Dearly departed: What does it mean to die well?

Dearly departed: What does it mean to die well?

Who would have thought death could provide a potential growth opportunity? Fresh thinking on what used to be a ‘taboo’ subject suggests we can now have more control, and say, into what it means to die well.

A number of scenes in the Hollywood blockbuster The Last Samurai revolve around the question: “How did he die? Did he die well?” Given the social upheaval at the time, this query received significant airplay.

In the Samurai World the criteria for determining the quality of departure was specific. Master swordsman Yamamoto Tsunetomo specified: By setting one's heart right every morning and evening, one is able to live as though his body were already dead, he gains freedom in the Way.

This guideline may have worked for a group tightly bound by the same codes of behaviour, but the notion of ‘dying well’ in the 21st Century is much more personal and open to engagement.

Thought leaders now promote the idea that dialogue about dying needs to be open, honest, authentic participatory. This attitude is in stark contrast to the traditional view that people were expected to merely ‘wait for death’ to occur. With the whole subject matter of death purposely shrouded in darkness and even fear.

Fear disappears

At a recent Selwyn Institute symposium in Auckland, visiting Brunel University Professor Holly Nelson-Becker shared her, and others, experience of people entering the final stages of life.

Behaviour, and expectations, do change. Based on Socioemotional Selectivity Theory, she suggests that the ‘rules’ of engagement become quite specific.

“There is motivation to deepen relationships with key people in their lives. People prefer emotionally positive information rather than negative matters but overall they find information goals less important.” Time is spent in a different way that does not involve punctuality or sticking to routines.

“Spiritual time is not predictable in the sense of a timetable or conventional measures. Nor is it like an arrow of sequences pointing at transitions, endings, or other ways of knowing and understanding events.” The focus becomes very specific on what is relevant, nourishing and enduring. The actual ‘fear’ of death disappears in the process of redefining time, space and life.

By opening up the discussion and seeing death as part of a progression, there is substantial room for people to experience new ways that make it clear how they want to ‘live’ as they approach dying. It is an opportunity, says Professor Holly Nelson-Becker for asking questions so that people define how this part of their life’s journey evolves. On their terms but in consultation, and support, from those they choose to have as part of their dying plan.

Redefining life

From a growth viewpoint, this transformation can involve a redefinition of self, a degree of independence and being very specific as to what sort of ongoing investment in life people want.

Others have written about themes related to the way we live determining how we might die. In a groundbreaking work Dying Well: The Prospect for Growth at the End of Life physician Ira Byock states that development landmarks take place at the start of life as well as the end. These are, he says, typically accompanied by feelings of mastery, expansion, a sense of wellness and, at times, exhilaration.

“These same feelings are expressed in the stories of patients who may be said to have died well. Often the challenge for family, loved ones and other care givers is to recognize the opportunities for growth and development and help the dying person achieve them.”

Ira Byock observes it takes a willingness to talk about things usually avoided.

From his experience, two questions can be helpful to begin the process of discussion and subsequent planning.

“One way to start the journey is by asking: ‘What would be left undone if I died today?’ and ‘How can I live most fully in whatever time is left?’ These questions can illuminate the tasks, and landmarks, ahead.”

Practicing surgeon Atul Gawande, in his bestselling work Being Mortal, sheds light as to how death is not an event in isolation but rather a final ‘act’ in a life story.

“Medicine has triumphed in modern times, transforming the dangers of childbirth, injury, and disease from harrowing to manageable. However, when it comes to the inescapable realities of aging and death, what medicine can do often runs counter to what it should. The ultimate goal is not a good death but a good life…all the way to the very end.”