— ‘If you want to die well, then first – live well’

Over the past 15 long months, the pernicious effects of a contagious microscopic pathogen have taught us a lot about the state of relationships in our world, in our families and communities.

By Sean O’Connor

If used as a kind of illuminating lens, to paraphrase the Ugandan priest Gideon Byamugisha when discussing what HIV and Aids can teach us, Covid-19 shows us where our relationships are weak and where they are strong, it shows us where they are corrupt or broken and where they need mending.

Power relationships and patterns of privilege have become especially visible. In this sense, Covid-19 has shone a light on the unequal ways that many of us live in relation to each other. It has also highlighted the “unnatural” ways that many people have died, behind closed doors, away from home and without their loved ones who are unable to say goodbye, complicating their bereavement. Our experience with Covid-19 has shone a light on the end of life, for many a light that has been obscured for a long time, through a combination of mainstream death denial and a prevailing feeling, perhaps, that to die means that you have somehow failed to stay alive – that death itself is antithetical to life.

Just as Covid has revealed some of the uglier sides of human nature, with predictable fear and distrust and a swirl of conspiracy and corruption, so too in many places has it highlighted our resilience and compassion, and our status as social animals who need each other not just for survival but for our mental and spiritual wellbeing.

I feel that it has taught us to value those we love for death can take them at any time, just as it always could, just as it has taken so many. (Multiply the number of global dead by five or six to get an index of active grief visited upon the world right now. That is a true index of suffering, I believe, and not the bald statistics of lives lost.)

For many millions grieving, their grief has been attenuated, disrupted, titrated into what is permissible and what is not under lockdown regulations. For millions and millions of people, this experience of loss has caused us to look at death more closely and invited us to consider how we ourselves might wish to die one day. For the privileged, Covid-19 may have slowed things down, and for those who can afford to ask the question, invited people to ask what they want from life, beyond the task of mere survival.

The lens provided by Covid-19 has also brought into focus this nascent idea of having “a good death”, whatever that means. It is this idea, which is both absolutely necessary and deeply flawed, I believe, that holds the possibility of heralding a healthy interrogation of mortality and what it means to cherish life, and what it means to fear death, too.

But it also romanticises death and encourages us to feel that we can expire on our terms, which is mostly not the case. It’s not about the elegant fluttering of a white handkerchief and aptly chosen final words. Just like birth, which can also be beautiful, I happily concede, I suspect that death is usually a bit of a messy struggle, and like birth, more associated with bodily fluids and end of pain.

Still, “what is a good death, and how could you increase your chances of having one?” was a popular discussion point at the Death Cafes I gained so much from attending. I liked to say my father had one – quick, and in a place he loved, after saying he was ready to go and had enjoyed a wonderful life. He was 67. Some people pulled in their breath when they heard that. Certainly, I’ve heard of painful deaths, drawn-out deaths, and others – sad deaths, horrible deaths, and deaths that are extremely difficult for the living, or the dying, to accept.

How are we to die? Do we have any choice in the matter? This question is animating legislators and activists locally and abroad, as they revisit laws to compass or deny the quite reasonable, in my opinion, perspectives of the “right to die with dignity” movement. At present, it seems that many governments around the world, ours included, simply do not trust their subjects to make the informed choices that are in their best interests. For now, however, I will skirt this rather vexed issue and instead indulge in a quick survey of available resources on this idea of a “good death”, and for this, invite you back quite some way.

Ars moriendi (The Art of Dying) was originally published in Latin as two related texts, a longer and a shorter, in around 1415 and 1450, and gave advice on how to “die well” according to Medieval Christian precepts. It appeared in more than 100 editions in most Western European languages. It’s an early example of “death lit”, traceable back from the present, a genre that seems to be having a bit of a moment right now with personal accounts of loss and reflections on mortality high on the bestseller lists – Atul Gawande’s Being Mortal being the most obvious (and excellent) example.

Originally written by an unknown Dominican friar in the aftermath of the Black Death (which halved Europe’s population), and within the profound social, religious and political upheaval of the Middle Ages, the Ars moriendi might be seen as evidence of a shift in the way people experienced and understood death. No doubt this genre is set to explode, given our collective experience of grief in these times.

The Ars moriendi were recently updated, signalling another shift. The Catholic Church has done so to “assist terminally ill people and their loved ones deal with death”, according to this article in The Guardian. The Art of Dying Well website includes animations with a voiceover by Vanessa Redgrave, who is said to have had a stiff brush with mortality and a wish to die after health complications. A slew of other books and articles entitled The Art of Dying clog the digital ether.

Is dying really an art then?

I guess it depends on what you think art is. Perhaps the simplest definition involves the idea of “skill” in grasping the world, and that whatever art is, it’s quintessentially human. As a reflection of human experience then it is subject to notions of value, as good or bad, worthwhile or not. So, can dying be an art? Can it be skillful, if it is so utterly happenstance and beyond our control, and also so banal – so normal – that every single one of us does it?

Implicit in these and other more conventional understandings of death, however, as well as this idea of a “good death” and dying as an “art”, is the veiled assumption that death is some sort of final performance. In one sense only is this true. But death is not just an occurrence, I think.

Certainly, the idea of a “good death” has gained in mainstream popularity and become widely aspired to. It was a feature article in a recent issue of Fair Lady magazine. This I understand as a natural backlash to a prevailing culture of death denial, of avoiding death at any costs, which is shifting, as people everywhere tire of the false and dehumanising promises of the consumer capitalism and recoil at the same time from the scientific tendency for overmedicalisation (is that a Scrabble word?) at the end of life. Still, in our own peri-Western culture, suffused as it is with a plurality of local African and other belief structures, death remains very much a taboo and what my friend Peter Fox calls “an unwelcome visitor”.

In a useful little online essay, “The Dangerous Myth of a Good Death”, blogger and nurse Kathleen Clohessy quotes from Frank Ostaseski’s lovely treatise, The Five Invitations: What Death Can Teach us about Living Fully. He says: “We treasure the romantic hope that when people pass away, everything will be tied up neatly. All problems will have been resolved, and they will be utterly at peace. But this happens rarely. Very few people walk toward the immense challenge of dying and find peace and beauty there… who are we to say how another should die?”

I think this is the risk inherent in ideas of a “good death” – that it’s up to the dying person to do it well, or not, imposing some kind of value judgement on it. Think of all those people you’ve met, bleating “but oh, I’m not creative at all!” now being informed that their dying was meant to be done with artful skill, done well. Wasn’t school hard enough, relationships, and all the rest? Now we must excel at death too?

Clohessy writes: “Placing expectations on the dying is an easy mistake to make. But when we do so, we limit our ability to open our hearts to what is happening and be truly present with the person who is making the journey in the here and now… When we impose our beliefs about what death ‘should’ look like on someone who is dying, we deny them unconditional love and acceptance they need and deserve.”

So, calling death an art may well make things more difficult. This is not to say one should not prepare for death – by all and every means, prepare for the inevitable by talking about it and doing what you can to make it easier for you and your loved ones. Complete your advanced-care directive and fill in your organ donor card, update your will and try to find peace. Speculate about your death with the people you love no matter how hard that might be and let them know how you wish to be disposed of and how to be remembered.

Perhaps it’s simply about doing death better. The “death positive” movement, with the redoubtable Caitlin Doughty, possibly the world’s most popular mortician as its high priestess, is a growing community that has some really useful things to say about this in a manifesto of sorts on its website. The Order of The Good Death, which she co-founded, has a mission to “make death a part of your life”.

Implicit in these and other more conventional understandings of death, however, as well as this idea of a “good death” and dying as an “art”, is the veiled assumption that death is some sort of final performance. In one sense only is this true. But death is not just an occurrence, I think.

Instead of seeing it as “the end”, my discovery, which is hardly unique, is that consciousness of it provides the means to live a full life. Without wishing to intrude on the province of the suffering, I understand that I am already dying, and that every day death is with me. It is in every cell of skin that falls from me, in each expiring blood cell that perishes within. I’m slowly dying, inside and out. Death surrounds me and I am in it and with it, as much as I am alive and in life too. It is in the grief of my friends, in my own grief, too. In my own dying I find my vitality. Death sharpens my appreciation of life.

So it’s a lifelong process, this dying shtick, kicked off at the moment of birth. Carl Jung reminds us that “life is a short pause between two great mysteries. Beware of those who offer answers.” Perhaps it’s a voracious scientific urge towards a complete system of knowledge that wants to dominate this unknown province, this final mystery – in fact, to cheat it, to perhaps even bypass it entirely – the next big tech “disruption”.

Gimme a break! I do well to remember that death is a mystery and something that mystifies. It’s also easy to theorise and extrapolate upon. Until it happens to oneself.

Consideration of death immediately brings life into focus. But a good death? An artful expiration? If you really must have one, then, to paraphrase Dr Kathryn Mannix, a palliative care doctor and author, if you want to die well, then first – live well.

That’s about as much as one can do, I think.

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