— End of life care can be varied, holistic, and filled with love. We look at two end of life services – hospices and end of life doulas – that show how medical, emotional, and spiritual needs can be looked after in different settings.
What is end of life care and what is palliative care?
There’s a lot of confusion around palliative and end of life care. For starters, although related these two terms do not describe the same thing – they are distinct.
Receiving palliative care doesn’t neccesarily mean you’re dying – rather that this kind of care is for people with incurable diseases, many of whom could or will live for many more years or decades. It’s about making life as manageable and as good as it can be.
End of life care is a form of palliative care you are given when you’re approaching end of life – it offers support and is wide-ranging and holistic.
When does end of life care start?
From a healthcare perspective, end of life care may be recommended if you are likely to die within the next 12 months, although this can sometimes be hard for doctors to accurately predict. End of life care may last a few hours, days, weeks, months, or sometimes more than a year – the only rule is that it begins when you need it.
Who provides end of life care?
End of life care doesn’t just take place in a hospital or hospice with doctors and nurses. Depending on your needs and care plan, you could receive various forms of this care at home, over the phone, or at specialist day centres. A whole host of specialists and non-specialists can deliver end of life care.
Specialists include palliative care physicians and nurses – such as Marie Curie and Macmillan nurses – but also counsellors, social workers, bereavement therapists, speech therapists, religious or spiritual carers, and many others.
Non-specialists are made up of people in your community who have different roles to play in your care. These include district and practice nurses, GPs, and pharmacists.
This should give an idea of how varied and personalised end of life care services can be.
What services are available for end of life care?
Here we take a look at two important forms of care that showcase the range of services available.
Hospices – hospices are specialised healthcare spaces for palliative and end of life support. Yet, hospice care extends beyond hospice beds and medical treatment.
End of life doulas – outside of your medical needs, doulas offer emotional and spiritual care, and they can do this inside or outside of the hospice setting.
Spotlight on: hospice care
In hospices, specialist palliative and end of life care is delivered by a multi-disciplinary team, made up of people who have different roles in a person’s care. This includes doctors, nurses, physiotherapists, occupational therapists, complementary therapists, counsellors and chaplains.
Jodie Morris is deputy director of nursing and care at Myton Hospice. She explains how hospices offer so much more than medical treatment:
“Hospices are happy places full of love and laughter where families can create special memories and spend quality time with their loved ones. This isn’t just about medicine – it’s about whatever is important to the patient and their family and friends. We take a holistic approach and see the person – not their illness.
“At Myton, we provide support right from the moment a person is told that their illness cannot be cured until the very end of life. We provide this free service in our three hospices, in the community via our Myton at home service, and as an outpatient service:
Our outpatient services – help people to live well for longer with their terminal illness. This may include advance care planning, counselling, lymphoedema therapy, complementary therapy such as massage for relaxation, physiotherapy, and occupational therapy.
Our hospice inpatient services – provide symptom control and end of life care.
Our hospice at home services – provide care and support for people in their own homes in the last weeks and days of life.
Our bereavement support – looks after the wellbeing of family and friends after their loved one has passed.
Going the extra mile
Jodie goes on to describe how the staff and volunteers at Myton go the extra mile to look after the wellbeing of their patients, welcoming beloved pets and arranging birthday celebrations, weddings and christenings at their hospices, often at very short notice.
Kerry and David’s Myton Wedding
David Black was admitted to Coventry Myton Hospice on Friday 13th May 2022 and less than 24 hours later he and his wife Kerry had their wedding at the hospice. On hearing the couple’s plans to marry, Myton staff and volunteers pulled out all the stops to arrange decorations, food, and refreshments to ensure they had the best possible day making precious memories. They were surrounded by close family members and their two sons, Fergus now aged 10 and Alfie, 7. David sadly died aged just 41, one week after being admitted to Myton.
Kerry said: “Alfie and Fergus were so excited to see us get married and I’m so pleased that they have such happy memories of the hospice. Their faces say it all and for that I will be forever thankful to Myton.”
Kerry and David’s wedding
Spotlight on: an end of life doula
An end of life doula, sometimes called a death doula or death midwife, is a non-medical specialist trained to provide emotional and spiritual support to terminally ill people. According to the International End of Life Doula Association, a doula “holds the space for the kind of dying experience that honours who the person is and has been in their life.”1
Alessandra Olanow is a trained end of life doula and author of Hello Grief: I’ll be Right with You. She explains how a doula can be a comforting and positive presence:
“Doulas are there to allow the dying person to be who they are, and to allow them to be more than old or sick. A doula listens deeply to the concerns, fears, hopes, and life stories of the dying person and their loved ones to bring them peace at the end of life.”
There are many things a doula can do, including:
Being a companion and source of comfort.
Offering emotional support to the care recipient and their loved ones.
Have conversations that help death seem less scary and lonely.
Providing practical support – for example, walking the dog, providing care, preparing meals, and running errands.
Being a point of contact for the other care teams.
Enabling family carers to take a break.
Advocating for the care recipient’s wishes – for example, making sure the desired religious or cultural rituals are followed during end of life or after death.
Doulas can visit people at home, or in a facility such as a hospice or nursing home. Alessandra volunteers on the palliative care floor of a New York hospital. She adds that training as an end of life doula has helped her appreciate living: “I used to avoid thinking about death and dying; it was just this fearful thing. Now, I choose to live my life with an understanding that every single day is a gift.”
Alessandra’s advice for coping with loss
If your loved one is approaching death, an end of life doula needn’t disappear the moment they have passed on. They can also support you through your grief, offering guidance and comfort.
Alessandra shares this advice from her experience helping with grief: “Allow yourself the time and space you need without expectation. There is a misconception that grief has a timeline and that there is a certain way to grieve. But there isn’t. Everyone grieves at their own pace and that is ok.
“It can be helpful to have a creative outlet to express overwhelming feelings of loss. When I first lost my mother, I began to draw my feelings – these drawings became my book, Hello Grief. I hope it helps others to process their own grief.”
Nicole Chung is a SlateCare and Feeding columnist and the author of the new memoir A Living Remedy,from which this essay was adapted.
There are so many things you do for a person after they die, things they don’t need—the living do. Rituals, memorial services, acts of public mourning are all ways of honoring the person we loved, intended to bring us comfort as well. After my father died, I welcomed the chance to work on his obituary, look for photos for the memorial display, find something suitable for my children to wear to the funeral. I even found some strange consolation in my attempts to explain the unexplainable to them, because these were all duties to manage, tasks I could do. As long as I had responsibilities, I didn’t have to sit with the wrathful stillness of grief.
In the end, however, there were few preparations to throw myself into once I got home to Oregon, because my parents’ friends were already hard at work on their behalf. In their hands, the service and burial would be exactly what my mother wanted. The choir knew their parts by heart. There was no need to hire a caterer, because everyone was bringing a dish to share. A craftsman in the parish was working on the casket and refused to accept payment for it.
A number of items went into my father’s casket to be buried with him: a cross, also made of wood and small enough to fit in one of his hands; a white cloth draped across his forehead, representing the crown of victory he had earned for running his earthly race, adorned with the prayer Holy God, Holy Mighty, Holy Immortal, have mercy on us; and an icon of the Ladder of Divine Ascent, a 12th-century monk’s rendering of St. John Climacus’ treatise on the 30 steps monastics might progress along in order to reach Christ, who awaits the faithful at the summit, his once-pierced hands outstretched.
I had never been to an Orthodox Christian funeral before, but my mother had told me it was a beautiful liturgy. With my father’s siblings unable to travel and my mother’s largely absent, it was their parish community that drew together to mourn and bury him. Many people approached before the service to tell me how much they had loved my father. As happens at all open-casket funerals, everyone told my mother that Dad looked really good for being dead. “They did a great job on him,” she agreed.
During the service, my parents’ priest spoke of the daily pain Dad had lived with and how, in the end, he’d allowed this suffering to bring him closer to God. Of course, he couldn’t know the day or the hour.But he knew he would soon meet our Lord, and he prepared for that meeting. This, he concluded, is why my father ultimately knew peace at his death: It did not find him unready.
If that was true, I thought, why hadn’t my mother and I known? Had my father truly spent the past weeks, maybe even months, preparing to die? If he’d known his death was imminent, why didn’t he warn us? I stared at him in his casket, and the sudden flare of anger I felt was so unlike sorrow that I let myself take momentary refuge in it. If you really knew and didn’t tell us, that was a real dick move, Dad.
When we approached to say our final goodbyes, Mom put her arm around my shoulders, her solid warmth a familiar comfort. “Don’t despair,” she told me. “This is our hope in the resurrection.” The words might have upset me coming from anyone else in that church, anyone else in the world. But I felt her sorrow as something deeper and more powerful than my own, and couldn’t help but feel awed by her abiding faith in what she saw as my father’s victory over death. She was a warrior, even in grief.
Though raised in a devout Catholic family, I was no longer a regular Sunday churchgoer. There were too many things that I felt ambivalent about or disagreed with altogether. And as I get older, I’ve found that there are some answers I don’t need. I can’t say whether I will ever again feel as certain of anything as my parents were of the mercy of God or the promise of heaven. But it’s also true that the faith you’re raised in can still move fathoms below the surface, even when your relationship to it has changed beyond recognition. As I held my mother’s hand at the cemetery, watching my father’s casket disappear beneath a layer of earth, perhaps I shouldn’t have been so surprised to feel the old belief stir, bearing me up like a strong current, as undeniable as it was unseen.
My parents became Orthodox Christians after I had left home. My mother converted first—I think my father was less inclined than she to commit his time and energy to another church that might prove unworthy; plus, he liked having his Sundays free, especially during football season. Eventually Mom got tired of going to church alone. You need to find some church that’ll bury you when the time comes, you know.
The first time Dad went with her to church, he halted at the entrance, causing my mother to run into him and ask what he’d seen. He pointed to an icon above the door, one of dozens that filled the walls. “I’ve seen that before!” It was an icon of the Ladder of Divine Ascent. Mom, a recent but fervent devotee of iconography, started to explain its origins, but he interrupted. “I don’t mean I’ve seen the icon before. I mean, I’ve seen that ladder. I saw it right after we moved here.”
She stared at him. “What are you talking about?”
After my parents moved to the area, they would often spend their days off driving with no particular destination in mind, getting to know the landscape. One afternoon they were heading home from somewhere far out in the country, the region’s tallest mountain in full view, when my father glimpsed a ladder beside it, partially hidden by clouds encircling the peak. If he squinted, he could see tiny figures clinging to the rungs, some slowly ascending while others stumbled and fell. He watched in wonder for a few seconds, but when he blinked, the ladder had disappeared.
He didn’t have an explanation for what he’d seen, couldn’t begin to guess what it meant, so he never told anyone. Not until some 30 years later, when, entering a mission church housed in a storefront, he encountered an icon written by a long-dead monk at a monastery on Mount Sinai. “That’s what I saw on the mountain when we were driving home all those years ago,” he said to my mother, who was still looking at him in astonishment. “That’s my ladder.”
Written for monastics and studied by laypeople as well, St. John Climacus’ Ladder of Divine Ascent is an allegorical model of the Christian journey to holiness. The 30 rungs of his ladder represent 30 steps: passions to be mastered, vices to conquer, virtues to attain. Among the virtues extolled is “remembrance of death,” which, he asserted, should inspire us to live as God would wish and do as much good as we can.
“Just as the Fathers lay down that perfect love is free from falls,” he wrote, “so I for my part declare that a perfect sense of death is free from fear. … It is impossible, someone says, impossible to spend the present day devoutly unless we regard it as the last of our whole life.” It’s a charge that reminds me of the old Ash Wednesday exhortation: Remember, man, you are dust, and to dust you shall return. In the Christian sense, these are calls to repentance, but one can also read them as invitations to surrender: to accept our limitations and our mortality; to be prepared, not consumed with clawing fear, for our life’s eventual end; to focus on doing good and not harm, because any day could be our last.
After my father’s death, my mother told me she believed that he often perceived things she could not. She said he was able to grasp certain matters at an instinctive level, to accept them on faith, whereas she was always quick to question or feel frustrated by that which she could not immediately understand. Perhaps this also proved true in my father’s final months: She railed against his illnesses, resented them, as you do when someone you love is suffering. He struggled as well, and maybe at times even despaired, but I think, of the three of us, he was the quickest to understand and accept what would happen. He had to have been feeling his worst in the weeks before he died, yet when we spoke, he seemed so calm that I could almost forget how much he was enduring.
I couldn’t understand it after he died, of course, but then I am much more like my mother: I hated that he was in pain, blamed myself for not being able to help, yet could never manage to convince myself that he would die. If he had told me he was about to die but did not dread it—because he was “remembering death,” or because he had somehow found strength in something far beyond his own fear—I would not have wanted to hear him. I would have wanted him to fight. I would have denied him that peace until the end.
Maybe our refusal to accept his suffering, accept what it meant, is why he didn’t see fit to tell my mother and me. Or maybe, she later theorized, laughing and crying at once, he wanted to spare us the knowledge: It might have been the one truly noble act of his life.
By then, I was afraid of losing her, too. I didn’t know what to believe. I still don’t know what I want to believe. In my memory, my father wasn’t prone to hiding the truth in order to comfort others. But neither was he prone to visions. Was it really there, the ladder he saw that day, propped up against the snowcapped summit? Of course it wasn’t. I am sure that he imagined it. But I can’t claim to know what it means that he did.
The fact of our mortality is something we don’t like and tend to avoid. The face of death is one that drives our inner gaze away to livelier subjects should we happen to glance at it with our mind’s eye at odd moments, perhaps during the deep quietness of the 3am sleep-slipped nowhere time. But death, loss, and grief are all too insistent a part of life, despite our most fervent desire that it should be otherwise. How we face this inevitability, and the means for doing so, is the subject of this collection of philosophical essays by a range of scholars and thinkers. As always with a collection of this kind, there are some that succeed more than others, but the parts just about cohere into a whole that considers the meaning of mourning: what it is, how we perceive and practice it, and where it leaves us in the absence of the one who is gone, all of which help prepare us, even if only in a small way, for the day when the grey rain curtain of the world pulls away, and we step onto the new path.
Setting the Scene and Defining Terms
The collection spans fifteen essays from various disciplines and perspectives. The editor, Slawkoski-Rode, writes in the introduction that “while the collection is not designed to serve as a comprehensive study or companion, it assumes a holistic, interdisciplinary approach to the theme of mourning that combines philosophy, theology, psychology, medical science, and the arts.” The Introduction notes the universality but also the religious, cultural, and ethnic particularity of mourning and defines mourning briefly as “the public display of grief caused by the loss of a loved one.” As the introduction notes, the following chapters “invoke … the idea of mourning in a broad sense, which goes beyond” this definition.
Several of the chapters defined the matter of mourning in a more specific way. One is found in the chapter “Mourning: A Phenomenology,” where “Mourning, to put it simply, is the intentional structure of the extreme loss, especially death, while death is the material core of this intentional structure.” Another chapter, “Meaning and the Recognition of Value,” defines “grief as a kind of strong negative emotional response to loss, and mourning as a somewhat wider concept encompassing grief as well as patterns of behavior that manifest or are influenced by such grief.”
Mourning thus articulates and gives shape to the inchoate, roiling sea of grief that roars through the hearts of those in its grasp. Mourning, properly understood and practiced, is a beacon signalling the way to the dry land of gradual acceptance and closure, reconciliation with oneself for having outlived the lost and with the lost for having left us behind. The book is structured thematically, with the first six chapters philosophical in orientation. To begin, four chapters “that consider the metaphysics of death and the theology of loss, including expressions of these ideas in ritual form and their implications for concrete experiences, like reproductive loss,” followed by “two chapters which analyze the relationship between mourning and the recognition of value, and the role hope plays in the experience of loss.”
In a more personal psychological vein, the following four chapters “explore … themes in the psychology of loss and the psychological roots of grief in early childhood, psychological vulnerability to loss in later life when opportunities for rebuilding meaning are diminished, and the interpersonal phenomenology of loss.” The book then moves to the realm of political philosophy, “to a set of issues connected with public and cultural aspects of mourning . . . Community mourning and the need for public commemoration is considered, and how these may become complicated by cultural or historical factors. Differing attitudes to the loss of an idea are contrasted, and how mourning can be expressed in the rethinking of intellectual heritage of a culture.” The book draws to a close with a reflection by the sculptor Alexander Stoddart on “the cultural role of sepulchral art,” and ends with Alexander Tallis meditating on the need to live with loss.
Pitfalls
Overall, this book proved of significant value to me personally, of which more below. But it is not without flaws. This is an academic book, so we are therefore subject to the sadly expected dry, dense prose of academic writing in a number of the chapters. It seemed to me that the essays could be divided between those philosophers either unconnected to, or retired from, the academic life, and those still working within its halls, a divide delineated by the fluency or otherwise of style, and eloquence or otherwise of expression.
Those who wrote from this more formally academic position therefore laced their writing with the buzzwords necessary to stand up before their peers and the forces of publish-or-perish. Not everyone can approach the eloquence of an Anthony O’Hear or a Roger Scruton, but some of the chapters were so technical in subject matter and impenetrable in style that what could otherwise have been an intriguing approach to the subject of mourning was rendered illegible.
As one example, Amber L. Griffioen’s chapter, “Toward a Philosophical Theology of Pregnancy Loss,” considers a truly heartrending tragedy faced by many women, when “40 percent of all pregnancies do not result in a live birth.” Yet the use of Critical Theory and Gender Studies jargon acted as a barrier to a deeper understanding and appreciation of such a tragic part of the female experience: The repeated references to “neoliberal capitalism,” and “patriarchy,” calls to be “inclusive of all persons capable of gestating a human being inside them,” the ever present need to engage in different “discourses,” and finally the construction of a gestational model of God, God as potential birthing mother. Given the number of women who go through such a harrowing episode, and the ripple effects of grief and loss through those around them, this chapter represented a sadly missed opportunity because as Griffioen writes, there is a gap in the philosophy of loss and mourning for the life that ends before it begins.
Two other chapters that were less than successful for this reader were the aforementioned “Mourning: A Phenomenology,” by Balázs M. Mezei, and Mourning and the Second-Person Perspective, by the editor of the volume Mikołaj Sławkowski-Rode. It must be noted immediately that the main issue here is that I am not a trained philosopher, and I am especially not a phenomenologist. Both authors refrained from employing an opaque style of composition, but the expression and specific terms and phrases central to a field like phenomenology meant that I struggled to make head or tail of these essays.
This is, again, a shame because the question at hand, of death and how we encounter it, is such an endlessly urgent subject that I couldn’t help but feel disappointed at the opacity of these chapters. On the other hand, the fact that it was a struggle to grasp these chapters’ meaning at least shows they were nevertheless compelling enough to demand such an effort. The essay on “Grieving and Mourning: The Psychology of Bereavement,” by Colin Murray Parkes was much less compelling, bogged down in a scientism that failed to approach the matter at hand in a way that had an impact. This could not be said for the remaining chapters, all of which spoke powerfully, at least in some way, to the matter at hand.
Tending the Graves of the Lost and the Graves Within our Hearts
As Cathy Mason and Matt Dougherty argue in Chapter Six, for us to grieve and mourn means that there must be something of close to inestimable value that has been lost. This in turn reveals the fact that we as God’s creation find the value inherent to life, recognising its intrinsic nature. Mourning and grief may signal something of depthless sadness, but they also point to the fact that even in this darkness, the light of something to value is there, as the act of mourning and the feelings of grief testify to this. There is then the guilt felt when these all-consuming feelings recede after a time, as they do for most of us. This might suggest a less-than-wholesome sentimentality, an artifact of our neural biology feeding us different hormones at the loss of a loved one, undermining the claim of the sincerity of our attachment to those who have been detached from us.
But as the authors write, moving forward can itself be defended as a form of correctly valuing something. After all, in the Jewish tradition, one mourns the loss of a loved one for a year, but then one is expected to re-enter the land of the living, to say yes to life. Remaining forever in the shadow of the valley of death is a wrong, to oneself and to the one no longer here. Indeed the authors argue that moving on with life may be a sign of having given proportionate honour, respect, and love to the lost. If one is in a state of grief-stricken solitude ever after the loss, does that really point to an appropriate response?
If, as the authors write, “virtue, on a common conception, involves both acting well and having appropriate affective responses. For our purposes, the latter is the relevant aspect of virtue” one might suggest that this constitutes a devaluing of the mourning process, and therefore of grief at the losing of a loved one, and even a devaluing of love itself. Surely the one who is here no more would themselves be grieved if those left behind were reduced to some living death of bare existence, rather than moving forward through the rest of the life they have? As the authors conclude: “In the act of mourning, we mourn something or somebody lost, yet we connect this loss to the renewal already heralded in the act of mourning. Mourning is the gateway between decay and renewal, degeneration and generation. As opposed to melancholy, mourning uncovers the way to self-renovation, either at the individual or the communal level, and so it stops the ‘whirlpool,’ the self-destructive power of depression.”
To avoid being drawn into the trap of melancholia, grief and loss must be given shape and a context within which one can express such deep and powerful emotions. Religion has traditionally been the main form and means by which we have done this. In light of this, “What Can the Roman Catholic Liturgies of the Dead Offer Mourners: Solidarity with the Deceased and Hopeful Protest?” by Richard Conrad OP describes in detail the different forms this Liturgy has taken over the centuries, comparing the Old and New Liturgies and their differences regarding their approaches to death and mourning. Conrad mounts an eloquent defence of the perspective he argues is implicit in the Old Liturgy. For him, this form emphasises death’s unavoidable reality, and the loss-induced pain that accompanies it. In the Old Liturgy, Conrad holds, the different stages of prayer, ceremony, and reflection all provide a way to articulate the mix of sorrow and gratitude that people feel, as well as the anger at the injustice of the death of a loved one, which he sees as justified, a justification rooted in Christian theology.
This chapter’s focus on theology as well as its liturgical expression was both enlightening and consoling in equal measure: enlightening for its explication of a form of worship, remembrance, and mourning that I as an Anglican am not familiar with; consoling, for the depth of its commitment to describing something that fulfils Jesus’ proclamation that he lays no burden on us that we cannot bear. The Catholic Liturgy of the Dead guides the mourner through the vale of tears into which we plunge at the death of those closest to us, illuminating the path with the lamplights of faith, thereby illuminating the souls of those left behind with the warmth of Christ’s love. This instils a sense of hope that while death is an evil, for “God did not make death, and he does not delight in the death of the living,” it is also not the end of all things, our wretchedness having been saved and our pain salved by the sacrifice of Christ.
As the author writes, Aquinas saw death as both evil and natural, the evil of our life on earth ending in service to the greater, perhaps ultimate good of passing through to God’s Kingdom, uniting with the love that surpasses all understanding. The possibility of a final redemption and salvation is open to all those who repent of the sins and wrongs of their life, inherent to our lives in a world broken by sin, rooted in our fallen nature. The journey through the evil of death to the ultimate good of God’s friendship has been made more glorious by the overcoming of our Fall, more glorious indeed than if we had never fallen and known all the sufferings and wrongs of the world we call home. For Conrad, “In sum, death is a natural necessity but not a good; it is an enemy to be defeated. But it is indirectly willed by God, in a small way as penalty and sobering fact, in a more positive way for solidarity with Christ’s victorious journey through death and as a stage in our liberation to glory. The current Liturgy of the Dead seeks to emphasize how being patterned on Jesus’ Death leads to being patterned on his Resurrection.”
Vincent Van Gogh, “At Eternity’s Gate” (1890)
What happens, though, when we cannot come together to mourn through reciprocal acts of belonging? John Cottingham considers this question in Chapter Eight, “Bereavement, Grief, and Mourning,” in which he reflects on the challenges thrown up by the lockdown and social distancing responses to the Covid-19 pandemic. He argues that, deprived of the social contact that comprises the texture of a meaningful life, many of us experienced a kind of bereavement that may seem inconsequential when contrasted with those who faced and face actual bereavement. However, this kind of coerced social detachment sundered the links between human subjects, turning us into objects to be avoided for fear of infection and contamination.
To communicate the power of mourning in times of bereavement, Cottingham draws on a wide array of literary and religious references, from poets to the Psalms and the Gospel of Luke. These literary forms give structure and substance to one’s grief and sorrow as the Liturgies do, but in a broader way, reflecting the synthesis of the universal with the particular which comprises the ground of life. One quote that struck home for me was Dante’s, when one of his characters states that there is “No greater grief / Than to remember happiness gone by / In time of sorrow,” a line that explains why remembering times of joy in times of sadness increases the sorrow as much as the gladness of remembering such a time. Even so, sometimes grief can draw you into yourself, away from such memories where, as John Keats wrote, the muffled bells of mourning “tolls me back to my sole self.” This inward turn can mean that the outward world seems to mock us with its contrast, leaving us, in the words of J.H. Housman,“I, a stranger, and afraid, in a world I never made.”
These sentiments, expressed in poetry, are also given voice in the prose of Eleonore Stump’s chapter, “The Problem of Mourning.” Stump makes the point that mourning and grief at the supposed evil of death seem a strange reaction to someone’s passing over when traditional Christian theodicy holds that all parts of our lives, good or ill, are redeemed by the unification with God. Stump also makes the point that it is strange that the Creator should not Himself be in mourning at the fallenness of His creation, i.e. our sinful nature and the distance between our current state and the one into which we entered with God’s breath of Life still felt on our faces. In light of the Fall, Stump asks, “Why is there not something sad at best or devastating at worst about the lives of human persons in the post-Fall world, even if those persons are redeemed and restored in the end?”
Over the rest of the chapter she considers this question, wrestling with “the felix culpa view, which supposes not that the story of God’s creation with the Fall and its subsequent suffering is a disappointment for God but that, on the contrary, the world with its history of sin and suffering is better and more glorious than the world would have been if there had been no Fall.” This is the view held and defended in the chapter on the Liturgies for the Dead. Stump quotes the apostle Paul, who writes in Romans that “his true self is characterized by the higher-order will for the good. That is why Paul repudiates as alien to himself—alien to his true self—his own first-order volitions that are discordant with that second-order will.” As a result, “even in his internally fragmented state, the self that wants to will what is good is his true self.” Stump then questions what comprises the “true self” in light of “the wounds and scars of post-Fall human life.” Are these examples of the suffering that is part of life and so in fact crucial to our perfection through redemption in Christ?
This chapter thus proved particularly relevant for me, as it reflects something that I have also wrestled with, having been born with a genetic fragile skin condition that brings physical and emotional suffering in its wake, and which will ultimately prove fatal. As Stump argues, the suffering I experience is not reducible to these forms, however. It is also a result of what we as dependant, rational animals care about, which itself suggests a value hierarchy upon which we base our view of what and who, does and does not matter. This is as true for me as any able-bodied person, and perhaps more so, with my condition heightening and concentrating the experience of the human condition in all its triumph and tragedy.
As Stump writes, “Every human person has some care about what kind of person she is and about her being what she ought to be, where what she ought to be is something like thriving as a good specimen of the species human being. Consequently, part of what it is for a human being to suffer is for her to be kept, to one degree or another, from thriving, in this broad sense. What makes a human person thrive, however, is an objective matter.” At the same time, “what human beings care about has a subjective element too, which does not have to do just with thriving.”
In sum, “if we take suffering to be a function of what a person cares about, then suffering can be understood this way: a human being suffers when she fails to thrive, or she fails to have the desires of her heart, or both.” Out of this, we can say that “If in heaven a human being is her true self in its perfected state, and if in heaven she does not suffer, then in heaven she has, harmoniously ordered, both thriving and heart’s desires. She has the convergence of what she cares about on both an objective and a subjective scale of value.” Therefore, “the perfected version of a person’s true self, the condition of a person in the afterlife in heaven, is what she is when what she most cares about, in both an objective and a subjective sense, converge in her and in her life. … On Christian doctrine, human beings are made in the image of God. The perfection of a human person’s true self will thus also be the fulfillment of that image in her.”
The doctrine of the Trinity holds that God through Christ suffers with us and as we do, taking the sin and suffering of the world on his shoulders, which means that “the nature of God is most evident in Christ’s crucifixion because love is greatest and most evident there.” Therefore, “If it is the image of God in human beings that perfects the true self of a human being, and if the nature of the love that is God is most evident in the crucified Christ, then there may be some way in which the wounds of human suffering could intensify the image of God in a human being too.” It is because of this that “It may be possible to see a way in which the wounds of a person’s suffering could become for that person an image of Christ. On this way of thinking about the perfection of the true self of a human person, what makes a human person glorious and perfected is her resemblance to the incarnate Christ when the love of God is most manifest in him.”
Bringing the chapter to a close, Stump presages and defends the felix culpa view of suffering and loss seen in Conrad’s defence of the Catholic Liturgy of the Dead by arguing that
If the love that is God’s nature is most evident in the wounds of the incarnate Christ and if the wounds of human suffering could be suitably connected to Christ, then there is a basis for an argument that the wounds of a post-Fall human being can render him more in the image of God than he would have been had there been no suffering in the world. In that case, on Christian doctrine there would be something more glorious about redeemed human beings with wounds than there would have been had there been no Fall, no suffering, and no wounds and scars. On this view, it is the image of love incarnate that makes a wounded post-Fall human person more glorious in his true self than he would otherwise have been, and the image of love incarnate in the true self of a human person would have been less in a world without a Fall.
Again, this is something that I have reconciled with over my own life, as I’ve come to accept the final limit of mortality, one that we all share as the limited beings we are, but which I am subject to as I am to life’s sorrows, in a heightened and concentrated form. The cancer that will ultimately set me on the journey from this world brought me face to face with the death that we must all come to terms with. Some cannot do so, and ceaselessly seek a way to avoid stepping onto the road of our final journey. Most know that this is our fate, but understandably do not wish to think on it too deeply.
And yet, having accepted and reconciled with my finitude and the fact of my life’s end does not preclude sadness or a sense of regret. It is in this vein that Cottingham quotes Gerard Manley Hopkins’ poem, “Spring and Fall,” where the young girl Margaret weeps over the fall of Autumn’s golden glory:
Margaret, are you grieving
Over Goldengrove unleaving?
Leaves like the things of man, you
With your fresh thoughts care for, can you?
Ah! as the heart grows older
It will come to such sights colder
By and by, nor spare a sigh
Though worlds of wanwood leafmeal lie;
And yet you will weep and know why.
Now no matter, child, the name:
Sorrow’s springs are the same.
Nor mouth had, no nor mind, expressed
What heart heard of, ghost guessed:
It is the blight man was born for,
It is Margaret you mourn for.
Here Hopkins demonstrates the unique ability of art and literature to bring together the universality of the good, true, and beautiful, of morality itself, with the concrete experience of our own lives through which these moral ideals are made real and therefore attainable and comprehensible. The experience of seeing a striking winter’s day, the glitter of frost caught in the sun’s embrace, is as meaningful as the soft, sad beauty of the autumn, when we are reminded that our time here is short, but that it still has inestimable value for the fact of our being here to witness the glory and tragedy of God’s creation, the knowledge of our passing away intensifying the joy by edging it with sorrow. As Cottingham writes, each of us can feel the griefs of life during the succeeding stages of our lives, and no age or stage has a monopoly on such a thing. Is my grief or sense of mourning any greater or more righteous that someone older or younger? Of course not. What binds us across time and across the space between us in the here and now is the shared particularity of our sorrow, and the hope that there is a redemption to it in our lives and after we’re gone. We all, as Thomas Hardy writes in “At Castle Boterel,” see our lives and the loves we have known, we
look and see it there, shrinking, shrinking,
I look back at it amid the rain
For the very last time; for my sand is sinking,
And I shall traverse old love’s domain
Never again.
As Gandalf says near the end of The Return of the King, “I will not say do not weep, for not all tears are an evil.” This approach is echoed in the last two chapters considered here, by Anthony O’Hear and Roger Scruton. As O’Hear writes in “Mourning and Memory, Private and Public Dimensions,” “Christ, who had not foresworn this life … was moved by the tears of Mary to summon Lazarus from the grave (John 11:33).” Citing C.S. Lewis in his masterpiece, A Grief Observed, O’Hear reminds us that to leave our grief in its most private space, within our hearts, is to leave it to tear out what makes one alive from the inside, to leave one hollow and on the edge of despair. This kind of private grief is ultimately selfish, and it precludes the coming to terms in community that is the only way we can reconcile with the new world as interdependent individuals. O’Hear also references Aristotle’s call togive appropriate honour to the departed, to treat the body with awe for its constitutive part of life, but not to put the lifeless body in place of the living person.
Rituals and ceremonies of memorialisation and commemoration enable the rightly ordered expression of grief and mourning that binds up the hearts of those afflicted, through the binding together of those from whom the dead have departed. O’Hear gives a moving example of the potential for such a beneficial result when he describes the ceremonies of mourning and memorialisation undertaken in Ireland to remember those who died during the violence of the Troubles. Of course these could not totally heal or undo what had been done by either side; the world had still been rent and torn by the violence. But it at least brought people to reflect on the hope still intrinsic to life, the possibility of forgiveness, and the way forward to a future oriented to human flourishing, even in light of our fallen, flawed natures. If we become wrapped up in our private grief, not only do we neglect those around us now but also the past with its memories of those who went before and the future with those who will come after. We therefore build a tyranny of our grief, silencing and depersonalising those who do not share our inner, consuming turmoil. As such, these acts of remembrance and reconciliation not only serve to reweave the frayed ties that bind between people now but also across the years, restoring the cords of memory that bind the dead, the living, and those yet to be born, giving them back their voice in the democracy of the dead and the unborn.
Scruton’s chapter complements O’Hear’s arguments through an examination of an example of mourning made complicated by a terrible history and cultural suicide. Scruton reflects on the seeming impossibility of mourning for a destroyed culture, an impossibility that has come to define the German experience due to the recruitment, often willingly accepted, and subsequent exploitation of this nation’s undoubtedly great cultural heritage by the Nazi death cult. Scruton argues that such a culture of repudiation—one which refuses and discards those values which many Germans feel in their hearts have been tainted beyond purification by such use as the Nazis put them to—creates a conflict deep within the national soul. This deliberate discarding, repudiation, and ultimate suppression of the past denies the duty of piety we have towards those who came before.
This purposeful rejection of the past as such is not only confined to the German context, although given the horrors unleashed, it is certainly a special case. This denial of an obligation towards the dead is common across the Western world, constituting what Pascal Bruckner calls a “tyranny of guilt” that has risen to power in our cultures. This emphasises only the terrible things our ancestors did and ignores the noble things they also achieved. The result of the refusal of this obligation of piety, maintaining the threads that bind the past, present, and future into the tapestry of our culture across time, means that our role in remembrance remains unfulfilled. As Scruton closes by arguing, this makes it impossible to reconcile with the past, accept the loss that is our lot, and move forward having laid the dead to rest in one’s own heart. Without tending the graves of the dead, we leave the graves in our own hearts uncared for, scarring our souls as a result.
Conclusion
This collection of essays was not always successful in its aim to encourage reflection on the meaning of mourning. Its flaws demonstrate some of the problems with academia today, whereby employment of complex theoretical terms and language overrides clarity of communication and eloquence of expression. However, for the most part the collection succeeded in making me reflect on the reality of loss and the grief that precedes it and results from it. The need to reconcile with one’s finitude and live as good a life in light of this was made clear by many of the more successful essays and tallied with my own experience of coming to terms with the limits on my life from my condition, both in an everyday and an ultimate sense.
However, this reconciliation and acceptance can only be achieved in community with others, when one’s life feels knitted into a greater whole, our existence part of the greater life of the social ecology. This applies not only to the present, but also to remembering the past and anticipating the future. This has been something that those like O’Hear and Scruton have taught me, and the other essays in this collection that resonated layered atop these contributions, adding to the sediment of meaning that accrues over a life lived in a world that is a home from which we journey to our final rest, where our hearts finally know peace.
When I was as young as four years old, my mother would send me to my grandparents’ home to stay during the summer months. I was this little girl, neatly coiffed, dressed impeccably, and placed on a plane to fly across many states to Leakesville, Mississippi. I was a quiet and reserved child, and shy, which, I believe, others perceived as timidity and an inability to fit in. But I knew this was not true.
I was deeply intuitive, sensing, empathetic, and feeling all things around me. I wasn’t quiet. I was observant. I wasn’t shy. I was curiously aware. I wasn’t timid or unable to blend in. I was simply different. And this made others uncomfortable in ways I couldn’t name or remedy at such a tender age. So I shrank into myself and sat quietly as I watched others – aunts and uncles, cousins, friends – live their lives out loud. The only people I felt understood and knew me were my grandparents. They had a way of communicating, seeing and loving me in ways I can only attribute to them also being intuitive.
During those summers. I spent hours wandering in the fields and deep woods, exploring and communing with nature. I heard the sounds of animals moving from one place to another, giving instructions of where they were headed next. I would listen to the trees, the leaves and the brush as they sang, sending messages to one another of what season it was, and whether or not to bend and stretch when the breath of God blew on them.
And though these times were glorious, expansive, and faith-forming for me – instilling a sense of other-worldly trust and peace – there were moments of fear of the unknown, of otherworldly happenings that I couldn’t explain.
At times, asleep in the back room of my grandparent’s home, I would be overcome by a weighted feeling, making it difficult to breathe. Subconsciously, I was taken to a deep, dark, unknown place. No matter how hard I fought – to get away, to breathe, to scream – it was pointless, as the grip on me was too great to overcome.
“The witch was riding you,” a family member told me.
Whenever this happened, it would physically feel as if I was experiencing death, or the dying process. First: asphyxiation, immobility and panic would set it in because somehow, even in this state of paralysis, I knew death was imminent. And then, an unwavering calm, a gentle peace, a release or surrender to the unknown would take over, shortly after the “witch riding my back” dismounted and the paralysis ended.
These moments are what I understand to be my induction into the mystical world of death and dying. As these moments continued to happen over the years while visiting my grandparents, I began to intimately connect with the peaceful surrender of death. It no longer frightened me, but instead, drew me closer. I wanted to know more about what I was experiencing and the visions I saw. I wanted to know more about death and its transcendental relation to the beyond.
Early on, I couldn’t comprehend my curiosity about death or why these experiences happened to me. But I’ve come to understand this mystical phenomenon as a gift, a blessing and a means to serve others by becoming a death doula.
A culturally spiritual call
We live in a death-denying culture. But because of my childhood, the draw of the witch that was riding my back, and my growing intimacy with death, my curiosity grew into a deep passion: what happens, I wondered, when a physical body is no longer present in the natural world and has returned to its original form as a spirit, transitioning into its next phase of life?
For me, death is never ending; it is a transition from one life-form to the next. I am a soul cultivator, one who seeks to hear the heart of others, beyond the words they speak, desiring to reflect back to them the love, care, and peace they long for in their lives. If they never received this type of care in life, if I can give that to them in death, I will have lived fully into my call of “doing the work my soul must have,” as theologian Katie Geneva Cannon challenges each of us to do.
For me, death is never ending; it is a transition from one life-form to the next.
Like a midwife who assists in the process of birthing, a death doula “guides a person who is transitioning to death and their loved ones through the dying process,” according to the International End-of-Life Doula Association. Death doulas have existed as long as death itself; culturally, however, Black death doulas have specifically answered the spiritual call between Black people and their tormented, historical relationship to death and dying. This became more pronounced during the COVID-19 pandemic and the growth of social movements focusing on Black and brown lives — and deaths.
“The inequities in the way we live and die could not have become more apparent during this time, coupling both the pandemic and social movements we’ve witnessed in the last two years,” according to grief consultant Alica Forneret in a story on refinery29.com. Forneret also is the founder of PAUSE, which creates culturally specific spaces that provide end-of-life resources and grief support.
Nikki Giovanni once said, “death is a slave’s freedom.” Black people’s history with colonized culture has demanded that the care and personal needs of its own community regarding death and dying be met in ways that greater society doesn’t recognize.
“God’s salvation is a liberating event,” James Cone wrote in his book, The Cross and the Lynching Tree, “in the lives of all who are struggling for survival and dignity in a world bent on denying their humanity.”
New rhetorics of lynching and continual perpetuation of Black tropes dehumanize and distort one’s humanity in death. These are primary reasons why Black culture, by restoring power and dignity to the dead, has taken personal agency in God’s vision for humanity. Black funerals, therefore, are celebrations that honor the life that was lived on this side of eternity, and they rejoice in the transition into the next.
And this was what our ancestors did in remote, secret places: they practiced sacred religious traditions because they were prohibited from performing funerals or any traditions that commemorated the dead. Black funerals were once one of the only spaces not permeated with Whiteness, where we could live into our traditions in our own sacred ways.
And so, more and more Black people, by becoming or by employing death doulas, are seeking to protect the knowledge that not only Black lives matter, but also Black deaths.
Black ancestry has taught us to acknowledge death as a moment of joy, to celebrate the transition from pain and suffering in this world, to that of being in the arms of their Creator, where they will walk around heaven all day, as the song goes. Funerals, for instance, are called “homegoing services,” and are outpourings of both joy and grief. Helping the dying do so in dignity while remembering and honoring ancestral traditions, and ensuring that the family of the dying person is nurtured, became the impetus that moved me in the direction of becoming a death doula.
Black ancestry has taught us to acknowledge death as a moment of joy, to celebrate the transition from pain and suffering in this world, to that of being in the arms of their Creator.
While there are currently no licensure requirements to become a death doula, organizations exist to provide death doula certification and training. Going With Grace (goingwithgrace.com) offers death doula/end-of-life training “steeped in ancient wisdom traditions adapted to modern times” and prepares individuals to take the National End-of-Life Doula (NEDA) proficiency assessment. Passing this curriculum exam, according to the NEDA website, earns the doulas a badge that assures them and the families they assist that the doula has competencies and knowledge around, among other things, spirituality, the dying process, non-medical care and comfort, and grief, and that their understanding of these areas aligns with those of others in the field.
Being a death doula differs from chaplaincy and hospice care. While death doulas do not provide medical care, they do collaborate with hospice programs, bridging the gaps and strengthening the relationships between medical and non-medical support, as noted on cremationassistance.org. Hospice care is regulated by Medicare rules, which limits caregivers’ interactions with patients and families. Death doulas bridge this gap by showing up in the following ways: grief support, advance health care planning, end of life planning, practical training for family caregivers, funeral/memorial planning assistance, needed relief for family caregivers, companionship to patients, vigil presence for actively dying patients and more, as every death doula is different and has their own specialties they provide.
And while chaplains also do this work, there are differences between chaplaincy and being a death doula: education, training, certification, and ways of making meaning of a person’s experience of sickness, death, and dying. Chaplaincy is not only shaped by one’s own religious tradition but also the extensive religious and philosophical studies completed during graduate school. Death doulas have more flexibility in their practice. Doulas are able to serve as many or as few clients as they wish to serve at a time, whereas chaplains are limited to serving those within the institutions where they are employed. And death doulas are independent contractors charging an hourly rate or setting a flat fee, but services are not covered by insurance, Medicare or Medicaid.
A death doula can also help relieve the burden of improper or confusing end-of-life planning, and support family members who are responsible for completing their loved one’s affairs. You can find a death doula by checking registries that are available in individual states.
Death should not be a taboo topic
We live in a death-denying culture, where the discourse surrounding death is taboo, and we don’t want to accept that we live in a finite world. We shun people who talk about death, especially those people who may be living terminal lives. We do this as a means of self-preservation, not wanting to be exposed as being vulnerable or appearing weak for expressing emotion. I believe that if we talk about death and dying more, in constructive and life-giving ways, and with the support of a person like a death doula, the topic will become less taboo.
I recognize I have a unique perspective concerning death and dying. Death is inevitable, and neither humans, nor any of creation, were meant to live forever. I believe we are spiritual beings, having a human experience. And as I was writing this article, the song “Take Me to the Water (to be baptized)” by Nina Simone dropped in my spirit.
In death, we are reminded of our ‘maternal baptism’: dying to the spiritual realm from which we came and, born to life in the maternal waters of the womb, becoming the physical beings we were created to be. In baptism, we see the death and resurrection of Christ as well as our own. Though, in baptism, we are “not actually dead, placed in the tomb, and brought back to life …” the sacrament re-members us to Christ’s passion, giving us new life in Christ (Cyril of Jerusalem).
If we allow this consideration of baptismal grace being the death and life of a soul, then death becomes a return to the waters that once birthed us. No longer physically present in the earthly realm, and yet, still present as spirit.
Like other injustices, this “holy disruption” of a pandemic “has magnified the problems Black people face in the death and dying space,” says Alua Arthur of Going With Grace.
By dispelling myths regarding death, through curating soft landing spaces for mind shifts to occur, while holistically supporting those in the midst of experiencing death, I aim to become a change-agent in the death doula industry — re-writing the narrative of what Black death is and how beautifully sacred the dying process can be.
“When death comes to find you, may it find you alive.” — African Proverb
— Christian beliefs seem to underpin the views of many people opposed to assisted dying in the UK. As Prue Leith appears in an illuminating documentary about the practice for Channel 4, Kate Ng argues that allowing others to experience ‘good death’ is the most Christian thing you can do
Danny Kruger and Prue Leith in ‘Prue and Danny’s Death Road Trip’
My mother and I had a conversation about death recently. It wasn’t awkward or prolonged. In fact, it was a very brief exchange in the middle of a Christmas market in Germany while we waited for our bratwurst. “I think people live too long these days,” she told me. “I don’t want to live till I’m 100. And if I get sick, I don’t want to get to a point where it’s not worth living any more.” I agreed with her, we got our bratwurst, and went about our day.
I know many people will think this is morbid, but I’m glad that my mother and I are able to have casual conversations about death. Not because life isn’t precious, but because it’s too precious to dance around subjects like this. We all deserve a good death, just as we deserve good lives. Why not talk about it?
So when Prue Leith announced her new Channel 4 documentary about assisted dying, I was intrigued. Assisted dying, also known as assisted suicide, is defined by the NHS as the act of “deliberately assisting a person to kill themselves” and is illegal in the UK. The British Medical Journal says it is usually used in the context of “giving assistance to die to people with long-term progressive conditions and other people who are not dying, in addition to patients with a terminal illness”.
In short, if someone with a terminal illness or a condition that gets progressively worse wants to end their life, assisted dying would enable them to do so on their own terms. The alternative is to wait days, weeks, or even months to die. Leith argues that assisted dying is the most humane scenario here. I think she’s absolutely right about this.
However, Leith’s son Danny Kruger, the Tory MP for Devizes, strongly opposes his mother’s views. A staunch Christian, Kruger is the chair of the all-party parliamentary group (APPG) for dying well, which “promotes access to excellent care at end of life” and campaigns for better resources for hospice and palliative care services. This is an important and necessary cause. However, the group also “stands against the legalisation of doctor-assisted suicide in the UK”.
This puts Kruger head to head with his mother. Their documentary, Prue and Danny’s Death Road Trip, tackles this difficult discussion between mother and son, and sees them travelling across Canada – where assisted dying is legal – to speak to people who bolster both sides of their argument. At one point in the show, Leith hits the nail on the head when she asks her son if the root of his objection is because of his faith’s belief that “suffering is good for the soul”. Kruger replies: “I think suffering is part of life, but I don’t think we should suffer unnecessarily.” He doesn’t seem to grasp the irony of what he’s saying.
I would like the option to have a good death of my own choosing
Leith also points out that “a lot” of the APPG for dying well’s membership is made up of Christians, yet the individual members seem to avoid acknowledging the influence of their beliefs. They also seem to decline to admit that assisted dying goes against Christian beliefs. “Nobody would use that as their argument,” Kruger says in response. “We don’t go around saying, ‘God says don’t do this,’ I mean, that would be mad.”
But as long as assisted dying remains illegal in the UK, unnecessary suffering will continue. Perhaps he doesn’t want to believe it, but what Kruger is essentially saying – with all his religious bias – is that even if you’re already dying, you shouldn’t be given the choice to leave this mortal plane unless God decides it’s time for you to go.
As someone who grew up in a born-again Christian household, I know exactly how much Christians think suffering is crucial to the human experience. The idea is that the more you suffer in the name of God, the better your chances are of getting into heaven. So it’s hypocritical of Christians like Kruger to say they don’t think people should suffer unnecessarily.
The argument against assisted dying claims that legalising it would result in a “slippery slope that could lead to widespread abuse and distress” of vulnerable people. Members of the dying well group say that placing restrictions around who can access the service would not work, and the net would become wider and wider, even allowing people with no health conditions to qualify. Certainly, these are questions that need to be answered, and any policy drawn up should consider how vulnerable people will be protected. But, given that three-quarters of Britons support assisted dying for people who are terminally ill, MPs must begin having open and constructive conversations about changing the law.
I think about dying a lot. Not in a morbid or harmful way, but I think about how I want to die and what kind of memories I want to leave behind. And if it turns out that I should wind up with a terminal illness or a progressively chronic condition, then I would like the option to have a good death of my own choosing. I want my loved ones to remember me with joy, not with sadness or trauma at having watched me suffer till the end. It would be far more humane than any of “God’s work”.
Have you ever spent time seriously contemplating your own death? I haven’t. I’m 55, in good health, exercise regularly, eat well and – barring the proverbial bus – have no reason to think death is imminent. Thoughts of my own mortality naturally arise from time to time but they’re easy to banish. After all, both my parents are still alive, forming a kind of metaphysical barrier. Not my turn yet! But one thing I will do differently in the coming years is to begin reflecting on my demise. Does that sound mawkish? Self-indulgent? Pointless?
Well, I won’t be picking out a coffin or selecting music for the funeral or tearfully imagining the mourners gathering. All that would be a waste of time and, like everyone else, I’m busy. With work, family, friends, travel, trips to the theatre, galleries, restaurants and so on. What I mean to say is that I have not lost my appetite for life. Why, then, do I wish to begin meditating on death?
For two reasons: in order to live well during whatever years I have left; and to begin to confront and maybe even conquer the fear that, thus far, has stopped me from having more than a fleeting engagement with the knowledge that death is the inevitable outcome of life.
There’s a well-worn trope about living each day as if it’s your last, or if you only had one year to live you wouldn’t choose to spend it at the office. That doesn’t quite chime with me. If I only had a year to live, I’d still choose to work. (I might try to write faster!) Nevertheless, it is death that makes life meaningful. In Howards End, EM Forster puts it like this: “Death destroys man: the idea of Death saves him.” The value of our days floats on the metaphysical stock market of ideas that we hold in our minds.
The idea of ceasing to exist isn’t easy to contemplate. But I don’t believe in reincarnation or an afterlife. I don’t believe that raging against the dying of the light is going to achieve anything. And ignoring the issue isn’t going to make it go away. In fact, it makes the prospect more, rather than less, frightening.
I first read The Complete Essays by Michel de Montaigne when I was at college, but it’s only now that I’m ready to take on this piece of sage advice: “To begin depriving death of its greatest advantage over us, let us deprive death of its strangeness, let us frequent it, let us get used to it; let us have nothing more often in mind than death.”
How will I go about it, then, this new contemplative practice? Place a skull or some other memento mori on the shelf above my desk? Fly to Thailand or Sri Lanka and visit the Theravāda Buddhist monasteries where photos of corpses are displayed as aids to the maranasati (mindfulness of death) meditation? Walk around graveyards?
I’ve recently rented an office where I go to write. There’s a huge picture window under which I’ve placed the desk. The window overlooks a Victorian graveyard that’s still in use. When I sit down, all I can see are the trees. But when I stand I have a view of the tombstones and, in the distance, the crematorium.
One day I’ll be gone, my body consigned to the earth or turned to ash. Sooner or later I’ll be forgotten. Truly accepting that revivifies life. It doesn’t make every moment wonderful, but knowing I will die is a source of strength to endure the difficulties, and a spur to be more present for all that is good and precious in life.
But majority see role for health care providers in finding meaning or hope in the face of illness, and are comfortable discussing their beliefs with their providers.
But they do see a role for their health care providers in helping them cope with illness by looking for meaning or hope.
In all, 84% of people between the ages of 50 and 80 say that they have religious and/or spiritual beliefs that are somewhat or very important to them, including 71% who cited religious beliefs and 80% who cited spiritual beliefs, according to new data from the National Poll on Healthy Aging. About 40% of these older adults say those beliefs have gotten more important to them as they grow older.
Among older adults with religious or spiritual beliefs that are important to them, 19% say their beliefs have influenced their health care decisions, and 28% say they want health care providers to ask them about their beliefs.
Meanwhile, 77% of all older adults, regardless of beliefs, say health care providers should keep their own personal beliefs separate from how they deliver care.
“While 45% of older adults say their religious beliefs are very important to them, and 50% say that about their spiritual beliefs, even this group largely wants to keep this aspect of their lives separate from their health care,” said Marks, an associate professor of geriatric and palliative medicine. “But a sizable majority of all older adults – whether or not they say belief is important to them – reported that they’d turn to health care workers to help them find deeper meaning in their illness, and 78% believe health care workers will help them find hope when they’re having a health-related challenge.”
Brazier notes that many health care systems have a way to record the religious affiliation of patients in their electronic medical records, and that medical students and others training for health professions are told to ask their patients about any beliefs that might affect their future care.
“While 45% of older adults say their religious beliefs are very important to them, and 50% say that about their spiritual beliefs, even this group largely wants to keep this aspect of their lives separate from their health care.”
Having this information available can help providers ensure that patients with strongly held beliefs or specific religious affiliations receive everything from appropriate hospital food to visits with chaplains of a specific faith tradition when they’re having a health crisis or nearing the end of life.
But for those who do not follow a faith tradition or have strongly held beliefs, having that information available to health providers can also be helpful.
“Being a religious or spiritual person, or not following a faith tradition or spiritual practices, is a highly personal matter,” said poll director Jeffrey Kullgren, M.D., M.P.H., M.S., an associate professor of internal medicine at Michigan Medicine and physician and researcher at the VA Ann Arbor Healthcare System. “So perhaps it’s not surprising that only about a quarter of all people in this age range say they’ve talked about their beliefs with a health care provider, though this rose to about one-third of those who say their religious or spiritual beliefs are very important to them.”
In all, 70% of those who say their beliefs are somewhat or very important to them reported feeling comfortable discussing their beliefs with their health care providers.
Even if patients don’t want to discuss their beliefs with their health providers at a typical appointment, it’s important for providers to know if patients with significant health needs, or those experiencing a health crisis, are connected to a faith community that can help provide support.
In all, 65% of the older adults whose religious or spiritual beliefs are important to them said they belong to a community of people who share their beliefs.
The poll report is based on findings from a nationally representative survey conducted by NORC at the University of Chicago for IHPI and administered online and via phone in July 2022 among 2,163 adults aged 50 to 80. The sample was subsequently weighted to reflect the U.S. population. Read past National Poll on Healthy Aging reports and about the poll methodology
