Can I choose the cause of my death?
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7292.1003 (Published 21 April 2001) Cite this as: BMJ 2001;322:1003
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Sir,
Death according to Montaigne:
“Some deaths are brave and fortunate...a spleandour equal to that of
the moment that cut them short...one of the principal aims of my life is
to conduct myself well when it ends - peacefully, I mean, and with a calm
mind.” [1]
“Death is terrible to Cicero, but of no consequence to Socrates.” [2]
“Death is always inevitable.” [3]
“It is true that to most men the preparation for death has been more
tormenting than the pangs themselves...to contemplate death in the future
calls for a courage that is slow, and consequently difficult to acquire.
If you do not know how to die, never mind. Nature will give you full and
adequate instruction on the spot.” [4]
“Philosophy commands us to have death always before our eyes, to
foresee it and to reflect upon it in advance.” [5]
“Perhaps death is an indifferent thing, perhaps it is desirable. We
may believe, however, that if it is a migration from one place to another,
there is some gain in going to live with so many great men who have
departed...if it is an annihilation of our being, it is still a gain in
going to enter upon a long and peaceful night. We have no sweeter
sensation in life than quiet rest and deep dreamless sleep.” [6]
“The failure of one life is the passage to a thousand others.” [7]
“Cicero says "that to study philosophy is nothing but to prepare
one's self to die." The reason of which is, because study and
contemplation do in some sort withdraw from us our soul, and employ it
separately from the body, which is a kind of apprenticeship and a
resemblance of death; or else, because all the wisdom and reasoning in the
world do in the end conclude in this point, to teach us not to fear to
die.” [8]
“I would always have a man to be doing, and, as much as in him lies,
to extend and spin out the offices of life; and then let death take me
planting my cabbages, indifferent to him, and still less of my garden's
not being finished.” [8]
“Neither is there anything of which I am so inquisitive, and delight
to inform myself, as the manner of men's deaths, their words, looks, and
bearing; nor any places in history I am so intent upon; and it is manifest
enough, by my crowding in examples of this kind, that I have a particular
fancy for that subject.” [8]
“As our birth brought us the birth of all things, so in our death is
the death of all things included. And therefore to lament that we shall
not be alive a hundred years hence, is the same folly as to be sorry we
were not alive a hundred years ago. Death is the beginning of another
life.” [8]
“But nature compels us to it. "Go out of this world," says she, "as
you entered into it; the same pass you made from death to life, without
passion or fear, the same, after the same manner, repeat from life to
death. Your death is a part of the order of the universe, 'tis a part of
the life of the world.” [8]
“Happy is the death that leaves us no leisure to prepare things for
all this foppery.” [8]
Sources
[1] Michel de Montaigne, Essays, Penguin, London, 1993, Bk 1, Ch 21,
On Power of Imagination, p.36
[2] Bk 1 Ch 50, On Democritus and Heraclitus, 131
[3] Bk 3 Ch 12, On Physiognomy, 326
[4] ibid., 328-9
[5] ibid., 329
[6] ibid., 331
[7] ibid., 333
[8]
Essays, Bk 1, Ch.17
http://www.orst.edu/instruct/phl302/texts/montaigne/montaigne-essays--5.html#XVII.
Competing interests: No competing interests
While probably no one would want to argue for the
desirability of a slow, painful death, I do not think that
everyone would want to agree with Dr Indrayan's belief that
a sudden death is the best way to die. I certainly do not.
In medieval times a good death was a prepared death. Books
were published on the art of dying and generally it was
believed that a sudden, unprepared death is something
horrible, maybe even a sign of being damned. A sudden death
would not allow for confession of sins, last rites, last
good-buys, sorting of one's affairs etc etc.
In some ways more recent publications like Kubler-Ross's
books could be seen of promoting a similar view -
progressing through the stages of dealing with one's
diagnosis and prognosis one can develop something like a new
peace and even joy in the face of death.
Isn't the modern wish for a sudden. unexpected death just
one other aspect of the general denial of our mortality?
Competing interests: No competing interests
Choosing ones death is a rather novel concept. At first blush one is
inclined to strongly disagree with the idea, because, as the author
himself writes, one does not know when one is actually old. There are
several fit 95-year olds.
However this letter does bring out an important point. Death is not a
subject in the medical curriculum. This is amazing. Once we begin a proper
study of "how to die" rather than only "how to live", we will identify
several aspects that need scientific study.
Competing interests: No competing interests
Re: A Good Death
A sudden death need not be "bad" or unprepared, if we accept our mortality and live accordingly. A life that requires procedures of reversal at the last minute (making peace with others, saying things left unsaid, confession of sins on the deathbed) is far more a denial of the finite quality of human life than is the simple wish to die without lingering half-alive.
As someone who has experienced the deaths of others in both forms (slow and sudden) I too wish that my life will end in an instant. Processes of dying such as those enumerated by Kubler-Ross are more niceties for the survivors; there is nothing quite like coping with the shock of a sudden, permanent disappearance, and who would wish that on family and close friends?
But, once dead, all this matters very little. I've yet to hear from my father, 20 years gone, about any regrets at having passed on without warning -- and I don't expect any communication soon.
Competing interests: No competing interests