Before we can understand what the "beyond" of a good death might mean, it is necessary to examine the meaning the phrase "a good death". Edwin Sheidman, professor emeritus of Thanatology at UCLA and founder of the American Association of Suicidology argues that there are ten features of a good death.
He believes that the good death is a natural death. Accidental death, suicide and homicide do not fall under the criteria of a good death. Death must come after one has experienced life. Sheidman gives the age of 70 as the benchmark for a good mature death. The death must be expected and have "a week's lead time". The death must be honorable in the sense of De Mortuis nil nisi bonum (of the dead speak nothing but good). A good death is prepared. One takes into account all the necessary arrangements and legalities. The death must be accepted. Death is an "unnegotiable demand. A good death must be generative. In other words, it must pass down wisdom to younger generations. A good death must be rueful. One must be able "to cherish the emotional state which is a bittersweet admixture of sadness, yearning, nostalgia, regret, appreciation and thoughtfulness". Ruefulness teaches, "the paradigm that no life is completely complete". The last criteria that Sheidman lists are peaceable. A peaceable death is one "filled with amicability and love" Pain is controlled and competent medical care is given. In addition to these top ten features of a good death, Sheidman formulates a Golden Rule for the dying scene: "Do unto others as little as possible". Here the dying person must mitigate the pain his or her death will give to others. Sheidman recommends that we die with grace rather than with "coarseness and complaint". Like a good modernist, Sheidman gives us an aesthetics of dying and has not, in my opinion, analyzed death in its complexity.
The modern approach to death seeks to identify objective measurements related to the quality of dying and in doing so, levels off the unique singularity of my subjective death. Trying to quantify what a good death is reduced death to a scientific, medical model, especially when persons are reduced to being clients.
Many scholars reduce what a good death means to a checklist. For example, The Age, Health and Case Study Group (1999) lists the following features of a good death. One must: know when death is coming and understand what can be expected; be able to retain control of what happens; be afforded dignity and privacy; have control over pain; have choice, control over where death occurs, at home or elsewhere; have access to information and expertise; have access to hospice care; have control over who is present; be able to issue advance directives; have time to say goodbye; have access to any spiritual or emotional support; be able to leave when it is time to say goodbye.
I see these principles as a shopping list or as things to have packed before going on vacation. Such lists seek to reduce the uncertainty of death. As thinkers from Plato to Derrida have shown, such a stance is misleading. Principles are good for securing grants, analyzing data but these principles will never make one accept death. The principles and criteria of a good death are the "Martha Stewart" version of dying, where there is no mess and no fuss; where the napkins are folded properly before it is "time to go".
I would like to maintain that there never is a good time to go. The consensus of experts means little when it comes to death, because they are not the ones who are on the deathbed. I imagine there are more important things to worry about when one is dying other than a 10 or 12-point list. To die is to be fragile and dependent on others even as one has to leave them. Searching for meaning in death and dying will not be provided by the medical establishment who believe that "further research is required" to invent better "objective tools" to determine the exact meaning of what a good death is. Unamuno in his Tragic Sense of Life shows us what is at stake. No one wants to die and at the same time we know that death is inevitable. Life is to be lived in the struggle with death. There can be no serenity for Unamuno and for those who do not want to die. In this sense, the good death is the death that does not happen.
It is against this backdrop that we can make sense of James W. Green's excellent book Beyond the Good Death. Green examines the anthropology of modern dying. This important book analyzes the changes in the attitudes toward death over the last several decades. From the groundbreaking work of Kubler-Ross to the controversies surrounding Jack Kevorkian, Green documents the shift in attitude toward death and end of life issues. Green writes, "a culture assures us we have a continuing place in the cosmos and that our projects are literally of undying importance. Thus we beat the drums loudly, drowning out the prospects that death is the catastrophic end of everything we have worked so hard for".
Since we all die in different ways, it makes no sense to straightjacket our lives into categories that must be followed before a death is declared to be "good". It is as if the grim reaper as referee awaits us with a spiral bound notebook ticking off how many of the 10 points we have achieved. Would achieving 4 out of 10 points on the criteria scale make our death "bad"?
Green looks at a number of contemporary death practices that are still informed by "ancient, persistent and religiously inspired redemption ethos". This ethos determines how we understand the meaning and value of life and how we "solemnize its ending". Green wants to "give an ethnographic interpretation of some of the things many North Americans do when death is at hand".
Green details how various rituals help to deal with the body becoming a corpse. He affirms that every death is unique. Outlining the case of Terry Schiavo, Green shows how death becomes political and how the body becomes a theatre where conflicting forces reveal "the ambiguities of social death".
The complexity of these situations, chosen by Green "undermines all easy talk about death with dignity and the sanctity of life". Green writes, "hospitals are where many people die, and while some will have the peaceable and uncomplicated departure they expect, many will not". Again, the body in modern times takes on the role that the saintly relic occupied in the Middle Ages. The saint's body uncorrupted by death was said to give miraculous cures. In modern times, the body and its organs can prolong the life of others.
Green also examines American embalming practices. He writes, "death is hard work and messy. But no one wants to leave this world looking bad". Green documents embalming practices first brought to light by Jessica Mitford in her seminal essay, "Behind the Formaldehyde Curtain". The aesthetics of death attempt to make the deceased look as if they were only sleeping. Death is made to look beautiful just like the tanned corpses on CSI Miami, which do not pale in comparison to their CSI New York counterparts.
Green's chapter on Soulscapes provides an informative reading of Jesuit philosopher Michel de Certeau who asks, "what do we do when we believe?" Green traces how the soul and belief in an afterlife led to the phenomena of near death experiences. To cite Sacks, we long for "the charisma of eternity made real in the here-and-now".
Green shows how death is "memory work". He writes, " a death almost always bring a family and loved ones together to jointly grieve…and share the loss. But deaths are also times of anger and frustration, when family factions and old grudges threaten to disrupt the appearance of solidarity and mutual caring". Usually, after a time, it is business as usual for the family. The best example from popular culture comes from The Sopranos. While the rest of the family grieves the death of Christopher, Tony is happy because his secrets are buried with his protégé gangster who never had the opportunity to become a traitor and informant.
Green asks, "what does it mean to memorialize those who have died?" We give eulogies, construct monuments, write obituaries full of stock phrases and buy flowers. Green shows how obituaries can contain humor when they are allowed to highlight the singularity of the deceased. These authentic obituaries give "insight into the heart and soul of life". He writes, 'There is a larger pattern in contemporary dying, although it is not always visible to those who must deal with it". Green draws our attention to what has been overlooked, namely "death is full of contradictions and fearful". Green closes his book with the question, "Is death the end?"
Green returns us to the philosophical question asked by Keiji Nishitani in Religion and Nothingness. Nishitani writes, "our life runs up against death at its every step; we keep one foot planted in the vale of death at all times. Our life stands poised at the brink of the abyss of nihility to which it may return at any moment". Dostoevsky's Grand Inquisitor's "awful truth" that "beyond the grave they will find nothing but death", is the reason we fear this thing that already shoulders us with a cadaver. Following George Santayana insights, I also believe that "there is no cure for birth and death save to enjoy the interval". So we are left with the pleasure of the word. Psalm 103 informs us " As for mortals, their days are like grass, they flourish like a flower of the field; for the wind passes over it, and it is gone". Here human beings are compared to dry grass and to flowers whose delicate petals are strewn by the wind. One could ask what is the link between flesh and grass?
The Latin word gramen or grass is related to grow and green. Life sprouts. It shoots forth. If we are like grass then what is it that grazes us? What eats at us? What scrapes us? What bruises us? What makes us fall? Sometimes saying "It will be OK" may be a lie. We bloom. We may flourish or not. But all of us will be gone.
Green's book takes us beyond the good death. He show how such structures do not" fit well with current realities". Green gives us another answer to what it means to be human. We are more than what medical models shape us to be. As human beings, we are the impossibility of what cannot pass-away. We live spectrally. We who are both guests and ghosts, held hostage in each others arms through our universal mourning. We are not the corpse that will have been.
In memory of Joanie Tebbutt.
© 2009 Marko Zlomislic
Marko Zlomislic is professor of philosophy at Conestoga College, Institute of Technology and Advanced Learning in Kitchener, Ontario, Canada