The end: How would you choose to die?

In our own bed, sipping claret. Tending cabbages in the garden. Standing, arms outstretched, on top of a mountain. Under the spotlight on a live TV show... We all have different ideas about how we'd like to go. John Walsh grapples with mortality
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Indy Lifestyle Online

How do you want to die? It's not a cheerful or a very welcome question, but it's the one we'll all have to ask one day. How would you want it to happen – quietly, violently, quickly, slowly? Should it be philosophical or action-packed; unashamedly secular or swathed in religious observance; done by your own hand or with the help of another? Should it be in private or in public?

"I want death to find me planting my cabbages," wrote the French savant Michel de Montaigne, and there's much to be said for the pottering-in-the-garden option, the fate that extinguishes Don Corleone in The Godfather as he sprays his tomato plants and tries to frighten his grandson with vampire teeth made from orange peel. I think we can agree that his was a better death than those suffered by his many victims, shot, stabbed or garrotted in cold blood. But would we really want the Don Vito heart-attack and the nasty moment of consciousness telling you, inarguably, that it's all over? Wouldn't it be better to die in your sleep, never knowing your spirit had packed up and fled while you were suspended in dreamland?

Then again, if you knew nothing about it at all, would you miss an important life-experience: the final stocktaking, the profit-and-loss account of how you lived, the counting of blessings, the regrets (you'll have a few) for transgressions you can't now undo?

Death is preying on our minds because of the Jade Goody total-surveillance project. Other cancer victims (mostly journalists who treated death as a subject like any other – John Diamond, Ruth Picardie) have minutely notated their path to the grave for the edification of newspaper readers. But Goody's decision to let a film crew follow her around during her last few weeks, recording her gradual decline in return for money, is unprecedented. So is the concept of a magazine buying the rights to someone's death, after already bidding for the rights to the wedding and first-baby pictures.

Much is being made of Jade's "bravery", her management of celebrity to ensure that her children get an expensive education, the exploitation of her imminent demise to persuade more young women to have cervical smear-tests. But dying in public, in front of a camera that will relay to millions of television watchers the dwindling of light in your eyes – what kind of choice is that? Is it disgustingly ghoulish? Or is it a recognition that humanity likes to inspect the extremes of its own nature?

In her confessional poem "Lady Lazarus", Sylvia Plath reported from the edge of her third suicide attempt and bragged, with a certain bitter pride, "Dying/ Is an art like everything else./ I do it exceptionally well." She looked at her role as the most confessional of poets, and imagined her verses as unwrapping the grave-clothes of her near-death for the amusement of the crowd. "There is a charge," she wrote: "For the eyeing of my scars, there is a charge/ For the hearing of my heart –/ It really goes./ And there is a charge, a very large charge/ For a word or a touch/ Or a bit of blood/ Or a piece of my hair or my clothes."

That was written in October 1962, 47 years before Goody announced her own tariff of charges for inspecting her death. Should we believe that a good death is one that transforms our final experience into a work of art, to be consumed by the public as something beyond everyday life and everyday death?



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Many writers down the years have disdained the traditional deathbed scene, with weeping relatives gathered round a stricken matriarch, exchanging their goodbyes and putting their affairs in order. Dylan Thomas in 1951 directed his father to "Rage, rage against the dying of the light", to curse and bless him with "fierce tears", but not simply to drift away.

Fifteen years later, the Liverpool poet Roger McGough published "Let Me Die a Youngman's Death", embracing a number of vivid scenarios (being run over, aged 73, at dawn by a red sports car while coming home from an all-night party; or being discovered, aged 101, by a mistress, in bed with her daughter, and cut to little pieces by the former) rather than endure "a free from sin tiptoe in/ candle wax and waning death/ not a curtains drawn angels borne/ 'what a nice way to go' death."

It's a brave conceit, to shout, or laugh, in the face of Death and go out in a blaze of glory like James Cagney, dying on the top of the gasometer in White Heat, shouting "Made it, Ma! Top of the world!" Taking Death down a peg has been a preoccupation with artists, from John Donne's "Death be not Proud" with its clever, if effortful, logic ("Thou art slave to Fate, Chance, kings and desperate men,/ And dost with poison, warre and sicknesse dwell,/ And poppy, or charmes can make us sleepe as well,/ And better than thy stroake...") to the knight who challenges the Grim Reaper to a game of chess in Ingmar Bergman's The Seventh Seal. And Dennis Potter, the playwright behind Pennies From Heaven and The Singing Detective, who, when he was diagnosed with terminal liver cancer at 58 and given only months to live, offered a final interview to Melvyn Bragg. It was intensely moving: he talked with furious glee about politics, media, religion and the decline of television while smoking cigarettes clutched in his psoriatic hands, alternately drinking champagne and sipping from a hip flask of liquid morphine. He announced that he'd named his cancer after Rupert Murdoch, whom he blamed for "the pollution of British life". He died two months later.

We know, though, in our secret heart, that none of these brave strategies will actually stave off the Big Inevitable. And that a mature response to the idea of death is not to ignore it, pretend it'll never happen, or fight the idea of it, but to anticipate its arrival, to embrace the idea of it, always to be aware of its proximity. Montaigne, in his essay "To Philosophise Is To Learn How To Die", insisted that "Death has us by the scruff of the neck at every moment," and counselled: "To begin depriving death of its greatest advantage over us, let us adopt a way contrary to the common one; 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. At every instant, let us evoke it in our imagination under all its aspects. In the midst of joy and feasting, let our refrain be one which recalls our human condition... That is what the Egyptians did: in the midst of all their banquets and good cheer, they would bring in a mummified corpse, to serve as a warning to the guests."

The mummified corpse is perhaps overdoing it, but you see what he means. Montaigne thought we should have our noses rubbed in mortality to free us from being afraid of our human condition. "A man who has learned how to die has unlearned how to be a slave," he wrote later. "Knowing how to die gives us freedom from subjection and restraint."

Few things illustrate this better than the English funeral, when compared to its Irish counterpart. In England, mourners gather at the church, see only the closed casket and the flowers, bury them in a graveyard and retire to a relative's house for tea and cakes. In Ireland, an easy familiarity with death is the norm: friends and neighbours descend, en masse and uninvited, to view the deceased, lying on a bed or in an open coffin, to inspect their dead faces, stroke their hair, pat their flesh, clutch their arms and kiss them goodbye.

In England, mourners are hopeless at expressing sympathy or knowing what to say, relying on "Abide With Me" and priestly bromides to get by, while struggling not to give way to grief. In Ireland, everyone says the same formulaic words ("I'm sorry for yer trouble") after which they tell stories about the deceased, get drunk and weep like the Kaieteur Falls. And everyone goes home hoping their own funeral will be equally boisterous and fondly disposed towards the departed (or, please God, even more so).

A good death, from the point of view of the bereaved, is a massive send-off with crowds of friends, speeches of admiration and a collection of meaningful music tracks from the dead person's long, well-travelled and busily mouvemente life. From the perspective of the dying person, who will know nothing of these happy funeral details, a good death is one that's prepared and stage-managed, in which you get to say goodbye to those you love, put your affairs in order and "take a last look/ at sunshine and brook," before retiring to your deathbed, the prayers and the priests.

The trouble with this is knowing when to cease making final arrangements. We are bewildered by the ideal of completion. When do you decide you've done enough to leave the world behind? An extreme case of pre-death micromanagement appears in the pages of Julian Barnes's mature rumination on death, Nothing To Be Frightened Of. It concerns Eugene O'Kelly, the 53-year-old chief executive of a US accountancy firm and the boss of 20,000 employees, an A-type personality and a firm believer in management by schedule. When diagnosed with inoperable brain cancer and given three months to live, he goes into scheduling overdrive. He draws up "the final and most important to-do list of my life" for his last 100 days, identifying goals, targets and priorities. He arranges his own funeral (so it would be "the best death possible"), writes a book about death with the help of, appropriately, a ghost, and finally sets out to say goodbye.

"O'Kelly lists and categorises the friendships he needs to unwind," Barnes writes. "Even before he gets to his inner circle there are, astonishingly, a thousand names in his book. But with the speed and attack of one used to closing deals, he completes the job in three weeks flat: sometimes with a note or phone call, occasionally with a brief meeting which might perhaps contain 'a perfect moment'." He also made an urgent call to Almighty God, a slightly transparent piece of life-or-death insurance, having shown no inclination towards religious observance before.

Was he over-organising his own demise? No; he was just retrospectively ordering his life like a man tidying up his desk, neatly arranging his files and stationery, his friendships and family baggage so that he could leave them all with a clear conscience. Others, faced with the final, most awful deadline, might race to the Taj Mahal, the Pyramids and the Grand Canyon to tick them off their to-see list. The vast majority, though, will settle for being at home, in bed, surrounded by favourite works of Trollope or Conan Doyle, listening to mid-period Pink Floyd or late Beethoven, dining on pâté and steak, vodka and Chateau Musar until they become incapable of anything stronger than intravenous sugar solution, with their loved ones only a couple of rooms away, ready at a moment's notice to change the spring-loaded morphine drip...



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Maybe, though, the best death is simply the one you can organise for yourself, when the pain in your body exceeds your capacity to medicate it. Take the case of the multiple sclerosis sufferer Debbie Purdy. Wheelchair-bound since 2001, with her ability to perform everyday tasks progressively impaired, she went last autumn to the High Court (fruitlessly, as it turned out) to find out whether her husband, Omar, could be prosecuted (and jailed for 14 years under the 1961 Suicide Act) for helping her to kill herself. A one-time jungle trekker and parachutist, she has watched her life slowly winding down since she was diagnosed with MS in 1995. As she becomes unable to use a wheelchair and enjoy the vestiges of an ordinary life with her husband, she's prepared to step into oblivion at a moment she chooses, with help from Omar or from a Swiss clinic called Dignitas.

And who's to say her moment of self-annihilation isn't superior to all the stage-managed, steak-and-wine-and-Beethoven deathbed scenes? Who would blame Jade Goody if, instead of waiting for the End to arrive, lik e a vast black night-bus, she seized the moment to kill the pain permanently, and stage-managed it for the TV cameras?

Both Goody's embrace of death-in-the-camera-lens and Purdy's appeal to the courts call into question our relationship with death: how we conceal it, how we choose not to discuss it, how we approach its sudden acceleration in our lives, how it sits there at the end of our long journey like a dismal flag. But also, how its abrupt nearness makes us contemplate our lives with a new clarity, to see all that is most precious to us in a new light, and to hold our loved ones closer.

And suddenly death doesn't seem a cold, hostile and terrifying thing, but a kind of dark mirror that reflects your years of life and your identity back at you – that simultaneously finishes you off and makes you whole at last.



Final thoughts: Touched by death

Felicity Warner

Author of 'Gentle Dying', and founder of the Hospice of the Heart Trust

I think we have an impoverished attitude to death, and it's a taboo that's increasing. We live in a culture focused on youth and materialism, but death is the one thing we can never resolve in our favour, so it produces huge fear. People put off thinking about it, and hit it full-on without preparation. We're also not used to seeing death. It used to be part of community life, but we have handed it over to the experts, who preside over it in institutions. In losing that link, we have lost the comfort zone that comes with it and thrown away an important rite of passage. Death brings its own wisdom and riches. It's a time when families get together, bring difficult issues to a close, and honour people.

I worked with a man called John who, aged just 37, suffered complete organ failure after a heart attack. He ended up in intensive care and, while he was surrounded by hi-tech machinery and incredible expertise, nobody was there to touch him or talk to him. It illustrated how clinical modern death has become.

There is a better way. I once worked with a woman in her forties who was in the final stages of breast cancer. She was at home, so her children could snuggle up to her and play music, and was happy and serene, which often minimises pain and other symptoms. She died, but her family's involvement gave them a sense of empowerment that helped with grieving.

Havi Carel

Author of 'Illness' and sufferer of a potentially fatal disease

I was diagnosed with a rare degenerative lung disease in April 2006, when I was 35. My parents live in Israel, where I had the first scan. When I confronted the radiologist, I spotted a line in his manual describing the disease. It said that I had a prognosis of 10 years. It was like a terrible nightmare. For the first week I was in shock and didn't want to be alone. You feel angry and jealous of others, and depressed and disempowered.

I had to learn to appreciate my finite existence and that every day is special. You can no longer sustain the illusion that everything's going to be OK. It's a bit like being a child; you've got this innocence and once it's broken, you never get it back.

I'm now taking an experimental drug that shows good results in some patients, and I've been stable for a long time, which is good because you get tired of thinking about when you're going to die.

Barry Albin



Funeral director at F A Albin & Sons, south London

My parents were funeral directors – you could say I'm a thoroughbred. There was a stigma attached to death when I was growing up; children didn't want to come to my house to play, and shouted silly things at me. My sons grew up above the shop, as I did, and have a healthy view of death. I never had to explain what was behind the doors because they were never closed – the boys would see the work, and the bodies. My mother died when I was 17. It was the worst thing she ever did to me, and the greatest gift she ever gave me, because I understood how painful grief can be. For some, it's like a cold that can be brushed off; for others, it's like life-threatening pneumonia. A funeral is the most important event in a person's life. The bigger and better attended it is, the longer memories of the deceased last.

Children are the hardest to deal with. Recently we did the funeral for a little boy who died of a terminal illness. His sister has the same disease and the family know that when she's the same age, she won't be with them either. That funeral was the hardest thing I've had to do. Every evening since, at 5.30pm, the father comes to my memorial garden to be with his son. For him, building a new life is going to be hard, but he will. He inspires me every time I see him.

Christine Allardyce

Marie Curie nurse, Forth Valley

I have been going into people's homes for the past 28 years to nurse the terminally ill. It's very rewarding because you work so closely with patients and families. A lot of our work is to give them a break. Given the choice, I think we would all like to die in our own bed. This is an important decision for families. It means they are involved until the end and helps them to create good memories. I recently nursed a 42-year-old man who wanted to be treated at home so he could be involved in his children's lives for as long as possible, and we helped that happen. It's impossible not to form a relationship with patients, especially in cases like that. But it's not as if you can't cry in front of the family when someone dies. It shows that you care.

Marie Curie Cancer Care is asking everyone to wear a daffodil pin this March for its Great Daffodil Appeal. For more information, visit www.mariecurie.org.uk/daffodil

Robert Moss

Bereaved son

Five years ago, my father, Leonard, died of lung cancer. He was 78, but might have lived to 100 if he hadn't smoked all his life. It was a shock to see this big strong man in bed, so weak and bruised. I told him that I was proud of him. We hadn't always seen eye to eye, but I told him that I was grateful for the opportunities he'd given me and for his being a really great dad. He shrugged, quizzically, but I'm glad I said it, and I think it meant something to him. It sounds perverse to view deaths as good, but my dad had a good death. He didn't go out in a blaze of glory, but he was at home surrounded by people that loved him.

Angela Carby

Cancer patient

Six years ago, I discovered a lump in my breast. My mum had died of breast cancer so it wasn't a great shock. I had it removed and had radiotherapy, but it was too late – the cancer had already spread to my lungs and beyond. Since then I've had surgery, radiotherapy, hormone treatment and chemotherapy – everything they can throw at it. My oncologist has produced cards from up his sleeve when we have hit brick walls, but there's nothing much he can do about the tumours in my brain.

I can't think too much about the future. One of the few things I've been able to plan is my funeral. I don't want a flashy coffin or anything like that – I think it's a waste of money. I want single roses and I've made a CD of the music I like. When the time comes, I'd like it to happen the way I like it. Death is always there in the background, especially on off days. But you're born, you live, you die – that's how I look at it. I'm only 50 but I'm prepared for the inevitable. For me, death is something I no longer fear.

Cathy Newsam

Ward sister, St Wilfrid's Hospice, Chichester

People imagine hospices to be full of sadness, but there's actually a lot of laughter. And it's not as if everybody who comes in dies – a good percentage of patients go home in the end. It's a wonderful place to work. We have time to get to know patients and their families, and it's a privilege to work with them. I think I'd find it hard to work in a hospital with all that rush and bustle – hospices have peaceful atmospheres. We have lovely rooms that, in the summer, open on to the garden, and patients are pushed in their beds into the sunlight. Cats and dogs can visit, and we even had a horse visit a patient once. You can't nurse like that in a hospital.

Our aim is to allow patients to have a peaceful death. It isn't always possible but it's what we strive for. We're sad when people die – it wouldn't be right if we weren't – but knowing we've done our best to make their final journey as comfortable as possible helps us to cope.

Interviews by Simon Usborne

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