Podium: Whose death is it, anyway?

Extract from the Abbeyfield Lecture by the director of the Royal College of Nursing Institute

THERE IS a certain paradox in our attitude towards old age and death. We live longer than at any other point in human history, but we seem less capable of coping with death. Rather than celebrating the fact that more people reach the age of 65 and even more are living beyond 85, we see that phase of life being associated with loss.

As the Archbishop of Canterbury said in his lecture to you last year, "if we are terrified of dying, we shall be frightened of old age. Ageism is, in fact, associated with relative inattention to the spiritual and non-material side of life. Our appreciation of older people will depend on how much we mind about those benefits, hopes, ideals, which give purpose to life."

With the rise of modern medicine, we have fallen into the rising expectations trap. We expect to be fitter, younger, sexier, healthier than ever before, and for longer. Science seems to be fulfilling the wildest dreams of science fiction. We become blase about stories of widows being impregnated with their dead husband's sperm, and yet when asked about our attitudes to death, most of us would respond like Woody Allen: "Personally, I don't have a problem with death - I just don't want to be there when it happens." Somehow this detachment seems to be a modern phenomenon.

How we understand what we are - how we find meaning in our lives before our deaths - must be one of our most important quests.

How, then, can each of us be helped to experience a good death? How can you promote good deaths?

In Kurt Vonnegut's short story Welcome to the Monkey House, mankind has solved the dual problems of over population and ageing. For the former, Earth inhabitants take ethical birth control pills which stop people wanting to have sex. And everyone takes their anti-ageing pill. When it is time to move on, inhabitants obediently go along to suicide parlours where, supported by suicide hostesses trained in psychology and nursing, they are helped to let go of their perfect, wrinkle-free lives.

Vonnegut's world is perfect in the sense that it has overcome two of the biggest challenges: overcrowding and growing old.

Yet the twist in the story is that an underground movement - those people who want to enjoy sex again and to grow old, and, most dangerously, write poetry - begin to question the whole point of existence. The denouement of the story comes when one of the main underground leaders encourages a suicide hostess to stop taking her pills, and she runs away with him. Their view is that it is better to live, and experience joy and sorrow, than to make do with an homogenised existence.

This story was written in the late Sixties but it still speaks to us today, reminding us that life is not just about our physical state, but must take account of the emotional, spiritual, psychological and aesthetic dimensions that make us human.

There is also the interdependence of human beings - each of us needs to see our life as a whole but, as actors in our own lives, we find ourselves in numerous subtexts of other people's dramas.

Despite an officious array of well-meaning persons who are there to help us in that transition from life to death, we are still left with the vague notion that, as in Vonnegut's story, if death could be cheap, timely, clean, unambiguous and orderly, then it would suit everyone. Thankfully we have not reached that point, but we do have to be mindful of the insidious pressures around us that may, unintentionally, lead us to such conclusions.

It is often the profound feeling of being abandoned in the face of death that leads to so much anger, resentment and pain. Ruth Picardie, who died of cancer last year at the age of 32, talked about her anger at the incompetence, duplicity and lack of concern of those people around her who were supposed to be helping her. She wanted genuine dialogue with her doctors and nurses, but all she seemed to get was false hope and chemotherapy. On reading her book you are struck by the isolation, and the fear and anger.

Good deaths require honesty, fidelity, connectedness and a recognition of our interdependence. They also require good technical skills, the right environment, the right pace and the right respect.

But in our post-modern society, where we still find death so difficult to talk about sensibly or constructively, can we expect to be any more sophisticated or mature in the way we deal with it?