Taboo #10 – Death
“Our new Constitution is now established, everything seems to promise it will be durable; but, in this world, nothing is certain except death and taxes,” Benjamin Franklin 1789.
He concluded with a note about his own mortality to his friend:“My health continues much as it has been for some time, except that I grow thinner and weaker so that I cannot expect to hold out much longer.”
Franklin would succumb to a combination of illnesses at the age of 84 in Philadelphia on April 17, 1790.
We are now heading towards 7,000,000 deaths worldwide from this dreadful disease. These are ‘just’ the official figures and many sources will be ‘guestimates’ so the real figure may well be much higher still. There doesn’t seem that any government had the perfect plan and those supposedly doing well in terms of mortality in the beginning have had their peak merely delayed. Certainly first world countries have fared better than those in the third world in part more latterly because of higher vaccination rates. However regimes with stricter rules and tighter law enforcement have seemingly fared best. Freedom comes at a price and for many that price is death. Antivaxxers can feel safe when well and of course most will survive even if they get Covid-19, however many won’t and local experience shows that although there are many patients being admitted to hospital despite being fully vaccinated it is in the main those who are not that pay the ultimate price. ragic stories abound of those who decline treatment and accept treatment when it’s too late. The other tragedy of course is that it is the very cohorts that are most at risk that seem to be declining vaccination the most – those in poverty and ethnic minorities in the west. I have no answers but would urge you all to get vaccinated, if not for yourselves then for your family and wider society. Of course there are risks but these pale into insignificance when compared to the risks of contracting Covid-19 even when surviving Long Covid may well be the next hurdle we have to face, that and the epidemic of mental health consequences and let’s not forget that those of us in the Northern Hemisphere are about to enter the Flu season and deaths were always higher in winter due in large part to this other virus.
Death – How do we deal with it? How do we plan for the inevitable?
Benjamin Franklin wrote in a 1789 letter that “Our new Constitution is now established and has an appearance that promises permanency; but in this world nothing can be said to be certain, except death and taxes.” To this should be added change. You can’t avoid change, it’s mandatory, progress however is optional. Reinhold Niebuhr’s, The Serenity Prayer (1943) helps us with this and to my mind is as relevant in the secular as well as religious context.
God / (Through my efforts) grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.
So, if we accept that death is inevitable and change mandatory and best to be progressive, should we not learn to live our lives so as to get there with as few regrets as possible? How are we to do this? Well a good place to start might be to ask the dying about what they would do differently and use this information to plan forward without leaving it to our own deathbed. Bronnie Ware in her 2012 book, ‘The Top Five Regrets of the Dying: A Life Transformed by the Dearly Departing’ did just this.
So here are the top 5.
- I wish I’d had the courage to live a life true to myself, not the life others expected of me. “This was the most common regret of all. When people realise that their life is almost over and look back clearly on it, it is easy to see how many dreams have gone unfulfilled. Most people had not honoured even a half of their dreams and had to die knowing that it was due to choices they had made, or not made. Health brings a freedom very few realise, until they no longer have it.”
- I wish I hadn’t worked so hard. “This came from every male patient that I nursed. They missed their children’s youth and their partner’s companionship. Women also spoke of this regret, but as most were from an older generation, many of the female patients had not been breadwinners. All of the men I nursed deeply regretted spending so much of their lives on the treadmill of a work existence.”
- I wish I’d had the courage to express my feelings. “Many people suppressed their feelings in order to keep peace with others. As a result, they settled for a mediocre existence and never became who they were truly capable of becoming. Many developed illnesses relating to the bitterness and resentment they carried as a result.”
- I wish I had stayed in touch with my friends. “Often they would not truly realise the full benefits of old friends until their dying weeks and it was not always possible to track them down. Many had become so caught up in their own lives that they had let golden friendships slip by over the years. There were many deep regrets about not giving friendships the time and effort that they deserved. Everyone misses their friends when they are dying.”
- I wish that I had let myself be happier. “This is a surprisingly common one. Many did not realise until the end that happiness is a choice. They had stayed stuck in old patterns and habits. The so-called ‘comfort’ of familiarity overflowed into their emotions, as well as their physical lives. Fear of change had them pretending to others, and to their selves, that they were content, when deep within, they longed to laugh properly and have silliness in their life again.”
What’s your greatest regret so far, and what will you set out to achieve or change before you die?
Let’s assume inevitability has taken its course and we are close to death – what do we want for ourselves and from those others around us. This will be different for each of us and of course is best thought about well in advance. We can of course change our minds and keeping up to date with our own thinking is of course important. Discussing your desires and wants with those close to you and likely to survive you will be helpful for all concerned. It is especially important so that over and above the detail they can get a flavour of your thinking in case not all eventualities are covered.
Age UK has great resource at:-
What is an advance decision (living will)?
An advance decision allows you to express your wishes to refuse medical treatment in future. It is sometimes referred to as a living will. An advance decision would become relevant if there came a time when you were unable to make or communicate your own decisions. It allows you to refuse treatment, even if this might lead to your death. An advance decision is legally binding which means that those caring for you must follow your instructions. However, it will only be used if you lose the capacity to make or communicate decisions about your treatment.
What should I think about when making an advance decision?
Think carefully about whether there are any treatments you would not want to receive in certain situations. You should discuss your advance decision with a healthcare professional who knows your medical history and the risks and benefits of refusing certain treatments. You may also want to discuss it with your family and friends so that they understand your wishes. An advance decision to refuse treatment:
- Must be clear about the circumstances under which you would not want to receive the specified treatment.
- Should specify whether you want to receive the specific treatment, even if this could lead to your death.
- Can’t be used to request certain treatment.
- Can’t be used to ask for your life to be ended.
How do I make an advance decision?
An advance decision does not need to be in writing unless you are refusing potentially life-sustaining treatment. However, it is good practice to write it down and give a copy to your loved ones and all involved in your care. Your GP and medical team must know about your advance decision, so they can include it in your medical notes. You should review it regularly and can change it at any time. You must make sure that you clearly communicate and record these changes, being sure to date and sign it.
If you want to refuse potentially life-sustaining treatment your decision must be in writing, signed, witnessed, and include the statement ‘even if life is at risk as a result.’
The rules about how an advance decision and Lasting Power of Attorney for Health and Care interact can be complicated. It’s best to seek legal advice about setting up an advance decision.
What is an advance statement?
An advance statement of wishes explains your likes and dislikes and anything that is important for you to be comfortable. An advance statement should be considered by all those involved your care. Unlike an advance decision, it’s not legally binding.
You might like to include information on:
- Where ideally you would like to be cared for, for example your home, a care home or hospice.
- Your dietary requirements including foods you do and don’t like.
- Whether you prefer baths or showers.
- What kind of clothes you prefer to wear.
- The type of music you like and what you like to watch on TV.
- Whether you like to sleep with a light on.
- The time you like to go to bed and whether you’re an early riser or prefer a lie in.
- Your religious or other beliefs and values
- Who you want to be consulted about your care.
- Who you would like to visit you. (or not!)
You can record your advance statement in any way it works for you. However, it is important to give a copy of your advance statement to all those involved in your care – especially your care staff, GP and medical team so that they know your wishes.
What should I do next? Have a look at AgeUK’s helpful site.
Download our information guide Thinking about end of life (PDF, 656 KB)
Read our factsheet on Advanced Decisions and Living Wills (PDF, 443 KB)
Discussing death and funerals continues to be a taboo for many people, according to latest research from the Funeral Planning Authority (FPA). Despite the fact that filling loved ones in on your funeral wishes can potentially save them a lot of stress and worry when the time comes, less than half of us have told family and friends what sort of send-off we would like.
Most talked about funeral aspects are:-
- Cremation vs. burial (47%)
- Type of service (41%)
- Location (35%)
- Covering costs (34%)
- Music (31%)
Discussing funeral plans
Only 37% of Brits aged over 40 have discussed their funeral plans with friends and family, the FPA found. However, for those that have thought about and discussed their plans with loved ones, there are some common themes and popular requests:-
Five common funeral requests
- The dress code
While black remains the colour of choice at traditional funerals, many choose to avoid black so as to emphasise the positive character of the deceased, and to celebrating the life they led rather than mourn their departure. The more personalised a funeral is, the more chance there is that the family will request that the guests are free to make the occasion more colourful.
- The decorations
Some people may request that their funeral be a reflection of what they were like, and what they liked. So besides floral tributes, they may ask for items to be displayed – a favourite football shirt, flags, books, records – or they may request a plain cardboard coffin that can be decorated by mourners themselves at the service with messages and drawings.
- The music
Choosing the final music heard at your funeral is one of the most popular ways to personalise it in a touching, ‘this is me’ way. Hymns have got less popular as pop has taken over, and in 2016 the most popular were sentimental songs of farewell – the top three were “My Way”, “Time To Say Goodbye” and “Over The Rainbow”, while modern-day classics like Adele’s “Hello” and Robbie Williams’ “Angels” are increasingly common. Some people like to request live music or unusual musical choices –
- FIRESTARTER, THE PRODIGY,
- HIGHWAY TO HELL. AC/DC
- ANOTHER ONE BITES THE DUST, QUEEN,
- ALWAYS LOOK ON THE BRIGHT SIDE OF LIFE, MONTY PYTHON,
- BURN BABY BURN (DISCO INFERNO), THE TRAMMPS
- A final message to the mourners
The idea of a goodbye note as a eulogy, a last letter or even video to your loved ones can be a comforting thing for those grieving and can allow you an opportunity to say thank you to everyone, to let them know how much you loved them and that you will be looking out for them wherever you are.
- The funeral itself
Wills now specify if you prefer burial or cremation, but it is still good to let your family know which you prefer. Many now go for a humanist service or environmentally-friendly sustainable coffins made from biodegradable materials. Your funeral plan could also include giving roles in advance to family and friends which may make it more meaningful.
Q1. Have you got a will? (If not get one – you never know when the Grim Reaper will call by!)
Q2. Should you make an advance decision (living will)?
Q3. Who and what would you like at your funeral?