By Dr. Robin TW Chan
Have you thought about your own death?
I can understand if some may find this question too morbid, but I offer no apologies for this. Please feel free to skip this, and come back to read when you are ready.
Everything which is born will die. The impermanence of all life ends in death. This is the course of nature. What we do not know is when we will die, and how death will strike us. I have done some research on this and would like to share this with you.
I have looked through journals, publications and World Health Organization reports, and wanted to present the 10 most common causes of death, but I concluded that grouping the causes of deaths into three big groups based on the timeframe of events will be more meaningful in our preparation in understanding what a good death is.
The three broad groups of causes of death are:
1. Old age or chronic illnesses
2. Sudden death
3. Critical illness
Before you read on, I want to ask you, “Which of this way is the best way to die? Which of these three ways to die is considered good?” I will now go through each and see if you will change your mind as you read,.
Old age and chronic illnesses
How many of us want to live a ripe old age? I suspect very many of us hope to live to a ripe old age, and to slowly deteriorate over many years and even decades. I think this is like a prolonged suffering, especially in a modern and materialistic society. Imagine this: one is old and frail, maybe bed ridden or wheelchair bound, wealth and retirement funds are used up, medical insurance exhausted, sometimes with no dependents to support medical care financially, living alone, dying alone and often ending up in an institution for nursing care, and never recovering. His/her condition is always just getting from bad to worse over many years. My godmother was in this group. She stayed in a nursing home for 20 years. Everyone got so tired of looking after her that they did not even want to visit her in anymore. When she finally died, some people actually said that it was a relief.
How many of us want to die this way?
Tonight I go to bed, the next day I never wake up. I go jogging and keel over from a massive heart attack. I get hit by a bus whilst crossing the road. Is this a good death?
Whenever I give talks, I always ask the audience if this is a good death, and there will always be people who said that this is a good way to die! I always tell these people that they are very cruel. This is a terrible way to die!
The Chief Operating Officer of Singapore General Hospital was 49 years old when he fainted and never woke up again. He bled massively into his brain and despite surgery, he never regained consciousness and died within days of the bleed. To the dead person, it may have been an “easy” death, but for those who are left behind, it will be difficult to find closure. They had no opportunity to say goodbye. They had no opportunity to say, “I forgive you,” and they had no opportunity to say, “Please forgive me” or to settle outstanding issues. Those that are left behind may face a lifetime of regrets, anxiety and frustration. It may be an easy death for the dying but a tough way to cope with the sudden loss of a love one for those who are alive.
The third way to die, is either from terminal cancer or organ failure; perhaps you are told that you have six months to live. Is this a good way to die? Some think it is. Even if I have to suffer, I will only suffer for a few months, and I have these few months to prepare for my own death. By definition, if an illness results in an average remaining lifespan of six months, it is deemed “terminal.”
During one of my public lectures, a lady walked up to me, to tell me that she was diagnosed with a terminal illness, and was given only six months to live, six years ago. She then told me that she was sending the doctor a card every six months to tell him that she was still alive, and that he had made a wrong diagnosis. I explained to her that the doctor based their estimation using previous medical records and experiences from other patients and that no one can accurately predict the remaining lifespan that a person has.
The estimation of the balance of a person’s lifespan is to provide the dying with a time period for them to prepare for their own death and to settle personal matters. It is not intended as a curse, and we should not be offended by the doctor’s good intentions. I advised this lady to continue living happily and with gratitude that she is still alive today. I even suggested that she thank the doctor for telling her the diagnosis, giving her the urgency to prepare herself for the final day.
Living a life with gratitude is certainly better than that of hatred toward the doctor for his “wrong” diagnosis.
There are about 84,000 ways to die a good death. Everybody is different, and we have to discover our own destiny. Even if you want to choose how to die, can we really choose? When we are prepared for our own death, any way of dying is a good way. How do we do that?
A good death is therefore a prepared death.
Life comes and goes. Although death is certain, it’s nice to leave this world smiling as we have completed our journey, without any worries or regret. It stands to reason that anyone who learns to live well will die well. The skills are the same: be present in the moment, be humble and brave, and keep a sense of humour.
Dr. Robin TW Chan works, teaches and learns in a hospital and university in Singapore. He is a simple Buddhist, playing in a temple since he was five years old (destroying many vases and buddha statues) he grew up and got lucky in business and education. Professionally he is a pharmacist with legal training and a Phd. in Biomedical Ethics. He takes care of friends who are dying as an active palliative care befriender and a palliative care pharmacist cum legal advisor. Check out his blog here and follow him on Facebook.
Editor: Dana Gornall