Finding peace at the end of life

March 11, 2016

Conversations about death are often fearful: we humans worry about dying too soon, or in pain. We sometimes worry about dying too late – in the case of those who campaign for assisted dying and access to euthanasia. And so, often, we don’t talk of death at all. It is easier to just forget about the future and focus on enjoying the now.

Yet I know from my own experience how important it is for all of us to prepare a little for the inevitable – not just for our own anxious souls, but for those we leave behind. In order to do this, it can help to rely on more than the wisdom of theologians or philosophers.

A recent book When Breath Becomes Air by American neurosurgeon Paul Kalanithi shows that we can learn much from doctors about facing death. It is a topic Dr Kalanithi began to consider when he started medical training at Stanford University, and then Cambridge.

Poignantly, his research became personal. At 36, and on the verge of completing training, Dr Kalanithi learnt he had terminal lung cancer. A gifted writer, he decided to chart his feelings as a way of making useful sense of the experience.

What he describes learning is that we can separate the medical or physical questions from the existential ones. Even if one is diagnosed with cancer young, the medical truth is the same: we’re all going to die at some point. This is not in anyone’s control – no matter how clever or how advanced the therapies available.

What mattered, he found, was the decisions that the illness provoked: what do I want to do most with my time, who do I need to spend time with, what is my human legacy?

Atul Gawande, another US surgeon and writer, has also explored this theme. His book Being Mortal: Medicine and What Matters in the End discusses how medicine often runs counter to what it should be doing when it comes to the inescapable realities of aging and death.

For Gawande, the ultimate goal is not a good death but a good life – all the way to the very end. “You may not control life’s circumstances, but getting to be the author of your life means getting to control what you do with them.”

This was how Dr Kalanithi chose to live out his last few months: finishing his training, fathering a daughter with his wife, spending time with his family, and writing his memoir. In an email in the book’s epilogue, published after he died at 37, Dr Kalanithi explained he wanted to describe “not the sensationalism of dying, and not exhortations to gather rose buds but ‘Here’s what lies up ahead on the road’”.

I find this an inspiring description of how we can find an accommodation with death while enjoying every moment of life. Not a good death, as such, but a fearless one.

Bruno Wang, founder of the Pureland Foundation