Second thoughts about how to die

While recently confronted with a cancer scare and several months of inconclusive diagnostics, I found myself thinking about how I want to die.

Following some reading, my first answer was to die at home, with control over my care, and without substantial pain, views that are widely shared by others. But the more I thought about this, the less satisfactory the answer seemed.

For instance, being at home was never of high priority during my life, so why should it become a priority for dying? Even more vexing, I had never set avoidance of discomfort and pain to be a guiding principle for my life, so why should it be guiding principal when dying?

With much more reading and deliberation, I found myself aspiring to die with courage, humility, and consideration for others.

Courage is the ability to do what we think is desirable in the face of fear. Dying and death evoke fear in most of us. When dying, we will need courage to adapt to the diminution of our powers, to ask tough questions, and to make decisions about imperfect treatments. We will need courage to face the unknown, divine justice, or obliteration. And at some point, we might want courage to decline further treatment and loosen our grip on life.

The research suggests that both fear and courage are contagious. The best boost to our courage is the company of courageous people.

Nelson Mandela suggested courage is a process, “The greatest glory in living lies not in never falling, but in rising every time we fall.”

Churchill advised, “Courage is what it takes to stand up and speak, and courage is also what it takes to sit down and listen.”

Humility does not come easily to me or most Americans. Death is a violation of our birthright — at least death before old age, which we tend to define as 20 years older than whatever is our current age after we have passed 65.

Humility is recognition of the limits of one’s talents, authority, and powers; it is a comprehension that we are but glittering specks in a vast universe; and it is acceptance of the inevitable. Without humility, our last months and even years can be a frantic but fruitless struggle against decline and death.

Albert Einstein observed, “From a universal standpoint, something inside always reminds … us that there are bigger things to worry about.”

The psychotherapist David Richo noted, “Humility means accepting reality with no attempt to outsmart it.”

The blunt-spoken, Ann Landers’ advised, “Some people believe holding on and hanging in there are signs of great strength; however, there are times when it takes much more strength to know when to let go and then do it.”

Why aspire to die with consideration for others? For the same reason many of us seek to live with consideration for others. Our dying will affect others — a spouse or partner, children, siblings, relatives, friends, care-givers, and even society. We do not want to overburden them, traumatize them, or impoverish them during our dying.

There are many ways we can exercise consideration for others during our dying. We can start with a thorough living will and designation of a medical power of attorney, saving family and friends from agonizing decisions. If we want to die at home, we can make plans so that it doesn’t unduly burden family members. We can complete legacy projects, resolve old conflicts, send thank you notes, bestow forgiveness, and express our love.

Yes, I still would like to die at home, with control over my care, and without pain, but now my priorities are to die with courage, humility, and consideration for others.

Gregg B. Jackson is a professor emeritus, The George Washington University. He coordinates a public service website on dying at Our Last Passage.

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  • Rginsberg2

    Very thoughtful piece. Much appreciation. Shared…!

  • Ron Smith

    Hi, Gregg. Thanks for the post. Just some of my thoughts…

    Maybe I’m wrong but it seems what you describe as courage is really just keeping a stiff upper lip in the face of adversity, instead of crumbling under the weight of the trial?

    I think a unrepentant murderer going to the chair could have that kind of ‘courage’ just as someone who sees cancer take its final result. It could be that the courage you describe is like what some people equate to a strong British constitution as they faced the foes of WWII or someone who has simply given up to the inevitable as some did during the sinking of the Titanic?

    There are four cardinal virtues; wisdom, temperance (moderation), courage or fortitude, and justice. There are three others that I won’t discuss here. Wisdom occurs when your reason apprehends truth and your will acquiesces to it. Temperance or moderation is when our base instincts and appetites are held in appropriate check. Justice is the same thing as keeping promises.

    Lest anyone accuse me of teaching Sunday school, these are Platonic virtues recognized by various civilizations over centuries.

    Courage is all the virtues at their testing point. It is only when you are tested that you can see that you have wisdom and temperance. If you fail then you are left with foolishness and are overtaken by your appetites and instincts.

    Justice, the keeping of promises, is the result of courage which then acts toward other people.

    I reason that it is best to keep my marriage vows to Stacy, my wife of 36 years, so I temper my instincts and so careful to not let my eyes wander to other women. Courage and justice are what my wife sees therefore because I’ve kept my marriage vows to her.

    Whether it is courage or just a stiff-upper-lip stoicism or simple emotional resignation and acceptance at the end of life depends, I think, on the apparency of wisdom, temperance, and justice in the life of the deceasing person up to, and at that point.

    We all hope that any person we care for ends well. We each hope that we ourselves will end well. Medicine can take a person to a pain-controlled and possibly independent end.

    Beyond that a Sunday school would probably be required.

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

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