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FILLERS: What is a good death? Join in our online discussions BMJ 2003; 327: 66 [Full text]

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a good death

susanne stevens, n/a   (11 July 2003)

Support from friends and relatives

Mary B Murray   (11 July 2003)

Mauled to death by a lion

jefferson p jones   (15 July 2003)

no title

Stephen J.S Martin   (15 July 2003)

good death

dr.manan vasenwala   (15 July 2003)

QUALITY OF DEATH MEANS MORAL AND GOOD DEATH FOR ALL

Ioannis D Dimoliatis   (16 July 2003)

A New Beginning

Stanley J Lloyd   (16 July 2003)

What is gooddeath

Dr Anand Deshpande   (17 July 2003)

Death Cannot be Tamed

Mary J Curtis   (18 July 2003)

A good death follows a good life

Akheel A Syed   (18 July 2003)

Die in a bed

Joseph C. Watine   (18 July 2003)

Need for voluntary euthanasia.

Gerald P McGovern   (18 July 2003)

Euthanesia

Sanjib Kumar Deka, Assam 784505   (19 July 2003)

A good death in the emergency department

Anders I Ganstal   (22 July 2003)

Living with mortality

Andrew G Rivett   (23 July 2003)

How my grandmother died...

Martin Kittel   (24 July 2003)

Extending life or prolonging dying?

Mark Pickin   (25 July 2003)

A Failure to Rescue

Camilla Roskelley   (25 July 2003)

Assisted dying

David Ridley   (27 July 2003)

Doctor assisted dying

Edgar L. Killip   (27 July 2003)

Fear of Death

Peter Gilbert, Robert Harris, A Hill   (27 July 2003)

Do Prolong My Life!

Nimrod Pik   (29 July 2003)

What is a good death? To use death as a mirror and find the quality in life

Joav Merrick, Søren Ventegodt   (31 October 2003)

What is a good death? Memories of a mother's passing.

Fiona H French   (31 October 2003)

A Christian death

Barbara M Phillips   (31 October 2003)

What was good life is now a good death

roopa venktesh, nil   (31 October 2003)

A good death with an awakened state of mind

bruno friedberg   (5 November 2003)

a good death 11 July 2003
susanne stevens, retired cf24 3pf, n/a Send response to journal: Re: a good death	For me there is no possibility of a 'good death' it is a horror. I would hate to die in any kind of institution or hospital. I would not want to be bothered by the opinions of others who do not support my views at a time like this. I would not want any 'professional involvement' in such a personal decision - except to provide the means to kill myself or have a named person do it for me. I am afraid of being afraid at the end so I would like, if I felt the need, some kind of drug which I had experimented with already so that I would know it does not have adverse effects but does have a pleasant effect.I no longer care about conquering fear naturally in this respect or of being thought a weak character, I want to do the best for myself. I would like it to be totally private and if I decide on suicide not to have this reported in the papers. There is one organisation which does sell a book on how to carry out your own death but it has a strange rebellious and immature tone to it. There is a registration fee and they take months to send information which can be accessed for nothing on the net. The book costs extra. I would prefer something like dignitas but without it being medicalised. The persons own wishes are respected, nobody assumes the right to examine the person or decide whether they are competent, something I would find offensive and unacceptable. They are given the means to die with something reliable and quick. If it could be calm rather than quick this would suit me - which is why I need good info about drugs. I would like my attitudes and wishes about what happens after death to be respected ie my privacy respected, my information not to be passed on in any way I had not agreed to. Competing interests:   None declared
Support from friends and relatives 11 July 2003
Mary B Murray, young mother not applicable Send response to journal: Re: Support from friends and relatives	I have seen various members of my family die in recent years, and undoubtedly my father had the best of it. He was lucky enough to lead an active and fulfilling life until 85, became ill and died within a week of multiple causes. I am not against major medical intervention, but I would not accept one which would only prolong misery. In other words I'd like to know that there would be at least an 85% success rate for a positive outcome. From my experience the company of immediate family is the most important thing - which is why I chose psychological support. It was the nearest comment I could find. Spiritual support is important insofar as I would like to be sure there was no unfinished business. I would also probably wnat a religious element. I would like to know that my bereaved family would be supported. However I did not tick psychological support as it suggests a professional element; my preference would be for the genuine concern of friends and neighbours. I fear that in this country, the general public tries to pretend it has not happened and are not open about it. That is my experience too. Competing interests:   None declared
Mauled to death by a lion 15 July 2003
jefferson p jones, GP Rigby Surgery NE5 9DJ Send response to journal: Re: Mauled to death by a lion	After a stint of general medicine and geriatric hospital jobs, the mode of death and the build up to it became a source of concern to me. There seemed to be little dignity in the dying, or acknowledgement of the death. When a baby is born there is something of a fanfare, but when an elderly person dies on a ward it barely causes a ripple of acknowledgement. I had considered that when my time came, I would not want to slip away in such a fashion, but would prefer a more dramatic departure, such as being mauled to death by a lion. This isn't to be flippant about a serious subject. Such a mode of death would mean that I was likely to have been reasonable fit immediately prior to it (I couldn't have got in the vicinity of a lion if I was bedbound with a wasting disease, or locked in the clutches of the medical establishment undergoing pointless tests and heroic investigations in hospital). I would also be doing something I enjoyed at the time (on a safari preferably, rather than visiting a zoo), and I would hope a rush of adrenaline and the clinical precision of the lion would give me a quick, relatively painfree death. Of course, this is a selfish death. Families would have to cope with the sudden loss of a loved one, and there might be trouble for the lion keeper or safari owners. But no death is 'perfect', and in choosing where I died (although not necessarily when), how I died, and in keeping the distressing symptoms of death to minimum, such a death provides many of the requirements identified in your survey as those desired by your readers. I doubt, though, whether the NHS will ever be able to provide such a service. Competing interests:   None declared
no title 15 July 2003
Stephen J.S Martin, consultant psychiatrist County Hospital Durham, DH1 4ST Send response to journal: Re: no title	I would reiterate what Mary Murray has said, but, because of the wording of the options, actually ticked different responses; I think that my concept of the good death is similar to hers. I think of my own father's death also as having been pretty "good"; he had time to order his affairs and the possession of faculties to do so; he could see that his children were completing the final establishment of themselves in independence and could see that the next generation was appearing; he, and we, had opportunities to "say" goodbyes. The medical profession did him okay; they told him the truth about his bowel cancer, but also preserved his confidence that they would do everything possible for him; they treated his pain insofar as he told them about it and let them. I had some reservations about ticking the 'with whom' box as this might imply that others had to die as well, but did so assuming the 'company' interpretation; but this shouldn't mean that they have to be present at a final moment. This reading would satisfy, for me, the needs that are implied in the 'spiritual needs', 'psychological support', and 'bereavement care' options; I was unwilling to tick them for the following reasons:- Quality of death for the dying person is to do with acceptance of something unwelcome in its principle, but eventually inevitable; "good" life will always then be preferable. In this way, short duration of process and absence of difficult-to-endure symptoms are then "good" aspects. Otherwise quality has to do with the about-to-be-bereaved and mainly that there should be some such persons; that is to say survivors of significance for whom the death will likewise be unwelcome. The requirement for professional people to be around in order that these features may be achieved would detract from the quality; ideally the mourners would be able themselves, albeit that they might find supports helpful; I would regard their necessity as untoward. Ticking the 'no heroics' box would imply that one doesn't believe in the propriety of a lot of what we do as doctors. That we wolud like to be attended in a final illness by professionals who know what they can do and think about why they do it wasn't, unfortunately on offer as a box to be ticked. Competing interests:   None declared
good death 15 July 2003
dr.manan vasenwala, consultant-cardiologist k.k.heart center, aligarh-202002 Send response to journal: Re: good death	by good death i don't mean suicide. it should be a medically informed good death. if a patient has a terminal illness, or in very great pain or discomfort, and medical opinion leaves no room for hope, then it is futile to wait for a miracle. in this case the time and place should be of patient's choosing. the important ingredient here is information. both patients or their wards should know what is in for the patient. the patient chooses a time, i think, usually after winding up financial matters. we regularly inform critically ill or terminally ill patients that the end is near and they should wind up all their obligations, including finances. the place of choosing, at least, i would, would be my house, if i have one, next ,in a home or hospice.heroic measures only prolong the agony and often leave the patient in a far worse condition that they had in the first place. also some treatment are worse that the disease as in malignancy, treated with chemotherapy and radiation, which turns the human being into a skeletal remnant. Competing interests:   None declared
QUALITY OF DEATH MEANS MORAL AND GOOD DEATH FOR ALL 16 July 2003
Ioannis D Dimoliatis, Assistant Professor of Hygiene & Epidemiology University of Ioannina, Dept of Hygiene & Epidemiology, 45110 Ioannina, Greece Send response to journal: Re: QUALITY OF DEATH MEANS MORAL AND GOOD DEATH FOR ALL	What is a good death? - to die prior to children; “it is not bad to die when it should to, but to die prior to proper age and prior to parents” (Greek epigram) - to befall at the right time, i.e. when life is maximized,[1] that is when death occurs after having gained a life with no more than, say, 5% deviation from lifetime AND lifequality expectancy - the “mature death”,[2] i.e. when can be said “Lord, now you are letting your servant depart in peace” (Luke 2.29); not premature nor overmature (or perhaps rotten) - not to experience “negative life”[2] - not the prolongation of “dying process”[3] - all deaths of the person –physical, mental and social– to coincide; not the decomposition to parts from which human is made up - the death for which the dying person is prepared to want what it should to - the good end of a good life, “a natural phase of life”,[4] a “part of life”[5] (the opposite is not true, life is not part of death); “the end of our life to be painless, unashamed, peaceful” (Holy Service of John Chrysostomos) - “to be able to die with dignity”,[4] not simply to “allows people to die with dignity”[6] - not “the forbidden death”[7] - to pass away peacefully in the hands of your beloved, bidding them - your children and friends to remember you with positive feelings (to be remembered with bad ones is too bad) - not to become burden to your children (and the public) - not your children –at the bottom of their heart- to wish your death, nor to wait when you will die in order to regain their freedom (the lady in the waiting room of the asthma surgery wished the next lady, who was caring for her bedridden father-in-law and was suffering from asthma, “Good freedom!”) – not to incriminate healthy people, nor to reproduce the sick within the next generation (later on, the ones who wished your death will flood with guilt and gradually will become ill) - not to be opposed to the other edge of life, the births by next generation(s) - the moral death, i.e. its “externalities”[1] to be affordable by the family, the society and the whole biosphere - not merely the absence of bad death; something much more, though this absence is the minimum - and last but not least, good death means GOOD DEATH FOR ALL, including Iraqis. [1] Dimoliatis I. Lord now you are letting your servant depart in peace: a theoretical model combining quality of life and years of life, which offers clues for the proper time to die with dignity. Med Law 2000;19:635-55. [2] Dimoliatis ID. Negative life helps to detect mature (dignified) death: beyond QALYs and DALYs. http://bmj.com/cgi/eletters/326/7379/30#28888. [3] Ellershaw J, Ward, C. Care of the dying patient: the last hours or days of life. BMJ 2003;326:30-4. [4] World Health Organization. Health 21- health for all in the 21st century. Copenhagen 1999:37-8. [5] LeShan E. Learning to say Goodbye. Ann Elmo Agency Inc, USA, 1976. [6] World Health Organization. Targets for health for all. Copenhagen 1999:12. [7] Aries Philippe. Essais sur l’histoire de la mort en Occident. Editions du Seuil, 1975. Competing interests:   None declared
A New Beginning 16 July 2003
Stanley J Lloyd, PharmD/Editor 45236 Send response to journal: Re: A New Beginning	I chose to have my spiritual needs met, to have access to the appropriate palliative care, and to have bereavement assistance available for my family. A few years ago, I would have chosen a completely different set of priorities. But over the last few years, my Christian faith has become the central part of my life. It makes such a difference that when looking back, I literally cannot fathom how I made it through various trials in life on my own. I always thought that I would carry myself through anything, but paradoxically I now know (and have experienced) that depending on Christ, rather than being a sign of personal weakness, provides an inexhaustable strength. Suffering now has tremendous meaning in my life, and is something I can accept rather than run from. I am beginning to understand how it mysteriously unites us with Christ, and in some small way allows us to participate in His salvific work. Death will come when God wills it, as it does for us all. It's a time of tremendous sorrow, but also a time for joy as we look forward to eternity with a God who loves us as much as He does. Competing interests:   None declared
What is gooddeath 17 July 2003
Dr Anand Deshpande, non-principal BL5 2QE Send response to journal: Re: What is gooddeath	Dear Editor, Re: What is good death In a party with his friends when Julius Caesar was asked what kind of death was the best, Caesar replied: “The kind that comes unexpectedly.”* His wish was fulfilled. When we are young and healthy we would not like to think the way we die, as death is a negative thought and is subconsciously pushed out of our mind. Not being a burden (physically, mentally and financially) to our loved ones, the kith and kin at the time of death is a good way to die. Being physically and mentally completely independent almost to the time of death could be a wish only a few can hope to achieve. Non-lingering and quick death is a good death. Others would certainly applaud it for having saved them from experiencing prolonged mental trauma of the inevitable event of death of someone they loved, liked or revered. Not only how one dies but when one dies is also important. One would like to see certain tasks completed before leaving this world for good. Of course this varies from cultural, religious background of the individual. In Hindu mythology the Mahabharata the grandsire Bhishma had a boon of dying only when he wished. This is not the same as the modern day concept of euthanasia of ending ones life voluntarily. Bhishma could postpone his death indefinitely. Wounded by the arrows of his grandnephews in the Mahabharata battle he lay there until the sun turned northward journey. Even today, upper caste Hindus believe dying in the months when the sun is moving from south to north is an auspicious death. Similarly, every individual would like to see certain life events in their family happening before their death (such as children well settled, marriages etc etc.) which is psychologically fulfilling to the dying person as well as helpful to the living ones to cope with the sad death of the loved one. Certainly this acts as psychotherapy in certain cultures. Both How and When death occurs make it a good death. Dr Anand Deshpande Westhoughton, Lancashire *Plutarch: Fall of the Roman Republic. Competing interests:   None declared
Death Cannot be Tamed 18 July 2003
Mary J Curtis, Head of Education & Training Mount Edgcumbe Hospice PL26 6AB Send response to journal: Re: Death Cannot be Tamed	Tomorrow is not promised to anyone young or old. 'Death cannot be tamed. Death is unknown. Death is other. Death is death. When men die there awaits them what they neither expect nor even imagine.' Heraclitus (cited by James Hillman in The Dream and the Underworld) Competing interests:   None declared
A good death follows a good life 18 July 2003
Akheel A Syed, Specialist Registrar & Clinical Research Associate University of Newcastle, NE2 4HH Send response to journal: Re: A good death follows a good life	A good death is like the final chapter of a good book: it wraps up the story of ‘life’ with panache, is physically, emotionally and spiritually satisfying to the author (the deceased) and the reader (kith and kin), and leaves no loose ends to be explained in a sequel. Competing interests:   None declared
Die in a bed 18 July 2003
Joseph C. Watine, consultant, laboratory medicine Hôpital de Rodez, France Send response to journal: Re: Die in a bed	In opera, theatre, or literature, best deaths generally are those of brave fighters who kill themselves to avoid capture and degradation, suicide of lovers because they have, or believe they have, lost their beloved ones, self murder ordered by rulers, or even auto sacrifice for a just cause. But, I would rather die in my bed, making love, quite simply. Competing interests:   None declared
Need for voluntary euthanasia. 18 July 2003
Gerald P McGovern, Retired NHS Consultant not applicable Send response to journal: Re: Need for voluntary euthanasia.	A rational wish to end one's life in the face of intolerable and unalleviable suffering should out of humanity and a respect for the autonomy of the individual be made possible of fulfillment through legislation with strict safeguards like those in Dutch law. Competing interests:   None declared
Euthanesia 19 July 2003
Sanjib Kumar Deka, Railway Medical Officer N.F.Rly Hospital Rangapara North, Assam 784505 Send response to journal: Re: Euthanesia	According to me the good death is what a person dies with full dignity, painlessly and without any sufferings. In case a person is suffering from any sort of chronic illness or fatal diseases or there is no any chance of recovery, Euthanesia should practice and in our country this should make legal. Competing interests:   None declared
A good death in the emergency department 22 July 2003
Anders I Ganstal, Emergency physician Royal Alexandra Hospital, Emergency Administration, 10240 Kingsway Ave, AB, T5H 3V9 Send response to journal: Re: A good death in the emergency department	The final hours of a dying patient may potentially be spent in an emergency department. In 2001, 444 patients died en route or in the emergency departments of Edmonton, Alberta. The number of family members immediately affected by the disclosure of this news while in the emergency department is perhaps double or more. Family members often experience significant grief when death occurs in the emergency department as the patients are often younger and the death is often sudden and unexpected. [1] Ensuring a good death while the patient is in the emergency department is a multidisciplinary endeavor requiring the assistance of nurses, social workers, pastoral care workers and physicians. In a good death the patients’ advanced directive (if they have one) is respected and the patient suffers minimally. As well, in a good death the patients’ emotional concerns are addressed in a caring and compassionate manner. This may include informing family of the patients’ illness. Communicating with family members of critically ill patients can be challenging and stressful for both family members and health care providers [2]. A caring and considerate approach to communication with family members regarding the patients’ condition can perhaps help to minimize the development of potential pathological grief responses. Having family members present at the bedside of the patient as they undergo resuscitation or medical care can facilitate in communication of death and critical illness. Family members never have to question whether “everything was done".[2] As well the dying patient may gain emotional benefit from the comfort of family presence. Enabling a good death to occur in an acute care setting such as the emergency department is an important goal for healthcare providers to strive for. Respect for and attention to the patients’ and their families’ concerns may assist in achieving this goal. 1. Walters, DT, Tupin JP. Family grief in the emergency department. Emergency Medicine Clinics of North America. 1991; 9 (1), 189-205. 2. Iserson, KV. The gravest words: Sudden-death notifications and emergency care. Annals of Emergency Medicine, 2000; 36(1), 75-77. Competing interests:   None declared
Living with mortality 23 July 2003
Andrew G Rivett, SCMO in Health Protection Southampton SO16 4GX Send response to journal: Re: Living with mortality	At a recent training day on cultural awareness our facilitator commented that western culture assumes immortality, and then strives to achieve it. The trouble is that we then come up against the reality of death, and often find it unpalatable, unfair and something to be fought against. As Akheel Syed has already written, a good death follows a good life. His deeply thoughtful metaphor is very much to the point here: not only does the final chapter complete the story of the life that it concludes, but every other chapter is in its way working towards that denouement. So a good death follows a good life, yes. But also a good life looks forward to a death which, hopefully, will be good. We need to live in the light of our mortality. Competing interests:   None declared
How my grandmother died... 24 July 2003
Martin Kittel, GP Berkshire Send response to journal: Re: How my grandmother died...	My grandmother was what you could call a “grand old dame”, in terms of dignity, not wealth. One day she decided it was time to die. She lay down in her bed and did not get up anymore until she was dead – 3 months later. In the years before this day due to a razor sharp mind in a fragile body she had often asked if there was any way we could help her to die. She often suffered health problems and pain. However, she was a happy and friendly lady, who still enjoyed life’s good moments, family events, parties etc. She lived life to the full. When she went to a party, she exhausted herself so much; she often had to “pay” for days afterwards. I visited her one month before her death. I had to leave the country for a medical attachment in the US and we both knew we would not see each other any more. We chatted a whole afternoon, calmly and with breaks – she was already weak. We crowned this by having a small glass of beer together, which she loved. She then gave me her blessing for the future and I left. After I had left the room I cried, but sadness and happiness had melted into one great feeling in my heart during this truly amazing event. She died in her bland room in a nursing home at the age of 95 years, surrounded only by a few of her most cherished items and by my family. I am sure she at one time had feared the anticipation of this great last step in life, but she died in peace, happy and content and grateful. I hope I will one day be able to die up to her standards, in dignity. I hope my family will celebrate a good life (as so nicely put by A Syed) on my deathbed, just like their ancestors celebrated my birth and birthdays. Competing interests:   None declared
Extending life or prolonging dying? 25 July 2003
Mark Pickin, consultant orthopaedic physician Doncaster Royal Infirmary DN2 5LT Send response to journal: Re: Extending life or prolonging dying?	Just one very simple thought. Before we make any intervention in a patient with a terminal illness, perhaps we should stop to consider if that intervention will actually provide a useful extension of active life or if it is simply going to prolong the act of dying. Mark Pickin Doncaster UK Competing interests:   None declared
A Failure to Rescue 25 July 2003
Camilla Roskelley, self employed writer 22 Chercombe Close Newton Abbot TQ12 1YG Send response to journal: Re: A Failure to Rescue	People say to me that I should not fear losing my mind, 'because you wouldn't know anything about it if you did'. They miss the point. An important thing to me is my dignity, and to lose that is impossible for me, now, with my mind fully present, to contemplate. People say, 'Your family will remember you the way you are now'. Really? I question this because the only thing that comforted me about my dear mother's decline into senility was her eventual death. And the guilt I felt was that I had been unable to help her to that death earlier. I had promised her that, if she became demented, I would help her to die, but when she most needed my assistance I could not give it. And I remember her incontinent, mentally afflicted, confused, weeping at she knew not what. I betrayed her trust. And that is the memory I hold of my mother: not how beautiful and clever she was; not how loving and warm; not how smart; not how kind, none of those, just what she became. And how I did not help to rescue her from it. Competing interests:   None declared
Assisted dying 27 July 2003
David Ridley, Administrator Mental health charity, SR1 Send response to journal: Re: Assisted dying	I looked after my mother at home during her illness with Motor Neurone Disease, and strongly believe sufferers of this awful affliction should have the right to an assisted death at the time and place of their choosing. In my opinion, with the loss of the cough reflex and constant fear of choking, the arguments which cite continuing quality of life against assisted dying fly out of the window. Add to this the relentless decline, pain, loss of dignity, inability to communicate, and you have to question the point of continuing. I defy anyone to watch their own mother, fully conscious as her lungs collapse, fighting for breath, and then argue that assisted dying is wrong. I hope the current Bill becomes law and gives the choice of a peaceful and painless death to the 5000 people a year in Britain who suffer Competing interests:   None declared
Doctor assisted dying 27 July 2003
Edgar L. Killip, none BN6 8TH Send response to journal: Re: Doctor assisted dying	I write as a member of the public, aged 84, having refused a second coronary bypass operation in 1998 (first in 1992). We have made such extraordinary progress in keeping ourselves alive beyond the natural span through developments in medical and surgical science and technology. I feel that future generations will find it incredible that we did not have the intelligence to provide means whereby, with suitable safeguards, we can elect to die with dignity, without pain, at a time of our choosing. My wife, aged 75, holds the same view. Competing interests:   None declared
Fear of Death 27 July 2003
Peter Gilbert, GP principal Gateshead NE8 1NB, Robert Harris, A Hill Send response to journal: Re: Fear of Death	My father died aged 82 after a long terminal illness with Pulmonary Fibrosis. His breathlesness was severe for many months and being a doctor himself he was aware of his prognosis. The famous Woody Allen quote "I am not afraid of death, I just don't want to be there when it happens.".. stalked him for many months I placed freedom from distressing symptoms at the top of my list as did most others Dyspnoea is not managed well in patients with terminal non malignant lung and heart conditions. Competing interests:   None declared
Do Prolong My Life! 29 July 2003
Nimrod Pik, medical student Tel Aviv University, ISRAEL Send response to journal: Re: Do Prolong My Life!	Life is all that matters to me. I would not like it shortened even by a second. As a medical student, I have seen people who said brave things about dignity, but when the moment has come, they changed their minds - they didn't want to die. Neither do I. I am willing to suffer. I know what pain is. Please, dear doctors, do not take these painful moments of life from me. Do anything you can. Do prolong my life! It may be painful, but it is all I have. Competing interests:   None declared
What is a good death? To use death as a mirror and find the quality in life 31 October 2003
Joav Merrick, Medical director Ministry of Social Affairs, POBox 1260, IL-91012 Jerusalem, Israel, Søren Ventegodt Send response to journal: Re: What is a good death? To use death as a mirror and find the quality in life	EDITOR—Death can be seen as the real enemy (1). Death puts life in perspective as we finally see it as the very fragile, easily lost and infinitely valuable thing that it is. When you do not sense that death is after you, you relax and think yourself out of danger. But you have no guarantee that you are alive in five minutes. It is already later than you think. In a little while we are gone. In a moment we have all turned to dust. To live with the awareness of death – death is around somewhere, waiting for our final slip in order to sweep us away – is a sinister but also wonderful situation. When we are aware of death and know that we have too little time left and that time is the only thing we do not have, then we really do our best. When we acknowledge the unique opportunity we have to become aware, straighten our lives to get a better life while there is still a chance, then we can live the way that makes each day better than the previous and the next year better than this. We can live in such a way that we are on our way up. Ask yourself: “Am I on my way up or on my way down?” Do you have to admit that you are on your way down, even though of course it is a slow descent? The only thing that can make most of us change our course, so that we live in a manner that leads us upwards is the distinct awareness of death. When we see death threatening us all the time and coming at us in many various forms like loneliness, illness or hopelessness and when we realize that we constantly feed death with great chunks of our own flesh, because we do not make the right choices and thus unconsciously take one step further towards the grave, then we are motivated to correct these systematic faults. Only death has the power to really make us want to change our course in life. All lesser problems and crises throughout life may be unpleasant, but not really unpleasant enough to make us want to succeed in changing ourselves. The reason for this extreme conservatism is that we already have dedicated most of our decisions to survive, i.e. to avoid dying. Therefore, the death that threatens us now is computed in our minds as more important than the death threatening us in the past. But awareness of death does not come to us easily when we are only slowly decaying. We can see people die in front of us without understanding that we, too, consist of fragile flesh and that we have to depart soon. No force in life can change this: In a little while we are gone. We have to live here and now. This moment is all we have got (2). When you have only 700 days left When “terminal” cancer patients (the quotation marks are because maybe the patients are not as terminal as we usually think) visit their physician some time after they have received the diagnosis and the verdict, that according to the statistics they only have about two years left to live, they often say strange things like: “I am grateful that I got cancer.” The physician thinks that this is strange and asks why. “I have never felt so well,” the patient says. Most physicians tend to think that is peculiar, because here we have Mrs Larsen, who lost 35 kilogram, lost all her hair because of chemotherapy and her cancer has metastasized throughout the body. Also she looks like something the cat dragged in and then she insists that…”. “But it is true, doctor,” she insists. “My life has never had so much meaning, my life is more intense than it has ever been now that I know that I have only 700 days left. Now I have let go on all my worries and idiosyncrasies. I have turned simple. I see the sun rise, I feel the wind on my skin, I talk honestly with my friends and I have stopped arguing with my husband. And best of all I have started to say no in order to only do the things I really like”. However absurd it may seem, people with their back against the wall and knowing their days are numbered often live much more intensely than the rest of us, who imagine that we will live forever. Face to face with death we suddenly appear to remember that this is what life is all about, to feel good within ourselves and with each other and to do something we really like. “What a fool I have been” people often say and think. Time possesses the strange capacity to expand enormously, when we live intensely. A moment can feel like eternity or a year can appear to pass within a minute (have you ever experienced a New Year’s Eve, where you feel that the past year has been uneventful, so totally empty of anything essential ?). If you know that you only have a short while left before death, then even such a moment may be enough to change the course, that fate had in store for you. We may call this very strange power that steps in when you are facing death “the will to live.” We really do possess enormous potentials for growth and change, but only rarely do these potentials come into use. Our reason and our total naiveté towards the tough and wonderful conditions that apply to us prevent us from changing. You can reclaim the meaning of life. You can break through to the experience of being totally and fully alive, to your life having meaning and your existence making a real difference to the world you live in and yourself. Patients who become well again, drug addicts who become clean, prostitutes who succeed in love, all the miracles people talk about, but do not believe in. All this happens during this process. But, of course, up to this day it has been rare. If our culture held more insight into these things they would probably be much more common, the way they appear to have been in other cultures at other times. A holistic physician often has the great fortune to live in a world, where these miracles are almost normal. In our “quality of life as medicine” projects they occur surprisingly often (3,4). To pull yourself up by the roots of your hair A force stronger than reason is needed, when the course of your life is to be altered. Let us call it the will to a better life. If this will is present people will possess real humility, making them open and willing to learn and change. The strange thing about this will is that it is an irrational, nonverbal force that pulls up your existence. When the will influences your view of the world it becomes altered in a strange way. This happens because the will to live supplies a fixed point, namely what you have to believe in when you really love life, beyond all reason, beyond everything you have learnt and experienced in life. This fixed point can serve as a new foundation for your personal philosophy of life. From this moment on you will feel that deep down life is good and valuable, the world is full of opportunities, people are trustworthy, you are able to solve the problems in life on your own and through this battle you can make everything cohere. The experience of pulling yourself up by the roots of your hair literally means that you raise or lift your own existence. You correct your faults and close up all the holes that drain your vital energy. You remove all the good reasons for not having any self-respect and start a new life on a totally new foundation. You take responsibility for your own life. The essential part of the will is that it is able to cut through all the confusion and doubt that normally characterize human life. In reality, there is no rational way of determining the truth value of statements or philosophies of life. You cannot guess the truth about life and the world. Reason cannot distinguish very well between personal philosophies of life, because they all basically rest on principles that are irrational, ethical or even emotional. However, the will to live a good life cuts cleanly through doubt and mental fog and points out clearly and directly what is right and wrong in relation to our love of life. Some decisions and choices are in harmony with life, others bring ruin and destruction. Some decisions lead towards the top, others towards the bottom. Some views of the world can sustain life, others weigh it down. Only the will to live a good life can make a person rise above the immaterial, the meaningless, doubt and nonsense. You rarely discover that the will is the real resource for improving life, until you are facing death. When that happens, the will to live is often the only reason why you survive. The experience of pulling yourself up by the roots of your hair is quite amusing. But really, if we are to live fully and completely for just a moment this is what is needed, the ability to lift ourselves and take wings, despite the thousands of weights that are dragging us down. Taking responsibility for our own lives is really a process during which we elevate our own existence, in spite of all barriers and difficulties. The will to live a good life is the only thing that can create this effect. To find the quality of life We are free to choose our values, the things we think are important and good. Some people’s lives are centered on collecting stamps, while others collect good friends. Some chose expensive clothes or fast cars as values, while others grow ecological vegetables and wear only clothes made of recycled material. Some people collect dirty videos, while others are into bible studies. In our minds we are free to chose our own personal values, just as we have an enormous freedom to describe the world whatever way we want. One thing is values, another thing is how we feel or what state we are in. Something makes one person happy, something else makes another person happy. But what about the happiness we feel: is it the same kind of happiness or are there different kinds of happiness? And what about satisfaction with life? Do we all possess the same sense of satisfaction or do we experience satisfaction in different ways? What about the meaning of life itself? When we feel deep within ourselves, in our very souls and hearts (if we are able to find it), do we then feel the same meaningfulness in life, when it is meaningful and the same senselessness, when it is not? Do two people experience the same kind of love, the same feeling of hate or sexual desire? It is obvious that each experience carries its own qualities and intensity. But is the actual quality of the experience connected to the individual, to our egos and learned descriptions of the world? Or is the actual quality of happiness, satisfaction or the meaning of life something that is given by human nature? As it appears from this paper, we believe very strongly in nature and that life within us never has let go of its habitat in nature, because we possess our common description of the world not just as a possibility, but as a necessity. This is a given, because we are constructed the way we are and have to live together. The decisive factor for being able to change yourself is that you are able to regain your belief, that fundamentally life is good. When we here use the word ‘belief’ it is because from a rational point of view, such an attitude will always be a question of belief. Subjectively, of course, it can also be experienced as certain knowledge. And it is this inner certain conviction that makes the difference. You can believe nature as being the essential thing. Not, as is often suggested, in a primitive way, with coarse instincts and pre-programmed behavior parallel to animal behavior, but more refined. The idea is that deep down in our biological matter we possess a nature as humans. This nature is in the shape of an abstract recipe for being a human, and life is about expressing this recipe to the full, unfolding and manifesting its potential for a good life. In this light, our nature holds the potential for all the dimensions of our lives. It is in our nature to feel good or bad, to be satisfied or dissatisfied, to have sexual feelings, to be happy and feel there is a meaning in life or to work for our innermost visions and longings. Our nature is such, that we have a heart that we need to discern and obey so that we may lead the good life. To seize the meaning of life When we finally acknowledge that the world extends beyond our reason or that there are forces at large that matter more than our impulses then we can proceed. When we realize that there are values on Earth that far surpass the value of our small life, then we will be humble enough to accept the gift (and task) that is life. Then we can put our faith in authority and our loyal, but out-of-date and limited description of the world behind us. To rediscover the meaning of life means finding yourself and the values that you can always, and without faltering, use as foundation for your own life. To regain the meaning of life means that you acknowledge that you are a human being, subject to the conditions and laws applicable to humans. We am not talking about the highway code, but more profound laws that apply to all living beings. To take responsibility, to see yourself as active and not as a victim, to work at correcting your personal faults and repair the bumps in your inner map of the world. To regain the meaning of life does not mean to be forever happy. It means that you find your fundamental challenge as a human being and take up the challenge. You become a person with a mission. There are things to be corrected both on the inside and the outside, things within yourself and things in the world around you. If you are really clever you will see that in reality there is often little difference between the two. The flaws in the world are evident to you, because you also sense and work on similar weaknesses and flaws within yourself. The great struggle for a better world, that all people become involved in, when they acknowledge that the meaning of life is about coherence. They cannot escape this world, however much they want to, because of all its superficiality, materialism, abuse of power and false values, then their realize that this struggle is very much about improving that part of the world that is you. To clean the place you occupy, to cultivate your own spirit. Everything starts with yourself. Because all the barriers you see are actually within you, in your own personal view of the world. Becoming free means first and foremost becoming free of the constraints imposed by your own rational description of reality. It does not actually mean that you must get rid of this description or the framework it puts around your self -expression, but you can loosen the constraints so much that they no longer limits life, but support life. You need to get rid of the negativity in the description and the old pains that hold your limiting decisions in their place. Whar is the purpose of life ? Imagine that you really wish to know the meaning of your life. You rent a small cabin in the mountains, where nobody can disturb you for the next three or four weeks. You buy provisions for the whole stay. You go alone and you spend your time on only one thing, namely answering the question: ‘What is the meaning of my life’? Of course you have to find a wording that is all your own, which exactly fits you and your life. But it must be deep enough to penetrate all the way into your soul. What is the purpose of life for you? Why are you on the surface of the Earth for a short while? In what way do you make a difference in the world? What are your dreams in life, love, real friendship, a good job or harmony with nature ? When you compare the life you lead with your dreams, how do you measure up ? Is your personal relationship the love of your life or is it boring routine in bed and arguments at breakfast and before the evening news? Do you actually have one single friend with whom you can and do talk about everything and who does not begrudge you real progress ? A friend who can meet you right where you are and just wish you all the best and therefore ask you all the questions you should already have asked yourself, but did not dare to out of fear of meeting yourself ? Questions like what is it you want, what are your opportunities and what is needed for you to obtain what you want with the opportunities you have ? What about your work? Do you really exert yourself and improve anything? Do you gain the expertise necessary to express yourself creatively and spontaneously? Do you solve your tasks to your own personal satisfaction? Do you have enough influence on your own work? Do you actually accept what your company produces or should you be doing something quite different in order to be of use in the world? What about your time off? Do your holidays fulfill your dreams or do you just end up in some bar in Mallorca wasting your time on casual pursuits, before returning home to your boring routine? Do you burn for your life, your work and your love? Does you or your life contain any nerve at all? In the final analysis, how do you feel, if you are really and totally honest? Are you OK? Do you get out of life, what it can give you? Do you exploit all your opportunities? Have you accepted the challenge that is yours and is your life in balance? Are you at peace with yourself, because you have acknowledged your own personal mission in life? We suspect that after a couple of days you are having no more fun at the cabin. After all, to study the meaning of life is rather unpleasant. The really sad truth is that we have no wish to know the truth about ourselves or the deeper meaning of life, because it is painful to learn something decidedly new and we only do this if it is absolutely necessary. Actually, what began as a straightaway philosophical experiment now appears to be a dramatic process, where you have to confront and process the pains of a lifetime! All the bad things you have done since early childhood will come to you and ask you for a clean-up! This is not our favorite perspective, but the only perspective that will make us change into better, more innocent and more loving persons. The pain of knowing the meaning of your life Our problem is that deep down we do not really want to know the meaning of our lives, because if we do we have to acknowledge that the life we actually live is a pale shadow of the opportunities we hold, no matter how good life is, when compared to that of other people. We are not at all interested in realizing that we almost live in an existential gutter, when we compare our life with what we were actually created for. Our life is not first-class and maybe it is not even second- class, which we thought, but actually third-class, because our life is more or less without love to life, to other people or even to ourselves. We are also not the decent folks we thought we were, but rather harbor fairly violent and destructive tendencies. Not a fun perspective at all. Let us assure you that one of us was surprised when, one sunny day some years ago, he finally came to the realization that his basic intentions toward other people were basically mean, while he himself thought he was such a well-meaning fellow. A close examination showed otherwise. There is a reason why we do not want to know ourselves: It hurts. This realization that our life does not have the meaning it could have or that our life is far poorer than it needs to be does not give us a nice feeling. That we are actually at fault for wasting our life and perhaps about to lose something precious, our actual existence, this realization is actually very unpleasant. The unpleasantness lies in the realization of the magnitude of the problem, because it obliges us to do something about it for our own sake. We must take responsibility and see ourselves as the cause of our own personal mess. We must learn to associate with others and change our attitudes towards all kinds of things. We need to let go of all out-dated points of view for which we have fought and battled forever, ever since we learned them from our parents. It is important that you can face yourself in the mirror every morning. One reason this may be difficult is the painful feeling that you are not faithful to yourself. When you know deep down what life is about and what your real purpose and meaning of life are, it hurts inside if you just continue living as always and not true to your own intuitions. When you are conscious of your big dream, but shy away from working to make it come true, you suppress yourself. This works fine only as long as you are not too aware of it, but with the growing awareness the suppression of your own life becomes still harder to bear. The more you understand the game of life, the more you are obliged to engage in it. Knowing what you like, makes it much more difficult not to be good to yourself. When you face yourself in the mirror, you will know how much work you have to do to bring your life in better accord with the innermost wishes of your soul. Everybody, who engages totally in the challenge of improving his or her relationship with the self will find that this game can be won. It takes a real effort, though. For most of us it is hard work every day for many years. Frankly, because our state of being is so lousy, when we start out. We are rather far from being happy, cheerful and easygoing. One of us with the experience of this process felt a strong and almost unbearable sensation of unworthiness. When you develop an excellent inner standard of existence, you are likely to feel less proud of yourself. When you realize the brilliant standard that all mankind inhabits deep down in his soul(5) – all that we are meant to be, our real potential – then our present existence often seems pretty pale, insignificant, sometimes close to a total failure. As long as you compare yourself with your next-door neighbor you can always claim success. But when your start comparing your present state of being with that of a person at his full peek – like Moses, Buddha, Jesus, Leonardo da Vinci or and maybe spiritual masters like the Dalai Lama, Sai Baba or Baal Shem Tov– it is difficult not to feel gray. Now, humility and humor will always be helpful. It is quite funny to be an action hero, when you compare yourself to your friends and be an existential midget, when you compare yourself to your own potentials. You might find that what nature or God intended you to be is amazingly different from whatever you thought at first. The gift of knowing the meaning of life is energy. When we see our true potential it is tempting to reach for the power and glory, the creativity and the divinity that lie within. When we do this we will immediately get all kinds of problems with the outer world and we will get an immense amount of energy. An unsurpassed energy kick. People who know their hidden potentials and dig into them without hesitation or second thoughts will always blossom. They will soon be transformed into original beings, colorful, intelligent, troublesome, creative, lovely and often annoying like hell. These people will normally get everything they want. If they are sick they will get healed, if they are artists they will get fame, if they are scientists they will get a unique understanding of their field of research. Eventually, as their personal growth continues they might be recognized as the geniuses of this world. The secret of these success stories is lots and lots of energy drawn from the source of existence combined with other amazing qualities like intuitive competence and emotional intelligence. These qualities pour from one single source: life. More precisely, the abundant source of energy and motivation is “the joy of life”. Joyfulness seems to be the most basic and most mysterious quality of all living beings. The nature of joy is by the way still completely unexplained by science. The no man’s land between your old and new life Knowing what life is about does not necessarily mean that life becomes any easier. It is often quite the opposite: life turns even more difficult, when you wake up. But a conscious life has a peculiar quality. A person who experiences the deepest meaning in his or her life discovers that life now has touch of bliss and fragrance (6). No matter how chaotic, no matter how painful, deep down the new life is sweet. This fine sweetness makes it possible for a human being to endure almost incredible pain and sorrow. When you strive to realize yourself and your utopian dreams many people will react as if you have the plaque. You will often turn into an incomprehensible and disturbing element of other people’s worlds. To be sure, after some years of hard work you will come back as a beautiful, peaceful and happy person, but often the first thing that happens is that you turn annoying, selfish, difficult or even angry. The fine, inner sweetness gives these people an unstoppable quality. They turn into fighters. They have seen the light and they follow it. New jobs, divorces, new friends, new habits and values, new sexual and professional interests... we are talking about major transformations here. People are not the same and will never be the same again. They are forever lost for you, if you do not follow them by developing yourself. If you get a metastasized cancer and you heal yourself by letting go of the negative beliefs and self-suppressing decisions of a lifetime, you will be changed. You now have dramatically improved your quality of life and inner coherence. But you might also be in the situation, where you find yourself as reborn to the degree that not even your old clothing fits you any more. The price to be paid for personal growth is, unfortunately, chaos. As most people are very conservative they will try to oppose your growth the best they can. So, people who supported you, when you were down suddenly do their best to suppress you. It is sometimes difficult to believe that your relatives can jump on your back trying to hold you back. It is sometimes grotesque that you will have to escape from your whole family. Between your new blossoming life and the old normal, boring life of habits and routines is a no man’s land of very difficult nature. You discover that nothing is as your thought is was – it might be that your beloved does not really love you or that what you thought was the essence of your life is simply a substitution for a sound and healthy interest. Often people going through this transformation will at some point in time feel that they are going crazy. But relax: your are not going crazy. You have been crazy for half a lifetime living with values that did not make you happy. And now your are waking up. You are in the middle of a speedy, but unpleasant recovery. Loneliness of the most painful kind is normal at this stage. You are alone with your thoughts, and you are confused, unhappy, not seen, not loved and not understood. You cannot continue to live your old life, but you have not yet found your new ways. The fine order of your life has been broken and now chaos prevails both on the surface and in the debts of our soul. We are healing, but first we must acknowledge that we really are sick. The pain of a whole lifetime is often overwhelming us and survival becomes dependent on our ability to be good to ourselves. Nobody but yourself is there now to show you love and concern. The miracle is that it is enough: when we love ourselves we do not really depend on other people’s concern for us. But before we can enjoy the luxury of relying fully on ourselves, living in perfect inner balance, we must heal a lot of old painful wounds. This is why loneliness bites us at this stage. Most people live lives that are not truly a life. They sense this intuitively, but they do not want to look at it at all. There are plenty of symptoms telling you that everything is not as it is supposed to be. The terrible headache or low back pain that returns still more often, problems sleeping at night, the growing sexual problems that are taking the fun out of this part of life, problems with your skin, the slips of memory, maybe the arthritis making every step you take even more painful. Enough is enough. Some day you realize that this is not how you want to life. Enough of lies and politeness and pretension. Air! You need fresh air, renewal, new inspiration. The way you live brings you slow death and this is not how life was meant to be. It takes a lot of courage to break the well-known order of daily life. Sometimes we are lucky enough to be forced to make the move and wake up: the physician gives you the malignant diagnosis, the boss says he is sorry he has to let you go, because of your still poorer performance. This is the end. You have reached the end of the road. You only have one chance now: renewal from within. Your whole life needs repair. It is time to clean up the mess. Now a hard time usually follows. It is difficult not to feel that a lot of time is wasted living your old life. Realizing the distance to the existence you have been living, you are often overwhelmed with sorrow and bitter regrets. But eventually you will find mercy and realize that life is never wasted, you have learned your lesson, you suffered for as long as you had to. As time goes by you will appreciate a still deeper pattern of order and inherent logic in the universe. Conclusions We have a nature as human beings. It is this nature that makes it possible for us to be happy, cheerful, wise and lovely. When we turn natural and innocent, the extraordinary freedom that characterizes life at its fullest will return to us. All the life we hold as living organisms will now blossom and grow. Our love and passion will come back, a burning interest for our work will unexpectedly catch us, deep friendships will form and this divine creativity and humor will mark our new personality. All of us have the possibility do make a difference. The quality of our own life can be drastically improved and so can our use to people around us. We can be of real value to ourselves and to the world around us. Instead of being one more of these human beings tearing down the global ecosystem you will understand the web of life in all its forms and shadows and do what is needed to make mankind and our beautiful culture survive. As we see it, mankind is a highly endangered species, and only by transforming our old materialistic culture into a new spiritual culture with honesty, truthfulness and contributing people can humanity survive. The right place for all of us to begin is by saving ourselves. All it takes is that we decide to seize the meaning of life. But this must be one whole-hearted move: you must give it everything you have got if you want to succeed. You can change a poor life to an excellent life (5,6-11), but you must risk your life to win. One day you will find the courage. Maybe the day is today. The wise Jewish Rabbis have a few good sayings: “Live todays as if tomorrow is your last day” or “in order to perfect yourself, one must renew oneself day by day”. Let us conclude by telling the story of Sol Gordon, professor emeritus of Child and Family Studies at Syracuse University: “Growing up as an idealistic youth, I was determined to save the world and even the more I tried, the world became worse and worse. Then I decided I had taken on too much. I thought I would just try to save the United States. The more I tried -- conditions in the US got worse and worse. So again I thought I had taken on too much. So I decided I would just try to save my neighborhood. My neighbors told me to mind my own business. But just as I was about to give up in despair, I read in the Talmud (Jewish teachings) that if you can save one life, it is as though you have saved the world. That is now my mission -- one person at a time (12). What you start there, then you will have a good death. Søren Ventegodt, MD, is a general practitioner and the director of the Quality of Life Research Center in Copenhagen, Denmark. E-mail: ventegodt@livskvalitet.org. Website: www.livskvalitet.org/ Joav Merrick, MD, DMSc is professor of child health and human development, director of the National Institute of Child Health and Human Development and the medical director of the Division for Mental Retardation, Ministry of Social Affairs, Jerusalem, Israel. E-mail: jmerrick@internet-zahav.net. Website: www.nichd-israel.com --------------------------------------------------------------------- ----------- Competing interests: None declared. References 1. What is a good death? Join in our online discussions. BMJ 2003;327: 66. 2. Ventegodt S, Andersen NJ, Merrick J. Quality of life philosophy V: Seizing the meaning of life and becoming well again. Accepted by ScientificWorldJournal 2003. 3. Ventegodt S, Merrick J, Andersen NJ. Quality of life as medicine: A pilot study of patients with chronic illness and pain. ScientificWorldJournal 2003;3:520-532. 4. Ventegodt S, Merrick J, Andersen NJ. Quality of life as medicine II: A pilot study of a five day “Quality of Life and Health” cure for patients with alcoholism. ScientificWorldJournal 2003;3:842-852. 5. Ventegodt S. The life mission theory: A theory for a conciousness based medicine. Int J Adolesc Med Health 2003;15(1):89-91. 6. Huxley A. The perennial philosophy. New York, NY: Harper Collins, 1972. 7. Antonovsky, A. (1987) Unravelling the mystery of health. How people manage stress and stay well. Jossey-Bass, San Franscisco. 8. Maslow, A. (1962) Toward a psychology of being. Van Nostrand Princeston, NJ. 9. Ventegodt, S. (1995) Quality of life: Seizing the meaning of life and becoming well again. Forskningcentrets Forlag, Copenhagen. (Danish) 10. Saint-Exupéry, A.M.R. (1943) The little prince. Harcourt Brace, New York. 11. Castaneda, C. (1993) The art of dreaming. Harper-Collins, New York. 12. Gordon S. (1994) When living hurts. UAHC Press, New York. Competing interests: None declared
What is a good death? Memories of a mother's passing. 31 October 2003
Fiona H French, Research and Development Officer NHS Education for Scotland, Forest Grove House, Foresterhill Road, Aberdeen, AB25 2ZP Send response to journal: Re: What is a good death? Memories of a mother's passing.	EDITOR - My mother died many years ago, on Hogmanay 1985, aged 72. Having lung cancer, she had been admitted on several occasions to our local hospice, Roxburghe House. She was an ordinary woman, but extremely brave, thinking only of those around her, even in her latter days. I still remember her death as a traumatic but positive experience. I was determined that she would not die alone. She was moved to a single room and was surrounded by her family. There was an adjoining room if an overnight stay became necessary. Being a committed Christian and sure of an afterlife, she wished to have some private time with her minister (Church of Scotland). He later told us that she said to him "Well, I'll ken mair [know more] than you'll ken when you're preaching on Sunday." And maybe she did. He clearly found the experience a positive one too as he later spoke about her in a television broadcast. She was alert except for the final couple of hours. We were able to say goodbye. She told us to look after each other. My father wanted to put on her oxygen mask but she said "No, it is time to go." She was given her final injection of morphine and slipped into a coma. We will never know how she experienced her death but from her family's perspective I am sure it was as good as death can be. That I am sure helped us in our grieving. I have often contrasted it with death on a busy hospital ward with only the curtains affording some privacy. My father has now reached the grand old age of 91 and I can only hope that when the time comes his family will be fortunate enough to have such a positive experience again. Competing interests: None declared
A Christian death 31 October 2003
Barbara M Phillips, Consultant paediatrician Royal liverpool Children's Hospital Liverpool L12 2AP Send response to journal: Re: A Christian death	My father died about 24 years ago. He was a devout Christian and had been living with my family since my mother's death eighteen months earlier. He was in reasonable health for a man of 72 with congestive cardiac failure. On the day of his death he said to me "I'm going home today" We had recently moved house so I thought he was confused and said, "No, Dad, you live with us now". He replied with characteristic acerbity "Don't be silly, I'm going to be with your mother and the Lord". He then went to have a shower, put on clean pyjamas, lay down in bed, blessed my baby daughter and said "I'm tired". he shut his eyes and died peacefully. Competing interests: None declared
What was good life is now a good death 31 October 2003
roopa venktesh, clinical observer The Royal Oldham Hospital The Royal Oldham HospitalOL1 2JH, nil Send response to journal: Re: What was good life is now a good death	Every good beginning has a good end........what was a good birth is what transformed into good meaningful life and as good things have a good beginning and a good end......ends as a good death. But its hard for anybody to see good things ending so to say Death Competing interests: None declared
A good death with an awakened state of mind 5 November 2003
bruno friedberg, Biologist wissembourg 67166 France Send response to journal: Re: A good death with an awakened state of mind	When it is time for me to die, I would like to be serene for being conscious of a truth beyond myself, which means to be in an awakened state of mind... I would then sleep in this smooth certainty without any suffering or fear, like a fair human being. Competing interests: None declared