BMJ  2005;330 (9 April), doi:10.1136/bmj.330.7495.0-g

Editor's choice

A good death, or a public one?

Many people might think that part of a good death is privacy—or at least having some say over how wide should be the circle of family and friends who come to talk and touch and give support. But these last two weeks have seen two very public deaths—with room to doubt that the victims would have wanted it that way.

Last weekend the pope died. Even in a non-Catholic country such as Britain, a casual listener to the radio or watcher of TV could not help notice how closely each stage of the pope's dying was marked and reported on. As Sophie Aire says in her media review (p 850), "No patient with Parkinson's disease has ever died such a public death." Almost 30 years ago, when General Franco, Spain's dictator, died, the media was criticised for covering every detail of his dying days. But, as Arie points out, it was an "unprecedented flow of Vatican bulletins that informed journalists that the pope was being fed by a nasogastric tube, had had a urinary tract infection, which was followed by septic shock... and finally, intermittent loss of consciousness." Though some observers didn't find such detail tasteful, Arie's account suggests that "the media friendly way in which the pope died was in character with the way he lived."

Terri Schiavo, on the other hand, died after a bitter argument between her husband and her parents and a politicised public and legal debate among the courts, the media, and US politicians ( BMJ 2005;330: 746[Free Full Text]). She died after appeal courts refused to overturn an earlier court ruling that she was in a persistent vegetative state and that she should not be kept alive against what were thought to be her wishes. Though the issue in the Schiavo case is not euthanasia as such, the case has inevitably reignited debates about euthanasia—and ferociously so in the US.

In the UK the language is more measured, but last week's report from a committee of the House of Lords marks a softening in attitudes towards euthanasia and assisted suicide in the UK (p 807). Although the committee is split over whether law should be changed, it does want a debate on the subject early in the next Parliament. It also wants euthanasia to be distinguished from assisted suicide, thinking that assisted suicide might be more acceptable to doctors.

Meanwhile, A C Grayling reminds us that humankind's attitudes towards dying are a bit muddled (p 799). He argues that the right to die has its moral basis in the right to a good quality of life. Choosing when and how to die is, he argues, one of life's great questions that should be left to individual choice—like whom to love and whether to have a family. The problems arise when people lose their power to exercise their choice, and didn't voice it beforehand: when they were not, as Montaigne would have it, "booted and spurred, and ready to go."