Here's my mother. Just turned 88. For four months her nearly lifeless body remained nearly motionless. "She's lucky to be alive" her neighbor said after seeing paramedics remove her from home.
In just over two centuries, advances in medicine, public health, technology, and communication have transformed not only the Western way of life, but also the ways of dying. As the twenty-first century begins, traditional beliefs and practices regarding how to approach one's own death, how to treat and dispose of human remains, how to express emotion at parting, and how to suitably remember the dead are all being reexamined and often replaced by new options and attitudes. Throughout history, most human beings have lived brief, uncertain lives on the edge of disaster. The rich and powerful might enjoy a few more of life's pleasures, but, like the poor and humble who served them, they remained almost powerless against plagues and infections, crop failures, wars, fires, and floods. Today, at least in affluent nations, these scourges claim relatively few victims, the careless or unlucky. Death has new faces today, many less easy to recognize than those of the past, and some hard to visualize at all. Death from overabundance, bad judgment, or evil intent has replaced death by forces of nature, bad luck, and lack of essential resources as the greatest threats to individual lives. In place of cholera and typhoid we now have AIDS; in place of marauding hordes we have terrorist bombers; in place of famine and scurvy we have heart disease and cancer. A few natural forces with the power to kill (such as tornadoes, floods, and earthquakes) remain beyond human control, but better building codes and early warning systems help protect us. Greater dangers may come from natural processes that grow slowly over time. Global warming may already be at work making storms more frequent and more powerful. Large pulses of freshwater melting off the Greenland ice cap could deflect the Gulf Stream current, making winters in Europe and North America more severe and causing drought in areas as far away as Central Asia. Signs that killers from the past are staging a comeback are another ominous trend. Diseases like influenza, whooping cough, and even smallpox are showing up once more in new forms that resist antibiotics. Recent scares may only be a prelude to new plagues that travelers could spread around the world in weeks or even days. And rising steadily in rank among major causes of death worldwide we find motor accidents, crime, and suicide. Facing the Facts of Death Death, particularly our own death, still has the power to frighten. We today are less sure than our ancestors were of what to expect when we die and how to prepare for it. We lack direct experience: Death today often takes place out of sight in hospitals and nursing homes rather than at home with friends and relatives watching. Displays of mourning are more private and less prolonged. Memorial services are likely to be held in some rented space dedicated solely to that purpose, rather than in a home or place of worship where friends and family once interacted with the deceased. Instead of viewing death first hand, we get two-dimensional images and descriptions from news reports or watch death dramatized in fictions of all kinds, from kiddie cartoons and comic books to supernatural thrillers and action films. Such illusions of death give us the thrill of being close to death without experiencing either its danger or its reality. So we may become jaded, our sensitivity dulled to someone else's suffering, or we may feel an exaggerated sense of our helplessness and futility. Reasons why people tend to avoid thoughts of death and dying include fear of death itself, distaste for dead things and physical decay, and self-delusion--the hope that we ourselves will never die in spite of what we understand must happen to those around us. We may also feel that, if we cannot escape death, there is no point in thinking about it. But the fact is that a little serious futures thinking about death may ease our fears and improve our final days. Just as we learn various skills to improve our odds of achieving what we want from life, so we can influence how we are likely to die. One step many people take is to consciously avoid high-risk behaviors (such as smoking, unprotected sex, or not wearing seatbelts) that are likely to lead to an early or painful death. Another proactive option is to draw up a Living Will. This and other types of medical directives can help assure that your wishes and concerns about emergency treatment and long-term care will be honored whether or not you are personally able to make crucial decisions when they are needed. A more deliberate step might be to discuss death options openly with your doctor. As you and the doctor look over your medical history, compare various possible causes of death that appear particularly likely for you. Select which of these causes you might prefer to die from and which you would rather avoid. Then, together, tailor a personal fitness regimen with your desired end in mind. In his 1994 book How We Die, Sherwin B. Nuland of Yale Medical School describes in detail what progressive symptoms to expect from some of today's most common causes of death, including heart attack, Alzheimer's disease, AIDS, and cancer. While any mode of dying can be painful or at least unpleasant, Nuland makes clear that, by knowing what to expect, we can make better choices about what tests and treatments we are willing to undergo and deciding at what point we prefer peace and comfort to indefinite pursuit of an unlikely cure. Not every doctor may be comfortable with this frank approach, but what is the alternative? Only to pretend that, if we are very careful and avoid taking any risks, we will never die? Doctors know better than anyone that the treatments they prescribe to help ward off one danger often necessarily increase their patient's vulnerability to some other threat. Lifestyle changes may involve fewer unwanted side effects than drugs or surgery, but here, too, there are trade-offs to consider. Why give up pleasures we truly value just to prolong an existence that, without those pleasures, fails to satisfy? Doctors know what makes life possible, but only the patient can decide what makes life worthwhile. To take still more control, you may wish to learn about options for suicide, with or without assistance. Having the power to leave life at will--much as we now give bedridden patients a button to control the flow of their pain relievers--could actually relieve anxiety and make life seem more worth living. And even suicide need not be irreversible, as we shall see. Fear of an Afterlife Easing our fear of what comes after death is a more complex problem. For some people, the possibility of nonexistence holds more terror than any hellish afterlife. But what we fear about our own dying may be an extreme form of what we fear most about any future: change. Beyond simple anxiety at leaving the only existence we are certain of, there is the matter of whether any consciousness continues. Does the breakdown of our physical body mean the end of all awareness? If not, what will we experience? We can take some steps to reduce our sense of helplessness over this issue, too. Think of yourself as a test pilot. Your experience to date proves your ability to handle the familiar (i.e., to deal with the daily problems of being alive). But now you are suddenly presented with a new machine (we'll call it "death") unlike any you have piloted before. How can you learn to control it? You can start by reading the "manuals." The reasoning and speculations of religious leaders and philosophers through the ages offer strength and comfort in many forms. Whether you ultimately find relief from your personal terrors within the framework of a single doctrine or draw upon wisdom gleaned from different times and cultures, even sampling the immense range of speculation about life after death, is a good way to gain reassurance and perspective. Memoirs and biographies also offer insights. Human doubts and fears are seldom unique, and whatever your concern, someone else has probably faced it before you. The more you know about how other people have lived, died, and explored the nature of existence, the more possible solutions you can draw on to inspire and guide you in living your own life and facing your own death. Many religions (Judaism, Christianity, Islam, Hinduism, and Buddhism, among others) teach that life on earth is merely one stage of existence and that death is not necessarily the end. What matters then is not how long a human being lives, but how well. If the essence of an individual (for convenience, let's call it "soul") continues to exist, then actions and choices made on earth can be judged after death, and appropriate adjustments made to the conditions of each soul's future existence. This might involve rebirth into the world in some altered form, an ultimate reward, eternal punishment, or something in between. Whatever your beliefs, one type of "afterlife insurance" seems hard to fault: Avoid doing any harm that cannot be atoned for in this life. Helping others clearly benefits them here and now. If there is no afterlife, your good deeds have merely occupied time that you might have spent making problems rather than solving them. You have lost nothing. If, on the other hand, life begins again or continues on a different plane, having brought more joy than pain to those around you while you lived can hardly count against you. The Problem of Disposal Another disturbing thing about death is its messy physical aftermath. From rotten fruit to roadkill, we instinctively recoil from dead things. Dead human beings are no exception. It takes a powerful motive--often love, sometimes detached professional concern--to handle a dead body with dignified care. What to do with a corpse has always been a problem. For centuries, the most common options were burial or burning, but other methods have been used, such as feeding the corpse to birds of prey. Generally speaking, little has changed over time until recently. Since 1997, a Houston-based company called Celestis has offered "memorial spaceflights" that place tiny capsules containing human ashes into low Earth orbit. A few dozen people, mostly well-to-do Americans, have had samples of their cremated remains launched into space. The first of these "space burials" took place on April 27, 1997, and included ashes from Star Trek producer Gene Roddenberry and counterculture guru Timothy Leary. The ash-filled capsules orbited the Earth for about five years and then reentered the atmosphere as tiny meteors. Ashes from astronomer Eugene Shoemaker were packed aboard the Lunar Prospector probe launched in January 1998 and impacted on the Moon on July 31, 1999. Because of the high cost involved in lifting any object from Earth's surface into orbit, no one has yet had his entire body, even in the form of cremated ashes (which weigh only 5% as much) buried in space. But launching bodies out of the solar system or dropping them from low Earth orbit for meteoric cremation may become common once the international space station becomes fully operational or when permanent settlements are established on the Moon or Mars. At the opposite extreme, the Natural Death Centre in Britain, and similar groups throughout North America and around the world, are actively promoting simple, low-tech, ecologically sound ways to recycle human bodies. Death Debates Today The growing numbers of older people in affluent countries make these the likeliest places to look for signs of new ideas and attitudes toward death. Among the death-related issues highly controversial today are: * The right to die. Mercy killing and suicide appear sensible and ethically valid to some, socially dangerous and immoral to others. Attempts at compromise are complicated by the fear that, once approved, any law allowing doctors to help a patient die could be expanded to permit killing anyone considered undesirable or inconvenient. * Capital punishment. The danger that an innocent man or woman could be wrongly convicted of a crime and executed is clear. Less clear is when, if ever, allowing a convicted criminal to remain alive poses an unacceptable risk to society. Sooner or later the morality of targeted assassinations, surgical military strikes, and legal executions must be weighed against the real and threatened harm from suicide bombings, serial murders, and inhuman cruelty toward helpless victims. * Cryonic suspension. Attempts so far to freeze the newly dead for later revival seem no more than expensive, high-tech theater. But research continues, and more reliable options for life extension may emerge. One possibility might be to allow willing patients to be frozen before the disease they suffer from has reached its final stage. * Antiaging treatments and genetic enhancement. Perhaps the greatest near-term hope for extended life spans comes from cloning spare body parts and gene replacement or augmentation therapies. Experiments in these areas could soon produce costly but effective measures to extend or improve physical well-being as well as longevity. But such success could trigger a reaction against those who cling too long to life, especially if resource scarcity becomes a global concern. * Living machines. Already, self-proclaimed "cyborgs" like engineering professor Steve Mann, pioneer of wearable computers, wear television cameras that enhance and selectively edit all they see. Many more perception-shaping mind attachments are likely to appear in coming years. These could dramatically extend human abilities to absorb and process information directly through heightened senses of touch, sight, hearing, and smell. In time, human and machine may become hard to tell apart and impossible to separate without significant damage to one or both. What then becomes of the concept of death? Answers to all these dilemmas are still unclear and will likely fuel more public and private debates as the future unfolds. Who Wants to Live Forever? Immortality has been a human dream throughout recorded history. The gods in most religions are regarded as immortal, and stories of attempts by human rulers and heroes to be made immortal as a reward from the gods or directly by their own efforts are common in the myths of many cultures. But these myths record that most such attempts fail, and even success does not always assure happiness. Immortal characters even in fiction have no easy time of it. In Greek legend, Aurora, goddess of dawn, gave her human husband Tithonus eternal life, but forgot to give him perpetual youth as well. Tithonus grew steadily older and weaker, till at last he shriveled down into a cricket. If humans learn to cure all diseases and heal any wound, but not to prevent their cells from aging, they might face a similar unsatisfactory end. Even with eternal youth thrown in, life without death could easily prove a curse. How long could we keep straight all our accumulated memories, stay mentally alert, and find new things to surprise and delight us? Infoglut and boredom are bad companions with which to share eternity. Besides the problems for individuals, immortality poses tough questions for society as well. For instance, who will be allowed to become immortal? And how can we meet the material needs of even a small and stable population who would never stop needing to be fed, clothed, housed, and entertained? Alternatives to immortality and death-as-usual are worth investigating. Statutory Death: Reversible Suicide One way to end our fear of physical death might be to step into it consciously, by stages. In other times and cultures, the act of "leaving the world," often by joining some religious order, was an accepted and honored way to end public life. Retirement today is less about leaving the world than simply ending regular paid employment. As a result, retirees too often find themselves suddenly demoted from independent adults to tolerated children. Valued mostly by their families and their insurance companies, they move through what remains to them of life as perpetual consumers. For many, the life of leisure quickly loses its charm when vacation time is never relieved by any worthwhile work. Instead of dooming senior citizens to this diminished form of real-world life, we might augment retirement through a strategy I call statutory death. Any adult of sound mind would be allowed to voluntarily renounce his or her worldly rights and responsibilities simply by writing a witnessed legal will, thereby becoming dead in the eyes of the law. Existence would continue in a physically passive but mentally heightened state. This "twilife" condition would be maintained through the use of hallucinogenic drugs and direct electronic stimulation of the brain, supervised by trained medical personnel, at a special pleasure hospice created for this purpose. Why would anyone of sound mind want to be legally dead? There could be many reasons, including: * Control: You could attend your own "funeral," say goodbye to family and friends, arrange the transfer and dispersal of your worldly goods to your own satisfaction, then depart--avoiding inheritance squabbles, contested wills, or unforeseen objections. You might not "take it with you," but you could know for certain where your wealth was going. * Escape: Convicted criminals, bankrupts, even despondent lovers might all take this way out, instead of serving prison time or committing actual suicide. Twilife existence would still allow the legally dead to return and resume normal living status at any time before physical death occurred. Meanwhile, the legally dead would pose no threat to themselves or others. Periodic "resurrections" might be built into the process as a way to guard against regrets, adjust to changing circumstances, or correct judicial errors. * Fun: In twilife, nothing would be forbidden or impossible. With no responsibilities, and no way to harm anyone by their excesses, the legally dead could safely live out (in their minds) any fantasy or experience (in simulation) any physical sensation as if it were real. Would this mean a purely sensual existence? Not necessarily. Tastes change, and, while an 18-year-old undertaking statutory suicide might have no deeper interest than computer games, some 60-year-olds might well prefer an endless flow of wine and conversation or simply reading themselves to sleep with a background of music. Mini-Vacations as Warm-Ups for Death The twilife state would use drugs and electronic stimulation of the brain to mimic real-life experiences. But this will likely require fine-tuning based on practice and experiment. A course of mini-vacations during one's active life would help prepare and train the future "dead" to enjoy their twilife existence. As I conceive it, statutory death would not be an impulsive act. To prepare for it, candidates would undergo extensive physical and psychological testing to learn their sensitivity and tolerance to different drugs and to separate the fantasies they truly crave from the conventional dreams they think others would approve of. So long as they are only simulated, morality need not apply. Criminal longings, physically impossible behaviors such as flying, walking on the surface of a star, or swimming with whales in the ocean depths could all be experienced in virtual reality. Separation and grieving would have already taken place, so the physical end of life, when it came, might scarcely be noticed even by the dying individual. Presumably, the body after true death would be available for recycling in its most profitable form as whole or partial payment for one's stay in the pleasure hospice. Much research will be needed to learn how to use mind-altering drugs and virtual-reality simulations appropriately. But the technology required is already close at hand. In Australia, Phillip Nitschke, director of the University of Melbourne's Centre for Palliative Care, has developed a device he calls a "coma machine." It allows terminally ill patients to automatically receive a measured dose of drugs sufficient to keep them at any desired level of consciousness indefinitely. Any time a patient begins to feel pain, the machine adjusts the amount of drugs to exactly balance the unwanted sensations. Assuming that appropriate laws were enacted--and social attitudes changed to allow it--such a device could easily become a mechanism for delivering and sustaining pleasant twilife dreams. In a lecture on "Theories of the Good Life," philosophy professor Daniel N. Robinson of Georgetown University posed an interesting problem. If the best life possible involves avoiding pain and maximizing pleasure, and all we know of life comes from the activity of our brain, why not simply stimulate the brain directly to mimic the effects of pleasure--from good wine to witty conversation? Robinson rejected this as an ideal on the grounds that such an existence, limited to choices and actions that have no measurable consequences outside an individual mind, would not be "life" at all, but merely an imitation of reality. An apt comparison might be Plato's famous parable of the cave--where prisoners in chains can see only shadows moving on a wall and have no notion of a world where solid objects interact. Freedom of choice makes individuals morally responsible for the consequences of their actions. Fair enough. However, if life were not the goal, but rather an easeful death, then perhaps twilife really could be a better way to die, though probably not for everyone. The important point to remember is that entering twilife would be gradual and voluntary--the result of a deliberate decision, taken only after careful thought and months if not years of supervised experiment and personal preparation. Last Words Death is alive and well and likely to be with us in this world for some considerable time. In the past, death was always near at hand and often in plain sight; today, death has gone underground. Death is our forgotten future--the one we seldom seriously plan for and prefer to ignore. Discounting or ignoring death as a serious possibility can lead us to take foolish risks today and hold wildly unrealistic expectations for tomorrow. Often, we wait until age, ill health, or some impending disaster forcibly reminds us of our mortality. Instead, we can and should face death like any other future possibility that puzzles or frightens us. We should gather whatever facts we can establish, explore the aspects we still do not understand or cannot control, identify different possible developments and trends, select the outcomes we prefer, and then take concrete steps to make these outcomes more probable. "The dread of something after death, The undiscover'd country from whose |