally ill, who deal with death as part of their daily work, who are afraid of death (or not), and who believe in the afterlife (or, like me, don’t).

The gatherings are run like AA meetings about death (think of it as MA: “Mortals Anonymous”), but the precise format depends on the host. The greatest commonality is offering attendees something to eat or drink, typically cake or another sweet accompanied by coffee or tea. “It’s life-sustaining,” says Megan Mooney, Death Café’s social media head. “It makes people feel more comfortable talking about death.”

The concept began with “café mortels,” created in 2004 by Swiss sociologist and anthropologist Bernard Crettaz. The events were adapted and popularized as “death cafés” by Jon Underwood, who held the first one in the basement of his London home. Soon after, he and his mother, Sue Barsky Reed, started an official website with guidelines for anyone who wanted to host their own. From the beginning, the Death Café organization has been not-for-profit and run entirely by volunteers. Today, associated events are held in more than 60 countries. Though Underwood died suddenly last year at age 44, his mother and his sister, Jools Barsky, now run the organization.

Memento Mori

Death, you could say, is having a moment. Organizations like Underwood’s—as well as Death Salon and Death Over Dinner—are helping people talk about it. YouTube channels like Caitlin Doughty‘s popular “Ask a Mortician” are helping people learn about it. So, too, is Doughty’s group The Order of the Good Death, which aims to bring together funeral industry professionals, academics, artists, and others to help our death-phobic culture confront mortality. There has even been a recent spate of buzzy death-related books, like Mary Roach’s Stiff or Atul Gawande’s Being Mortal.

Yet, when it comes to appropriate cocktail party conversation, death is often put in a corner along with sex and money. Many prefer to avoid it altogether, even when faced with old age or terminal illness.

Our aversion to death is rooted, of course, in evolution. In psychology, there’s a term known as “terror management theory,” which refers to the fact that, while humans intellectually understand the inevitability of death, our survival instinct protects us from fully confronting it. Many, instead, seek a kind of immortality through their beliefs about the afterlife, their offspring, or even fame. Humans are wired to fear dying—and to be superstitious about it.

“People don’t want to talk about death because talking about it makes it real,” says Mooney, who researches mortality for the University of Missouri and is also a social worker for hospice and end-of-life care. “But there’s a saying in the Death Café world that talking about sex won’t make you pregnant and talking about death won’t make you die.”

Still, it’s scary at first. Do you remember the first time you realized you were going to die? Like, really realized it? I do. For me, it happened around age 9 during a visit to my grandparents’ home in Long Island. As I lay in a twin-sized guest bed listening to the sound of cicadas chirruping in the humid summer night, an understanding of my mortality hit me like a wave. Nothing in particular inspired this feeling, but there it was, definite and staggering. Someday, I will die. A pit grew in my stomach, the edges of my vision went dark. I cried out for my mother and when she came to me I told her, sobbing, what I’d been thinking about. Ever the realist, she brushed back my hair and said, “Of course, sweetheart. We all will. But you won’t for a very long time, so try not to worry about it.”

I worried anyway. Throughout childhood, I probably obsessed about death more than the average kid considering I kept a folder on my computer’s desktop titled “In Case I Die.” (Naturally, it was full of terrible poetry to read at my funeral, letters to friends, and directives about who should inherit my book collection in case of my untimely demise.) It was twee more than practical, but when I was a teenager, several family members died without planning much—one after a battle with terminal disease, another more suddenly—leaving the rest of the family to deal with their possessions and unclear wishes amid our grief. I vowed I wouldn’t pass as they did.

Yet seriously thinking about my own mortality still terrified me, even years later as I got my start in journalism as a crime reporter and became inured to regularly reading grisly coroner’s reports. Eventually, it was time to face the music. I forget how I first learned of Death Café, but the concept hit on something I needed to explore.

Funeral Parlor

Like me, Louvain Rees’ interest in death changed after her father passed. Today, she’s a historian who studies death and remembrance in Welsh culture. Because there were no Death Cafés hosted near her in Wales, Rees will soon be hosting one of her own at St. Fagans National Museum of History, which will include handling sessions with the museums’ “mourning collection,” such as jewelry made from human hair. “I cannot say that I have fully accepted the inevitable,” she says, “but I am in the process of doing so.”

Discussing death can feel a bit like talking about a hangover while you’re still enjoying the party, yet it can be immensely liberating and help prioritize what’s important in life. Mooney, who grew up dreaming of being a mortician, hosted her first Death Café in 2013 and, since then, has helped kick off events in Hong Kong and Austin. A pivotal moment came when her death-avoidant father attended the first café she ever hosted. Soon after, he began picking out funeral songs. “Every time I got in the car, he played Patty Loveless’ ‘How Can I Help You Say Goodbye,'” she says. “From that, he planned his funeral, made health care directives, did everything.” Death Café not only helped him confront his own mortality, she says, but made things much easier for her when he passed away nine months ago.

“I started making some big changes in my life because I didn’t feel like I was being true to myself,” Mooney says. “I felt I was just existing in certain areas of my life.”

Likewise, attending Death Cafés have loosened something in me. I haven’t gotten over all of my fears, and that’s fine. Death Café doesn’t aim to eliminate existential dread; it’s just about opening dialogue about something we’ll all have to face someday. It’s eye-opening to walk into a room full of strangers and remember that you have one essential thing in common. I’ve always been the youngest one in the room at these meetings and, several times, people have come up to me at the end of meetings to commend me for it.

“You’re so young to be thinking about death,” one older woman said to me. “I wish I had done this at your age.”

Complete Article ↪HERE↩!

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Life of assisted dying advocate celebrated by hundreds

By Taryn Grant

People left their seats to dance and sing along to a live performance of “Mustang Sally” while servers waited in the next room, poised with champagne and chocolate-covered strawberries.

This was not your typical funeral.

Hundreds of family, friends, and members of the public turned out for Audrey Parker’s celebration of life.

Audrey Parker wanted her friends and family to be uplifted by the ceremony and so she planned every detail with that aim before she died on Nov. 1.

“She planned it and she knew that when we walked out of here today we would remember that life is supposed to be a celebration. This is a celebration of life, not just Audrey’s but all of ours,” said her friend Nancy Regan, the master of ceremonies.

Several hundred people gathered at Pier 21 on Friday afternoon to commemorate Parker, the 57-year-old Halifax woman who chose to die with medical assistance as she faced a terminal cancer diagnosis.

Many of the speakers mentioned how popular Parker was, with a large and adoring group of friends and a close-knit family who made up much of the crowd. But the ceremony was also open to the public, who came to know Parker in the final months of her life as she advocated for change in Canada’s assisted dying legislation.

Parker left two legacies: one for the people who knew her and were inspired by her exuberant kindness and another for those in the public who were spurred to take a closer look at a complex law.

“I’m gonna get a little political now, because I want to talk about Aud’s legacy,” said her friend Kimberley King, the last of seven speakers at Friday’s ceremony.

“Audrey knew that she wanted to be a spark, but she never imagined she’d be a national advocate,” King said.

Parker was diagnosed with Stage 4 breast cancer in 2016 and as her illness progressed she experienced excruciating pain from tumours in her bones. She was approved by a doctor for medical assistance in dying (MAID), but as it stands, the law stipulates that patients must give late-stage consent.

It’s a safeguard that’s meant to protect people in a vulnerable state — such as when their physical health and mental faculties may be failing — but Parker said that in her circumstance, all it did was cut her life even shorter.

“I really wish that we had her this Christmas,” said her stepdaughter, Lucie MacMaster, after reflecting at Friday’s ceremony on past holidays they’d shared.

“But here we are,” she added.

Parker chose Nov. 1 for her final day because she knew that she would still be able to give the necessary late-stage consent. The cancer has recently spread to the lining of her brain, and she worried that if she waited much longer, the opportunity would be lost.

Before she died, Parker called on Ottawa to amend MAID so that people like her could give advance consent for their own death. It could not be amended in time for her, but she asked the public to keep pushing for the change.

“She did her part, and now it’s our turn. In Audrey’s honour and memory, I ask you to continue to support her movement. We have an opportunity to amend a federal law so that people who are invoking MAID don’t need double consent and therefore don’t need to die early like our Audrey did,” said King.

The political response to Parker’s plea has been mixed.

Local MLA Darren Fisher has said he’d like to see the legislation go “a little bit further,” but Justice Minister Jody Wilson-Raybould disagreed, telling reporters the day after Parker’s death that there were no plans to change the two-year-old law.

Parker’s friend Robert Zed announced on Friday that there will soon be a permanent memorial for Parker in Halifax’s Point Pleasant Park. A steel bench is to be installed on Monday, facing out toward the water on Sailors Memorial Way.

Complete Article ↪HERE↩!

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A Dress Rehearsal for Death

We had started down the path of honoring our mother’s wish to have a good death until a hospice nurse figured out that she wasn’t really dying.

Monona Yin, right, with her mother, Fay Hoh Yin, and brother, Duncan Yin.

By Monona A. Yin

Three years ago, my family and I had the experience of going through a full “dress rehearsal” for my mother’s demise. At 83, she had become alarmingly weak from stage IV lymphoma and atrial fibrillation, and asked me and my brother to come home to Delaware for her next oncologist visit.

Mom had already undergone chemotherapy and cardioversion, so we knew there were few treatment options left. Still, we were utterly unprepared when the doctor said, “She probably has less than six months,” and recommended that she begin hospice care.

Widowed at just 37 with two small children, Mom has trained herself to face challenges without flinching. She is that rare Chinese elder who isn’t superstitious about mentioning or planning for her own death.

True to form, when we got home from the oncologist’s office, Mom sat us both down at the kitchen table to discuss her end-of-life wishes. She had witnessed two horrible lingering deaths up close — her mother’s and a longtime friend’s. What she feared most was pointless suffering and the loss of control over her own life. She wanted us to understand that, if she had little hope of recovery, she’d rather go quickly than fall apart slowly and painfully.

My brother, at the other extreme, wanted Mom to pursue every medical option, no matter how long the odds. He believed that doctors were fallible, there was always another treatment out there, and life was worth clinging to. And he couldn’t bear the thought of living without her.

Then there was me, torn between them. I had spent hours listening to Mom’s fears and understood them. A decade earlier, my mother-in-law had died with a feeding tube in her side while her oncologist suggested more surgery — after six months of wasting away from metastatic cancer. It would have been infinitely kinder to allow her to die peacefully in her own bed.

We had given my paternal grandmother just such a “good death.” We sat by her bed and told family stories as she slipped into unconsciousness. We turned away from the outside world and drew close to one another. All was quiet and time seemed to stop. Finally, we held her as she took her last breaths, letting her know how much we loved her but also letting her go. I remember that week as a thing of rare beauty. It taught me that dying well can be a balm and a blessing to all involved.

Recognizing the enormous gulf between those two scenarios, I supported Mom’s right to die on her own terms. Like my brother, I desperately wanted more time with my mother. Despite her failing body, Mom’s mind remained sharp. In recent years, our occasional mother-daughter tensions had subsided, leaving a much warmer and less complicated companionship.

After an emotional week of debate, we all agreed to bring Mom to New York for a second — and final — opinion from the world-class doctors at Memorial Sloan Kettering. If they too determined that nothing more could be done, we would accept the inevitable.

At Sloan Kettering, Mom went through the scans without incident but afterward her blood pressure dropped dangerously low and she was admitted as an inpatient.

By the next night, Mom could hardly breathe at all. It was agonizing to watch her gasping for air. She was terrified of suffocating and on the verge of panic. Finally, she pulled me close to say, “Tell them to stop everything.”

I had promised to honor her wishes, so I found a doctor and activated her D.N.R. In a few minutes, my husband, Steve, and our 14-year-old daughter, Maya, arrived and Mom couldn’t hold back her sobs. “I’m so sorry I won’t see you grow up! I’m sorry I won’t see you graduate or get married!”

We had all been coming to terms with Mom’s mortality for months but the shock and pain were still overwhelming.

Then something that seemed miraculous happened. A hospice nurse, Tracy Kahn, arrived and went in to check on Mom. She came back to tell us that she didn’t think Mom was going to die that night, the next night, or maybe for weeks.

Based on years of observing hospice patients, Tracy did not believe Mom was dying of cancer right then.

Instead, without our realizing it, her heart had been severely weakened by the cardioversion, which required high doses of a toxic drug. Almost two liters of fluid had accumulated in the lining of her right lung.

We immediately reversed the D.N.R. but it would be another 10 days before Mom grew strong enough to have the fluid drained. Over the next month, the hospital’s lymphoma, cardiology and pulmonary teams worked together to bring Mom back from the brink. They administered steroids, gave her blood transfusions, stabilized her immune system, optimized her diuretic and treated her infections.

Mom transferred to a rehabilitation center for another month, then came to live with me in Brooklyn. With our newfound sense of “now or never,” Mom and I fulfilled one of her longtime dreams. We edited and self-published her memoirs, which she’d been writing for years, and she’s enjoyed positive reviews from friends and strangers alike.

Today, Mom still wrestles with neuropathy, shortness of breath, and sometimes crushing fatigue — but she is very much alive. Even more amazing, she has been living on her own for the past two years.

We’ve had time to reflect upon our decisions, how we influenced one another, and what we’d do differently. My central insight is that it took all three of us to steer clear of the twin shoals of dying too soon and dying too late. We made better decisions because we listened to one another and weighed all the conflicting information. In hindsight, my mother acknowledges that she wanted to “pull the plug” too soon because she became overwhelmed by fear.

No one thinks clearly in the grip of panic. That’s why it’s so important to start talking long before the end. Not merely about what constitutes a good death but, more important, what makes even a diminished life worth living. As Atul Gawande writes in “Being Mortal,” “Our ultimate goal, after all, is not a good death but a good life to the very end.”

The end-of-life conversation is equally important to both sides — the dying person and the survivors. One of my mother’s greatest comforts is knowing that her children understand her wishes and will honor them. We proved that during the dress rehearsal.

Only recently have Mom and I realized how much it cost me to be her health care proxy, rather than a grieving daughter who wanted to do anything to save her mother. I’m still going to be torn between those two roles “the next time” but simply being aware of that inner conflict helps mitigate it. And Mom’s future decisions will be informed by all the joy she would have missed had she died that night in late 2015.

Complete Article ↪HERE↩!

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‘Remember you will die’ – and 11 other tips for a better death

Hundreds of thousands of people have already discussed the last great taboo at one of Michael Hebb’s ‘death dinners’. Here he offers some advice for the rest of us

By

Two things preoccupy the US writer Michael Hebb – food and death – and he has managed to combine them in his new book, Let’s Talk About Death Over Dinner. It is the product of an idea he had five years ago when he set up an organisation called Death Over Dinner, whose goal was to bring disparate (and sometimes desperate) people together over an informal meal to talk about what is so often a taboo subject. Since then there have been more than 200,000 “death dinners” all over the world. The new book charts the gentle revolution Hebb initiated, as well as offering prompts for readers who want to organise their own death dinners and guidance on coming to terms with the loss of family and friends, and with our own mortality. No one, after all, is going to get out of this alive.

“The way we die in western society is broken,” says Hebb. Now 42, he was 13 when his father died, leaving a gap that he felt his mother and immediate family were unable to properly address. “I had a hunch that open conversation about our end-of-life wishes could be the most impactful thing we could do to heal that system and to heal the way we die. We are death-illiterate, and when we don’t discuss death we are not empowered to make decisions.” In a long phone conversation from his home in Seattle, he spells out his philosophy for dealing with dying. You may not be able to conquer death, but you can at least exercise some control over how it happens.

1. Remember you will die

Hebb says we have “ingrained cognitive bias” not to talk about death because we don’t really believe in our own mortality. “We believe we are an exception to basic rules,” he says. “If we haven’t experienced something, it’s hard to know it or to discuss it.” But there are no exceptions, and sooner or later you will have to confront it.

2. Talk now, not later

“Death is a reality for all of us,” Hebb says. “How prepared do we want to be? How comfortable? How much grace do we want to have in the face of it?” He argues that it is better to talk about death when you are well than when you or your parents or other members of your family are terminally ill. “Thinking and talking about death can identify how you want to live,” he says. “If we haven’t made ourselves comfortable with this conversation, we end up being oppressed by it.”

3. It’s not true that you die alone

Before talking to Hebb, I was doubtful that the living could relate meaningfully to the dying. My father died last year and, in the five months that were left to him after he was diagnosed with terminal cancer, I found it hard to find the right words to address what was happening to him or to know how to use what limited time we had together. Everyone, I surmised, had to face death alone, to make their own peace, but Hebb disagrees. “Dying is a realm with no experts, but my sense is that you can reduce the suffering of those who are dying by being as present as possible to them. A lot of people already start dying when they’re diagnosed, but you can live while dying. There is much to be gained from being present until the final chapter. It has the potential for deep connection. I’m not going to gleefully state that dying is a happy time, but I do know that people grieve longer when they don’t know how to honour the person who has died.”

4. Where there’s a will there’s a way

“Statistics show we are very unprepared for death,” says Hebb. “Most people don’t have their end-of-life documents in order.” Sixty per cent of adults in the UK have not made a will; in the US, that figure is 57%. For Hebb, this isn’t just foolish at a practical level; it suggests an unwillingness to talk about death at all. “The documents are important, but more important are the nuanced conversations. If somebody is going to be your health proxy or advocate for you when you are unwell, you want them to have more than just a signed legal document. You want that person to have an entire forest of information about how you feel about end of life.” He says that if you give someone power of attorney to conduct your affairs in the event of you becoming incapacitated, you need to make sure that person really understands you. Spell out exactly what you want in terms of end-of-life care, perhaps through an advance care directive or a living will; do not assume your proxies will make the right calls.

5. Decide what sort of funeral you want

Specifying what you want in terms of your funeral and disposal of your body can be important to the dying. But it may be even more important to the grieving family. “If it makes somebody’s last years more peaceful knowing that their wishes will be fulfilled, then fantastic, but communication is really a gift to the people you leave behind. It’s an important element of the moving through and getting on with their lives.” Making it clear that you do not want a gun carriage pulled by six white horses, or choosing a cardboard coffin rather than a fancy mahogany one with brass handles, can also save a fortune and keep relatives out of the clutches of funeral directors who may be tempted to oversell. How much is spent on a funeral is not a measure of the love felt for the departed.

6. Think about your legacy

Fretting about your legacy seems to me a pointless act of ego, but Hebb disagrees. “Many people do work in this world that they want to extend beyond their death. Some of that can be seen as ego, but some of it is humanitarian in nature, and I think it’s OK to want to have a continuing impact. If that’s what gives your life meaning, I’d say embrace it.” Above all, though, he says, don’t make your legacy suffering and confusion. “You will have a legacy. Everybody has a legacy. So often in families when these things aren’t discussed, there is infighting. For me, it’s not enough to say child A, B and C gets X, Y and Z; if they can have some understanding around your decisions, it’s less likely to haunt them.”

7. Be ready to talk to children about death …

You should involve children in your conversations about death, with one proviso – that you go at the pace they set. “My older daughter is interested in the topic,” Hebb says, “but my younger daughter has zero interest and I feel bad for her that her father is the death guy, so I don’t force it on her. But if a child is interested in, curious about, scared of or ruminating on death, it is of great benefit to meet them in their curiosity or concern or fear. It’s also a great way to know your child better.”

8. … And be there for bereaved parents

“We are often afraid to bring up death in the presence of parents who have lost children,” says Hebb. “It’s an unimaginable amount of grief for lots of us. But if we want to stay connected to those people, it’s imperative we engage with them because it is certainly in their thoughts and dreams all the time.” He says many people also lose friends when they lose children because those friends are too frightened to discuss the subject and the relationship breaks down.

9. God makes little difference

You would think belief in an afterlife would make the pain of dying less, but Hebb is sceptical. “Faith plays a role, but it isn’t as central as you would think. Grief will exist regardless of whether or not people have faith. If that’s an excuse not to have the conversation, you’re not doing yourself any favours.”

10. Accept that caring for the dying is hard

People who are dying fret about being a burden on their friends and family, while carers feel they have to be perfect and never show frustration or exhaustion. Hebb says both should be honest about any resentment they feel. “Care-givers should feel they have permission to have all these conflicting emotions,” he says. “If the person thinks they are the only one who feels this way, that’s much more traumatic than realising that it’s OK to resent the person you’re taking care of. ”

11. Death is not a medical act

Like others who have written about death, notably Atul Gawande in his book Being Mortal, Hebb emphasises that death is a human and community event, not a medical event. “Medicine is what keeps you alive and that’s what doctors are focused on,” Hebb says. “We have to reclaim the death part. Don’t leave it in the hands of tacticians.” He praises a project at the Cleveland Clinic called “The Pause” where the medical team gather round the bedside of a person who has just died to have a moment of silence and then share their recollections of the patient. It is not merely a medical failure to be recorded and a body to be disposed of; it is a life and a person to be honoured.

12. There are no rules for grieving

Finally, Hebb says, it is impossible to systematise grief. “Every case, every person, every situation is different. We should give ourselves permission to grieve in precisely the way we need to.” If you beat yourself up for the way you are grieving, you will only lengthen and deepen your grief.

Complete Article ↪HERE↩!

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Dia de los Muertos (Day Of The Dead) 2018

More than 500 years ago, when the Spanish Conquistadors landed in what is now Mexico, they encountered natives practicing a ritual that seemed to mock death.

It was a ritual the indigenous people had been practicing at least 3,000 years. A ritual the Spaniards would try unsuccessfully to eradicate.

A ritual known today as Dia de los Muertos, or Day of the Dead.

The ritual is celebrated in Mexico and certain parts of the United States. Although the ritual has since been merged with Catholic theology, it still maintains the basic principles of the Aztec ritual, such as the use of skulls.

Today, people don wooden skull masks called calacas and dance in honor of their deceased relatives. The wooden skulls are also placed on altars that are dedicated to the dead. Sugar skulls, made with the names of the dead person on the forehead, are eaten by a relative or friend, according to Mary J. Adrade, who has written three books on the ritual.

The Aztecs and other Meso-American civilizations kept skulls as trophies and displayed them during the ritual. The skulls were used to symbolize death and rebirth.

The skulls were used to honor the dead, whom the Aztecs and other Meso-American civilizations believed came back to visit during the monthlong ritual.

Unlike the Spaniards, who viewed death as the end of life, the natives viewed it as the continuation of life. Instead of fearing death, they embraced it. To them, life was a dream and only in death did they become truly awake.

“The pre-Hispanic people honored duality as being dynamic,” said Christina Gonzalez, senior lecturer on Hispanic issues at Arizona State University. “They didn’t separate death from pain, wealth from poverty like they did in Western cultures.”

However, the Spaniards considered the ritual to be sacrilegious. They perceived the indigenous people to be barbaric and pagan.

In their attempts to convert them to Catholicism, the Spaniards tried to kill the ritual.

But like the old Aztec spirits, the ritual refused to die.

To make the ritual more Christian, the Spaniards moved it so it coincided with All Saints’ Day and All Souls’ Day (Nov. 1 and 2), which is when it is celebrated today.

Previously it fell on the ninth month of the Aztec Solar Calendar, approximately the beginning of August, and was celebrated for the entire month. Festivities were presided over by the goddess Mictecacihuatl. The goddess, known as “Lady of the Dead,” was believed to have died at birth, Andrade said.

Today, Day of the Dead is celebrated in Mexico and in certain parts of the United States and Central America.

“It’s celebrated different depending on where you go,” Gonzalez said.

In rural Mexico, people visit the cemetery where their loved ones are buried. They decorate gravesites with marigold flowers and candles. They bring toys for dead children and bottles of tequila to adults. They sit on picnic blankets next to gravesites and eat the favorite food of their loved ones.

In Guadalupe, the ritual is celebrated much like it is in rural Mexico.

“Here the people spend the day in the cemetery,” said Esther Cota, the parish secretary at the Our Lady of Guadalupe Church. “The graves are decorated real pretty by the people.”

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Talking about death with those who are ill is sometimes the kindest thing we can do

If it is true that death and taxes are the only two certainties in life, it is astonishing how much we readily discuss the latter, but often shy away from the former

There are also many patients who simply want to know what will happen to them as their final days approach

By Jonathan Romain

It is the ultimate question that many of us will have to face one day: do we want to be told that we are dying, or would we prefer to be kept in ignorance?

If it is true that death and taxes are the only two certainties in life, it is astonishing how much we readily discuss the latter, but often shy away from the former.

Perhaps even more surprising is that those professionally qualified to deal with death are equally tongue-tied. This has just been revealed in a Royal College of Physicians’s report, which says that doctors are reluctant to talk about death with patients.

This is a dereliction of duty. As a congregational minister who regularly has to visit those who are seriously ill, it is very clear that some patients would benefit from knowing they are nearing the end of their life

It might be that they wish to sort out their affairs – like Derek, who had never written a will but was prompted to do so by the thought of his demise; or Sandra, who had written one, but it was over 30 years old and needed radical changes.

Alternatively, thoughts of imminent departure can lead to important conversations, whether telling loved ones how much they mean to the person, or, as with Beatrice, contacting the sister with whom she had not spoken for 12 years, and effecting a reconciliation.

There are also many patients who simply want to know what will happen to them as their final days approach. They may be fearful, but it is often not so much of death itself, but of dying and the process that they will experience. Talking about it, and the pain relief on offer, can be very reassuring. It can also allow them time to contact organisations such as Compassion in Dying, which provides support for both them and their families.

Of course, doctors also need to know when not to discuss death, for there are patients who prefer not to be informed. If they wish to take the attitude that “ignorance is bliss” and clearly mean it, then why disturb that bliss?

One of my own relatives had a phobia about death. Whilst a long period of therapy might have uncovered his reasons and allayed his fears, telling him he was going to die a few days before the event, was not appropriate.

How do you know if a person really does or does not want to know the truth about their condition? It can be hard, as long-held views can change when confronted with the reality of death. Asking the patient directly but obliquely is one option, such as: “Is there anything you’d like to discuss or talk about?”, and letting them give a signal either way.

The new report begs the question of why many doctors have been so unwilling to tackle the issue until now. It could be lack of training – which should be rectified as a matter of urgency. It might be their own personal anxieties about death, which should also be addressed before qualifying.

Perhaps it is a worry that, if they do open up the subject with patients, then, unlike mentioning a prescription, it is a conversation that could take half an hour – time they do not have, yet which should be considered an important part of patient care.

There may also be the feeling that death is a failure on their part, seeing their job as to keep patients alive, and a reluctance to admit they cannot help any further. Although admirable, this is misguided, for death can be a natural outcome of a life long lived, or the inevitable consequence of the way it was lived.

It is good that doctors do not want to let patients down, but they may be inadvertently doing so by not talking about death.

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