Revising The Concept Of Dying Well

The driving force of the death care community right now, is a death positive movement that claims everyone has the right to die well. There are sub-sections within that as well, like racially based movements intended to give people of color the same right to die well as those with white privilege. There are LGBT movements intended to give people of all genders, non-binaries and sexual orientations the same right to die well as cisgendered folks. There are also movements intended to give poor people the same right to die well as rich people.

While I love the sentiment and the passion behind that ideation, it just isn’t true. Dying well is not a right. A right is a moral or legal entitlement for everyone to have or obtain something or to act in a certain way. While it is noble to think that every single person, in every country, is entitled to a good death, they are not.

Dying well is a privilege.

Hard as we try we can’t make it any different. To say that dying well is a right, implies that there is something we COULD do to make sure that EVERYONE has access to a good death, but that is impossible because death is not predictable.

100% of people born will die. Some will die like Rose from Titanic, old and warm in her bed. Others however -many, many others- will die in sudden, unexpected and tragic ways that could never be considered ‘good’ by any definition.

The medical community operates under the ‘death must be avoided at all costs, and when it can’t then we aim for a good death’. Never mind that cost is often the ability to have a good death at all. The death positive movement, in an effort to counteract this directive by encouraging people and medical professionals to look at quality over quantity of life, have created yet another issue.

There are some outcomes in life that we have to accept as out of our control. They are just part of the hand we are dealt in life. Not every undesirable outcome can be avoided. Hard as we try, making ‘good’ choices does not guarantee ‘good’ results. We don’t have to make a bad situation worse, but we can’t be in control of all the circumstances of our death.

A good death is a privilege afforded to some, but not guaranteed to anyone. It isn’t a white, cis or rich people privilege. It is a privilege similar to that of being born traditionally attractive. It is a privilege to have good looks and be attractive to others, but it isn’t something anyone can do much about, plastic surgery notwithstanding. It’s a roll of the dice.

As a side note, this premise is insidious and it often at the root of most suffering. We have been conditioned, in one format or another, that if we do all the right things we will avoid unwanted circumstances. If we eat right and exercise we will be a healthy weight, have no cardiac issues, and avoid getting cancer. If we drive carefully we will avoid car accidents. If we are a good person, bad things won’t happen.

What does one do then when they feel they’ve done all the right things and yet something went wrong?

In a similar fashion, the subconscious programming that everyone deserves a good death, can set people up for complicated grief when a not-so-good death happens, because they will be stuck in the ‘what did I do to deserve this?’ or ‘what did I do wrong?’ quandary.

But I digress…

According to the CDC the leading cause of death, in 2020, in the US, for all genders, all races and all ethnicities, ages 1-44 (80,208 deaths) is unintentional injury. While the leading cause of death age 45 and up (701,497 deaths) is malignant neoplasms and heart disease. The #1 leading cause of death across ALL ages, ALL genders, ALL races, and ALL ethnicities is heart disease. There is no chart to distinguish which heart disease deaths were the result of sudden heart attacks and or slow disease progression. (Hard as I tried I had no luck in my search to find how many deaths were sudden -from any cause- and how many deaths were somewhat prolonged.)

And that’s just the majority of deaths, that doesn’t address unique circumstances the marginalized of our society face at a higher rate, like homicide.

My point is simply that when we talk about the right to die well, that conversation can only include certain kinds of deaths. I think we can do better. I think we MUST do better. I think we have to look with Eagle eyes to see the details in the bigger picture.

It is said that our society is death phobic, but is that really true? A phobia is an irrational fear of death, but is the fear of death irrational? The fear of death is actually the fear of the unknown- an unknown time and circumstance. Isn’t it rational and understandable to fear the unknown?

Our society is what I would categorize as ‘death averse’ rather than phobic. There’s an irrational subtext that death can be overcome and avoided. That it is an enemy to be fought and overpowered. At best, death can only ever be delayed – even if for many years, it is only a delay.

So then what IS everyone’s right regarding death, despite individual uncontrollable, unpredictable circumstances?

If the concept of ‘dying well’ initiates visions of people lying in a comfortable, clean, safe, warm atmosphere surrounded by people who care, what can we do to create that type of circumstance no matter the situation?

Let me outline the most ‘impossible’ example to illustrate what I mean.

Say a child has been shot and killed. How can this family have a ‘right to die well’ experience? The child is brought to the emergency room and after being officially pronounced dead, normally the family is just sent home.

What if there was the opportunity to have a ‘hospice type experience’?

What if a special room is created, with a soft homelike atmosphere, for the family to have time to come to terms with the situation. Where they could sit with their child, hold them, rock them, comfort them. Where family could gather and support one another. Where professional support people were available to facilitate healing grief rituals. Where saying goodbye could start with the body present, just like when someone dies with a terminal illness.

It took the medical community forever to finally realize the importance of this regarding stillbirths and neonatal deaths, why not generalize that awareness and give this opportunity to all bereaved? This would especially help grief that turns to anger when there is no outlet.

This model can be easily applied to every single death that occurs outside a hospice setting, including suicides where I think it would be especially valuable.

For those deaths occurring in such a way that a trip to the hospital is not warranted there could be a response team associated with emergency services, called to the scene to help facilitate such an experience at the home.

While, at first glance, it may not seem to change or benefit the deceased in any way, I would say that it matters a great deal to them as well. Metaphysically, we know that we can assist the dying on their journey, even after death, with our energetic support. This is especially important in traumatic deaths when the spirit may be confused and disoriented after leaving the body so abruptly. We cannot control the circumstances of an individual’s death, but we can equalize what happens after.

There is a need to do better with bereavement starting at the moment of trauma. The evidence is all around us. It is why you see little white crosses, or Stars of David, on the roadside where fatal accidents have occurred. Why there are altars made of flowers, teddy bears, plaques and candles at the site of shootings. We NEED ritual that is tied to the dying place. I believe that if we apply old school hospice practices to every death, regardless of the cause, our society as a whole will reap the benefits.

In our society we label death as a medical event. Unless someone has been referred to hospice, the emotional, spiritual, and grief aspects of dying are largely ignored. However, in EVERY death (regardless of circumstance) there is a spiritual/energetic component. We have failed as a death care community to bring peace to all deaths. By attending to that we facilitate healthier grieving, which leads to an emotionally healthier society.

We need to create opportunities for bereavement services at the time of impact, no matter where, or how the death takes place, because everyone has the right to grieve well.

Let’s start THAT conversation.

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