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The Urban Dharma Newsletter - July 11, 2008

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In This Issue: Buddhism and The Good Death

1. "The warrior rarely dies of old age." - Unknown
2. Death and Dying - by Ajahn Jagaro
3. ARS MORIENDI - by DONALD F. DUCLOW
4. THE GOOD DEATH - by ROBERT KASTENBAUM

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HI,

A friend of mine lost her husband (age 38) on the July 4th weekend to a motorcycle accident... I did the memorial service yesterday at his favorite beach, just north of Malibu on Pacific Coast Highway... It was well attended... And it got me to thinking, “What is a good death.”

Peace... Kusala



1. "The warrior rarely dies of old age." - Unknown



2. Death and Dying - by Ajahn Jagaro

http://www.katinkahesselink.net/tibet/death_jagaro.html

More often than not in this society of ours, which is a life-affirming society, a beauty- and pleasure-affirming society, the topic of death and dying is avoided. Not only this society, but most societies, including traditional Buddhist cultures, avoid the topic of death as though it were something unpleasant, depressing, to be avoided; even a bad omen: "Don't talk about it as you may encourage it to happen!" Of course this attitude is not very wise and certainly not in keeping with the Buddhist attitude. So this evening I would like to speak on the Buddhist attitude to death and dying.

Why think about it?

First of all, why should we think about death? Why should we contemplate it? Not only did the Buddha encourage us to speak about death, he encouraged us to actually think about it, contemplate it and reflect on it regularly.

On one occasion the Buddha asked several of the monks, "How often do you contemplate death?"

One of them replied, "Lord, I contemplate death every day."

"Not good enough," the Buddha said, and asked another monk, who replied,

"Lord, I contemplate death with each mouthful that I eat during the meal."

"Better, but not good enough," said the Buddha, "What about you?"

The third monk said, "Lord, I contemplate death with each inhalation and each exhalation."

That's all it takes, the inhalation comes in, it goes out, and one day it won't come in again - and that's it. That's all there is between you and death, just that inhalation, the next inhalation.

Obviously the Buddha considered this a very important part of meditation and training towards becoming more wise and more peaceful. Why is it that this contemplation is encouraged? Because we don't usually want to think or talk about death. Be it conscious or unconscious, there is a fear of death, a tendency to avoid it, a reluctance to come face to face with this reality.

Death is very much a part of life; it's just as much a part of life as birth. In fact, the moment of birth implies death. From the moment of conception it is only a matter of time before death must come - to everyone. No one can escape it. That which is born will die. The mind and body which arise at the time of conception develop, grow and mature. In other words, they follow the process of aging. We call it growing up at first, then growing old, but it's just a single process of maturing, developing, evolving towards the inevitable death. Everyone of you has signed a contract, just as I did. You may not remember signing that contract, but everyone has said, "I agree to die." Every living being, not only human, not only animal, but in every plane, in every realm, everywhere there is birth, there is the inevitable balance - death.

Today, according to a book I read, about 200,000 people died. That is the average everyday. Apparently about 70 million people die every year. That's a lot of people isn't it? The population of Australia is only about 16 million and every year 70 million people die by various means, 200,000 in one day. That's an awful lot of people. But in our society we have very little contact with death. We are not usually brought face to face with death, we are not encouraged to contemplate death or come to terms with it.

What we are usually encouraged to do is to avoid it and live as if we were never going to die. It is quite remarkable that intellectually we all know we are going to die, but we all live as if we are never going to die. This avoidance, this negation, usually means that we will always be afraid of death. As long as there is fear of death, life itself is not being lived at its best. So one of the very fundamental reasons for contemplating death, for making this reality fully conscious, is that of overcoming fear. The contemplation of death is not for making us depressed or morbid, it is rather for the purpose of helping to free us from fear. That's the first reason, which I will explain later in more detail.

The second reason is that contemplation of death will change the way we live and our attitudes toward life. The values that we have in life will change quite drastically once we stop living as if we are going to live forever, and we will start living in a quite different way.

The third reason is to develop the ability to approach death in the right way. By that I mean dying, the way we actually die.

The contemplation of death has three benefits:

* relieving fear
* bringing a new quality to our lives, enabling us to live our lives with proper values, and
* enabling us to die a good death.

It enables us to live a good life and die a good death. What more could you want?
Being conscious of death

First, let's look at the contemplation of death. This entails actually making oneself acknowledge death by consciously bringing into mind the fact: "I am going to die." You may say, "I know that." But you don't know it; not fully, not consciously.

There should be many opportunities to do this contemplation, but in present day society there are not, simply because we are so far removed from death. We don't see it. Oh yes, you see it on television and at the movies, but it's all a game, you know they are only acting. It's only a game isn't it? You sit there and watch people being shot, hundreds of them, and it's only a game. This actually has the opposite effect. It makes you even less able to acknowledge the reality of death, because it's like a game, it's not real, it's reinforcing the perception that death is not real.

We are very far removed from the experience of death, not because death is not to be found, but because of the way our society is structured. How many of you see death? How many of you see dying people? How many of you are present at the time of death? How many of you have the opportunity to sit with a corpse? Not many of you have that opportunity.

But it doesn't matter how far removed you are, you can never be completely removed, because it is such an imposing reality, especially when someone in your family dies. Even so, most often it is taken away from you. People die in hospital. If they die at home you call the funeral directors and they take the body away and put it in the funeral parlour. If you have a service the body is all sealed up and then it is cremated for you.

So you have very little contact, which is very different from the way things used to be. In earlier times, in more simple cultures, if a member of your family died you washed the corpse, dressed it, and burned it or buried it yourself. You had to do it; no one was going to come and do it for you. You, your family and your friends had to dress the body, carry it, collect the wood, make a pile and put the body on the pile of wood and burn it.

This is how cremation was - very basic. In fact this is very much how we still cremate bodies in our forest monastery in Thailand. There we usually use a very simple coffin that the villagers make themselves. They just collect some planks, knock up a coffin, put the body in it - no lid - put it in the hall and everybody is there to see and contemplate it. Then they make a pile of logs, place the body on top, and burn it while everybody stands around and watches. So there is an opportunity to see the natural end of life, the end of one cycle of life. And that has a very good effect in helping us to rise up and come to terms with this reality, rather than it being a ghost, a skeleton in the closet waiting to sneak out and haunt you.

Anything that is not brought out and fully confronted, fully come to term with, can have power over you. Ghosts usually haunt at night when you can't see them. They sneak up behind you when you're not looking and can't see them. When you put on the light there is no ghost. In order to have power over us, to make us frightened, it must be something that we can't face, something that we can't fully, consciously, clearly see. It must remain unknown and mysterious. As long as we allow death to remain that way it will bring fear into our hearts.

But through contemplation, through attention and consciously finding ways of bringing this fact into the mind and coming to terms with it, fear can be overcome. This is why the contemplation of death is one of the main contemplations in Buddhism. It can be done in many ways. Most mornings in our monastery we chant one particular reflection which goes:

"I am of the nature to age, I have not gone beyond aging. I am of the nature to sicken, I have not gone beyond sickness. I am of the nature to die, I have not gone beyond dying. All that is mine, beloved and pleasing, will change, will become otherwise, will become separated from me."

When you contemplate this reality with a peaceful mind and really bring it into consciousness, it has a powerful effect in overcoming the fear of old age, sickness, death and separation. It's not for making us morbid, it's for freeing us from fear. That is why we contemplate death: it's not that we are looking forward to dying, but that we want to live and die without fear. So to have an opportunity to be with a dead body is to be encouraged. It's good if you have such an opportunity to actually sit and be with the body, to actually witness the end of a human life, to ask yourself, "Is this death?"

When you die, you can't take anything with you - not even your own body. In Buddhist monasteries this is considered so important that quite often skeletons are displayed in the meditation hall. In one monastery there was a monk who left instructions that after his death his body, fully robed and sitting in full lotus, was to be put in a glass case. There he sat slowly disintegrating. Written on the front of the glass case was: "I used to be like you; soon you will be like me." Now when you see that, it has quite a powerful impact. It's a fact you just can't escape.

The fact is that every single person is going to die. This is not a prediction I'm making through clairvoyant powers. It's just the inescapable fact that because you're born, you're going to die. All that remains to be known is the time: when is it going to happen? That's the unknown factor. The fact that you are going to die is not questionable, it is reality.

So we contemplate. When there is death it's good to come into contact with it. Someone who was living perhaps ten minutes ago is now dead. Yes, that's what's going to happen to me, too. Even if there is no body, no corpse in sight, one can do this just sitting quietly, just making that thought very clear in one's mind. "I am going to die. I am going to die and I am going to have to leave everything behind, every single thing, every mortal being is going to be left behind."

Now remember the purpose of this. It is to force the mind to come to terms with this reality. Quite often you will feel fear. There is still fear because you haven't accepted it yet. That's the purpose of the contemplation: to allow the fear to arise so that we can learn to transcend it, to get above this fear and to be able to acknowledge death without fear.

Buddhist monks see a great variety of life. People often think the opposite, that because we're monks we're removed from the realities of life, that we're protected and sheltered, that we live in a remote realm where we don't really know what life's about. In a certain sense that may be true, but in another sense we have more contact with many aspects of life than most people do. This is because the role of monk within a community of people is to act as a spiritual guide and refuge. When there's a birth, everybody brings the baby to the monk and he gives a blessing. The monk experiences what it is for everyone to be happy. When someone is sick: 'Get the monk.' So the monk has very close contact with sickness, pain and fear.

When there is death it is very important for the monk to be there, because most people are terrified of death, both those who are dying and those around them. People feel at a loss: 'What do we do?' As a monk I find that I have many occasions to come into contact with these things, both the pleasant and the unpleasant. I have found death to be one of the most rewarding experiences. I have also found it to be one of the most meaningful ways to be of service to others, because that is the time that I feel most useful. You may think that I feel most useful when I'm teaching meditation or giving these talks, but I really feel most useful in situations where there is death. That is the time when I feel that through my contemplation, through my appreciation of this process called life, I can be a refuge for the dying and for the people around the dying. As I said, it is also rewarding as a learning experience, especially the first few occasions when I had to be with someone who was actually dying.

So there are opportunities for us to contemplate, to bring into the mind this part of life which is normally avoided. Notice if fear arises. If fear does arise, it must be dealt with, we must rise above it. How do we rise above the fear of death? The first thing is to acknowledge its inevitability. Everything, both animate and inanimate, follows the same process. It is just part of life, there is no problem.

It's not that we look forward to it. Some people respond to this with, "Well, if you're not afraid of death, why don't you go and kill yourself?" But we're not afraid of living, either. Just because you're not afraid of something, does that mean that you have to do it?

This rising up and acknowledging is part of life. Inevitably, I'm going to die - everybody, every plant, every tree, every insect, every form, every being, follows the same path. Soon it will be autumn, the leaves fall off the trees. We don't cry, it's natural, that's what the leaves are supposed to do at the end of the season. Human beings do the same thing. We have to rise to this occasion and acknowledge this reality.

Another quality that is very helpful is confidence. Religious people usually have less fear of death than very materialistic people, because for the materialist there is only one life and that is it. Death is zero - finish - kaput! Of course to some people that's quite appealing, but for most people the thought that's it's all gone is not very desirable, in fact it's quite frightening.

But from the Buddhist perspective, death is never seen as the end. From the Buddhist perspective birth is not the beginning and death is not the end. It's just one part of a whole process, a whole cyclic process of birth, death, rebirth, dying again, rebirth, dying again... If one has some appreciation or understanding of that, death begins to lose its sting, because it's not final, it's not really the end. It is only the end of a cycle. Just one cycle along the way and then the way continues with another cycle. The leaves fall off the trees, but it's not the end. They go back to the soil and nourish the roots, next year the tree has new leaves. There's no disappearance into nothing. The same can be said of human life. There are bodies, there are living beings, but death is not the end. Conditioned by the moment of death is rebirth. An appreciation of that helps to relieve a lot of the fear about death.

So we bring up the thought of death, we sit and bring it to mind. If fear arises, then we try to rise above that fear so that the mind comes to terms and is at peace with reality.

Living consciously

Now this really does free us up, enabling us to live our lives more fully. The contemplation of death, rather than making us depressed and morbid, can actually help us live our lives more fully, with more joy, with more gratitude and appreciation. If we live our lives as though we were going to live forever, we don't appreciate them. We take them for granted and live in a very foolish and heedless way. We all live in foolish ways, simply because we don't consciously contemplate the fact of death.

How do we live our lives in foolish ways? Just consider how much time we waste. For a start, how much time have we wasted today worrying about next year, about the next twenty years, thinking about the future, so that we are not fully living this day: "I'm looking forward to Wednesday. Then two more days to go... Thursday, Friday... then it's Saturday. I'll go to the football, the cricket. Sunday morning... meditation at the Buddhist Society. Great, I'm really looking forward to that."

That's the mentality of our Australian society. Five days of the week are spent waiting for the weekend. So you live two days out of seven. Most people just endure five days of the week. From nine to five is a dreary existence, then in the evening they live for a couple of hours. We don't really appreciate life. We don't live our lives fully. We take it all so much for granted, as if we're going to make it till Saturday. You may not make it till Saturday! I may not make it till Saturday. If you or I really aren't going to make it till Saturday, we'd better make the best of today.

This is how the contemplation of death helps to break this habitual way of living, where we take so much of life for granted, constantly overlooking the present and looking to the future. That is one of the foolish aspects of the way we live when we're not contemplating the reality of death.

Another, which is even worse, concerns some of the things we do to each other. We can be very cruel and mean, holding on to hatred and resentment: "Oh well, let him stew for a few more days." Or: "Let her suffer for a few days, I'll apologise next Sunday." We do a lot of things to each other in unskilful ways in the expectation that next time we can fix it up.

"Next week, next month, I'll smooth it over." But what if there is no next month, no next week? What if there is no tomorrow? Suppose you have an argument today? You may die tonight, she may die tonight. You really wouldn't want to part having some terrible argument as your last memory, would you? It's better to apologise now before it's too late.

You see again how we take for granted that there is always going to be a tomorrow. "But," you say, "I'm sure I'm not going to die tonight." Well, maybe not tonight, but one night or one day. It is so uncertain. It really is uncertain, you really don't know - 200,000 die today, tomorrow another 200,000. There is no guarantee that it won't be one of us.

Has this every happened to you? You say, "I'll have to go and see so-and-so," taking it for granted that you will be able to see them. This happened to me with the person whose skeleton now hangs in the meditation hall at Wat Pah Nanachat. The skeleton is of a lay-supporter who used to come to the monastery, but then she developed cancer, which caused her a great deal of suffering. I used to visit her regularly, and one day I had intended visiting her as I was coming back from the town to the monastery, but I thought, "Oh, not today, maybe tomorrow." I was feeling a bit tired, so I thought I'd visit her in a few days time. She died, and I really regretted that I hadn't dropped in. I had assumed that she would be around the day after. That can happen to all of us. If we really recognise that, if we can bring that consciously into our minds, it can help us live our lives a little more wisely, by not leaving unfinished business, negative experiences, resentment, hatred and conflict to linger.

I've seen this in practice. For sixteen years my father and I were not on good terms. He resented my wearing this robe and was very unhappy being unable to come to terms with it. He'd also had an argument with his brother, before I was born, and they had not spoken to each other since. My father's brother lived in Italy and the feud between them started before my father left Italy. They wouldn't speak to each other at all, and this went on for thirty or forty years. Then one year my father changed quite radically, quite drastically. One of the factors for this change may have been something I said to him. I said, "If you are not going to change your view about me, then you're going to suffer for the rest of your life, until the day you die." I think that had quite an impact, as he was getting old. At that time he was 74 or 75. He recognised that he was going to die, it became a conscious reality.

So he decided to set his home straight. He made peace with me. He went to Italy and resolved the argument with his brother that had being going for forty years. He settled all the financial matters that had been left pending for about fifteen years or so and he came back. I remember him saying to me, "I don't want to die with any of these unfinished things on my mind. I want to die peacefully."

That's the effect of contemplating the reality of death. It makes us live more wisely, resolving these unfinished matters. Don't let them linger: the fights, the hatred, the conflicts, the feuds, the debts, whatever. We have the chance, let's get it in order. That's very important. That's a benefit of contemplating death, it affects the way we live our lives. We live them more fully, with gratitude. We don't let things linger on, we don't leave unfinished business.

And our values in life will change. What is important in life? What is motivating you? What is the drive in your life? If we really contemplate death it may cause us to reconsider our values. It doesn't matter how much money you've got, you can't take any of it with you. It's true about everybody, about every religion. You can't take anything at all with you. Whether you have a million dollars or just ten cents, you can't take it with you. Your own body has to be left for others to dispose of in one way or another, it's just refuse left behind. You can't take your body with you, you can't take your wealth with you, you can't take your cars or your houses with you; we can't even take our Buddhist temples with us. That should make us consider how important these things are to us. What is important in our lives then? Is there anything that we take with us? What do we take with us? What is important?

Maybe the quality of life is more important than material acquisitions. The quality of life is primarily the quality of our minds. How we are living today may be more important than a lot of these other things. Considering that the Buddhist perspective of death is not the end, but the condition for rebirth, and that rebirth is conditioned by death and the quality of the mind, there is one thing you take with you. There is one inheritance that you don't leave behind for others:

I am the owner of my kamma, heir to my kamma, Born of my kamma, related to my kamma, abide supported by my kamma. Whatever kamma I shall do, for good or for ill, of that I will be the heir.

That is all that follows, the qualities that we develop within us, the qualities of mind and heart, the spiritual qualities, the good or bad qualities. This is what we inherit. This is what conditions rebirth and shapes the future. So again this gives rise to a new value in our lives. The contemplation of death may change our values. Then we may not think it so important to strive so hard to make that extra million. We may not live long enough to enjoy it; we may as well enjoy the million we've already got, living more peacefully and starting to build up some spiritual qualities. It can have a very good effect on the way we live our lives and on the values we develop. It's not just a matter of being successful, it's how we become successful. What we're developing within us is more important than becoming successful.

I was giving a talk the other evening to a group of people. In the audience there were quite a few young people and a question was asked about the relevance of Buddhism in this competitive society. I said I don't mind competition, I think competition is good. As long as competition doesn't mean abandoning your humanity, competition is fine. However, it should not be at the expense of your humanity, of the humane qualities of virtue and compassion. You can still compete, you can still strive, but not at the expense of these qualities, because ultimately these are more important. They are your true inheritance. Whether you succeed in getting that business deal or not, whether you make that $100,000 or not, whether you get that new car ten thousand dollars cheaper or not, seems so important in the short term. Ten thousand dollars is a lot of money, but if you have to do that at the expense of your humanity, your moral principles, your virtue and your compassion, it's not worth it, because you'll have to leave the money behind sooner or later - perhaps sooner than you expect. Your only inheritance is the quality of your mind.

This contemplation of death can help us to live our lives with more gratitude, with less fear, with more immediacy and with values that are really important. That is why we encourage contemplation of death and the process of dying.

Dying peacefully

Having considered all of this, if dying becomes no longer a contemplation but an actual experience, we can face it without fear. Not only can we face it without fear, we can also do a lot towards dying a good death. If we have led a good life, dying is easier. But regardless of how we have lived, we can still endeavour to die a good death. To help in the dying process, we stress very much the development of the same quality of fearlessness. Death is not to be feared, it's just natural.

The fear of death is often connected to the fear of pain. For many people it's more the fear of pain and the fear of separation from all that is loved that is fearsome. At the time of dying encouragement and reassurance are essential. For a start you need to reassure yourself. The pain is difficult to bear, but we are fortunate in that modern medicines make it possible to reduce the amount of physical pain a human being has to experience at death. Pain need not be such an overwhelming object of fear.

I usually reassure a dying person, such as someone who has cancer, that they won't be allowed to suffer, that they won't have to endure excruciating pain, that they will be given medicine. They certainly should be given medicine to alleviate the pain. An important result of this is that they can relax and die more peacefully.

The other worry is the separation from loved ones, from one's possessions. Of course, if we've contemplated this before, it's a lot easier. We know that to come together implies separation. That's all life is, a meeting and a separation. I came to Melbourne two months ago, in a few days I'll be leaving. That's just the way it is. If we contemplate that, it won't be so frightening to us. If a dying person hasn't done this kind of contemplation, then you need to gently encourage and reassure him or her that the children and those left behind will be taken care of. They need to be reassured that it's all right, that there are friends to take care of them, they need to be encouraged to relax and be peaceful, not to worry about other things, that they'll all be taken care of.

The whole emphasis is on trying to encourage the dying person, be it oneself or another, to become more peaceful. How can you die a good death? By becoming more peaceful. The Buddhist way is to try and maintain an atmosphere of peace in the room where someone is dying. It's not very good to have people shouting and screaming, waving and crying and tugging and pulling. What does that do to the poor person who has this very important thing to do, to die? They make it very difficult to die peacefully. Give those present time to become quiet. It is good if friends and relatives are present, people who can show by their presence that they care, that they love, that they are willing to let go, to reassure, to offer support - that's enough.

Symbols are very useful. If the dying person is a Buddhist, then a Buddha statue, and possibly the presence of Buddhist monks, soothing words and teachings to allow the person to give up their life with the greatest peace and dignity, is very beneficial. It's a wonderful thing for them to move into their new life in the best possible way.

So these are some reflections with regard to death and dying. There are many other aspects to this topic that I could cover but I don't want to go beyond my allotted time. There are a few stories from the Buddha that illustrate very much what I've been saying. The classic one, which I tell at every funeral, is the story about Kisagotami, a woman who lived during the time of the Buddha. She had a baby son of whom she was very proud. Now this little boy got very sick and died. Kisagotami was so disturbed, so distressed by his death that she became a little mentally unhinged. She could not accept the fact that her baby had died. "No, it's only sick, I need medicine. I have to have medicine to cure my baby." She went from place to place, from home to home, from friend to friend, but no one could help her. They told her the baby was dead, but she couldn't accept this and kept asking for medicine.

Finally she went to the Buddha because she had heard that he was a spiritual teacher with great psychic powers. She asked the Buddha, "Please give me some medicine to cure my baby." The Buddha said, "Put the baby down here, I will cure your baby provided you can get a few mustard seeds for me. But you must get these mustard seeds from a home where there has never been a death."

So she went running off into the town and went to the first house, where she asked for mustard seeds. Being a common commodity of little value they were promptly offered to her. As she was about to accept the mustard seeds she asked, "Has there ever been a death in this home?" Of course the reply was, "Oh yes, only a few months ago so-and-so died." She went from home to home and the experience was exactly the same. This gradually had an effect on her.

When she came towards the end of the village realisation finally pushed through her demented state of mind: death is everywhere; in every home there is death. Death is part of life. She was able to recognise this fact and come to terms with reality. She went back to the Buddha who asked her, "Kisagotami, did you get the mustard seeds?" "Enough of mustard seeds, Lord," she replied, and took her baby and cremated it. She came back and became a Buddhist nun and not long afterwards became enlightened.

I like this story because it represents the Buddhist approach to death. Rather than bringing the baby back to life, the Buddhist way is to acknowledge the reality of death. Being a reality, it must be accepted. We don't look for death, but we don't fear it; we don't ask for death, but we're willing to accept it when it comes. Through the understanding that comes from this contemplation of death, we can live good lives with skilful values, with true appreciation, and we can die a good death, peacefully.



3. ARS MORIENDI - by DONALD F. DUCLOW

http://www.deathreference.com/A-Bi/Ars-Moriendi.html

The Ars Moriendi, or "art of dying," is a body of Christian literature that provided practical guidance for the dying and those attending them. These manuals informed the dying about what to expect, and prescribed prayers, actions, and attitudes that would lead to a "good death" and salvation. The first such works appeared in Europe during the early fifteenth century, and they initiated a remarkably flexible genre of Christian writing that lasted well into the eighteenth century.
Fifteenth-Century Beginnings

By 1400 the Christian tradition had well-established beliefs and practices concerning death, dying, and the afterlife. The Ars Moriendi packaged many of these into a new, concise format. In particular, it expanded the rite for priests visiting the sick into a manual for both clergy and laypeople. Disease, war, and changes in theology and Church policies formed the background for this new work. The Black Death had devastated Europe in the previous century, and its recurrences along with other diseases continued to cut life short. Wars and violence added to the death toll. The Hundred Years' War (1337–1453) between France and England was the era's largest conflict, but its violence and political instability mirrored many local conflicts. The fragility of life under these conditions coincided with a theological shift noted by the historian Philippe Ariès whereas the early Middle Ages emphasized humanity's collective judgment at the end of time, by the fifteenth century attention focused on individual judgment immediately after death. One's own death and judgment thus became urgent issues that required preparation.

To meet this need, the Ars Moriendi emerged as part of the Church authorities' program for educating priests and laypeople. In the fourteenth century catechisms began to appear, and handbooks were drafted to prepare priests for parish work, including ministry to the dying. The Council of Constance (1414–1418) provided the occasion for the Ars Moriendi's composition. Jean Gerson, chancellor of the University of Paris, brought to the council his brief essay, De arte moriendi. This work became the basis for the anonymous Ars Moriendi treatise that soon appeared, perhaps at the council itself. From Constance, the established networks of the Dominicans and Franciscans assured that the new work spread quickly throughout Europe.

The Ars Moriendi survives in two different versions. The first is a longer treatise of six chapters that prescribes rites and prayers to be used at the time of death. The second is a brief, illustrated book that shows the dying person's struggle with temptations before attaining a good death. As Mary Catharine O'Connor argued in her book The Arts of Dying Well, the longer treatise was composed earlier and the shorter version is an abridgment that adapts and illustrates the treatise's second chapter. Yet O'Connor also noted the brief version's artistic originality. For while many deathbed images pre-date the Ars Moriendi, never before had deathbed scenes been linked into a series "with a sort of story, or at least connected action, running through them" (O'Connor 1966, p. 116). The longer Latin treatise and its many translations survive in manuscripts and printed editions throughout Europe. The illustrated version circulated mainly as "block books," where pictures and text were printed from carved blocks of wood; Harry W. Rylands (1881) and Florence Bayard reproduced two of these editions.

An English translation of the longer treatise appeared around 1450 under the title The Book of the Craft of Dying. The first chapter praises the deaths of good Christians and repentant sinners who die "gladly and wilfully" in God (Comper 1977, p. 7). Because the best preparation for a good death is a good life, Christians should "live in such wise . . . that they may die safely, every hour, when God will" (Comper 1977, p. 9). Yet the treatise focuses on dying and assumes that deathbed repentance can yield salvation.

The second chapter is the treatise's longest and most original section. It confronts the dying with five temptations and their corresponding "inspirations" or remedies: (1) temptation against faith versus reaffirmation of faith; (2) temptation to despair versus hope for forgiveness; (3) temptation to impatience versus charity and patience; (4) temptation to vainglory or complacency versus humility and recollection of sins; and (5) temptation to avarice or attachment to family and property versus detachment. This scheme accounts for ten of the eleven illustrations in the block book Ars Moriendi, where five scenes depict demons tempting the dying man and five others portray angels offering their inspirations.

Of special importance are the second and fourth temptations, which test the dying person's sense of guilt and self-worth with two sharply contrasting states: an awareness of one's sins that places one beyond redemption and a confidence in one's merits that sees no need for forgiveness. Both despair and complacent self-confidence can be damning because they rule out repentance. For this reason the corresponding remedies encourage the dying to acknowledge their sins in hope because all sins can be forgiven through contrition and Christ's saving death.

As Ariès notes, throughout all five temptations, the Ars Moriendi emphasizes the active role of the dying in freely deciding their destinies. For only their free consent to the demonic temptations or angelic inspirations determines whether they are saved or damned.

The third chapter of the longer treatise prescribes "interrogations" or questions that lead the dying to reaffirm their faith, to repent their sins, and to commit themselves fully to Christ's passion and death. The fourth chapter asks the dying to imitate Christ's actions on the cross and provides prayers for "a clear end" and the "everlasting bliss that is the reward of holy dying" (Comper 1977, p. 31). In the fifth chapter the emphasis shifts to those who assist the dying, including family and friends. They are to follow the earlier prescriptions, present the dying with images of the crucifix and saints, and encourage them to repent, receive the sacraments, and draw up a testament disposing of their possessions. In the process, the attendants are to consider and prepare for their own deaths. In the sixth chapter the dying can no longer speak on their own behalf, and the attendants are instructed to recite a series of prayers as they "commend the spirit of our brother" into God's hands.

The illustrated Ars Moriendi concludes with a triumphant image of the good death. The dying man is at the center of a crowded scene. A priest helps him hold a candle in his right hand as he breathes his last. An angel receives his soul in the form of a naked child, while the demons below vent their frustration at losing this battle. A crucifixion scene appears to the side, with Mary, John, and other saints. This idealized portrait thus completes the "art of dying well."

The Later Tradition

The two original versions of the Ars Moriendi initiated a long tradition of Christian works on preparation for death. This tradition was wide enough to accommodate not only Roman Catholic writers but also Renaissance humanists and Protestant reformers—all of whom adapted the Ars Moriendi to their specific historical circumstances. Yet nearly all of these authors agreed on one basic change: They placed the "art of dying" within a broader "art of living," which itself required a consistent memento mori, or awareness of and preparation for one's own death.

The Ars Moriendi tradition remained strong within the Roman Catholic communities. In his 1995 book From Madrid to Purgatory, Carlos M. N. Eire documented the tradition's influence in Spain where the Ars Moriendi shaped published accounts of the deaths of St. Teresa of Avila (1582) and King Philip II (1598). In his 1976 study of 236 Ars Moriendi publications in France, Daniel Roche found that their production peaked in the 1670s and declined during the period from 1750 to 1799. He also noted the Jesuits' leading role in writing Catholic Ars Moriendi texts, with sixty authors in France alone.

Perhaps the era's most enduring Catholic text was composed in Italy by Robert Bellarmine, the prolific Jesuit author and cardinal of the church. In 1619 Bellarmine wrote his last work, The Art of Dying Well. The first of its two books describes how to live well as the essential preparation for a good death. It discusses Christian virtues, Gospel texts, and prayers, and comments at length on the seven sacraments as integral to Christian living and dying. The second book, The Art of Dying Well As Death Draws Near, recommends meditating on death, judgment, hell, and heaven, and discusses the sacraments of penance, Eucharist, and extreme unction or the anointing of the sick with oil. Bellarmine then presents the familiar deathbed temptations and ways to counter them and console the dying, and gives examples of those who die well and those who do not. Throughout, Bellarmine reflects a continuing fear of dying suddenly and unprepared. Hence he focuses on living well and meditating on death as leading to salvation even if one dies unexpectedly. To highlight the benefits of dying consciously and well prepared, he claims that prisoners facing execution are "fortunate"; knowing they will die, they can confess their sins, receive the Eucharist, and pray with their minds more alert and unclouded by illness. These prisoners thus enjoy a privileged opportunity to die well.

In 1534 the Christian humanist Erasmus of Rotterdam wrote a treatise that appeared in English in 1538 as Preparation to Death. He urges his readers to live rightly as the best preparation for death. He also seeks a balance between warning and comforting the dying so that they will be neither flattered into arrogant self-confidence nor driven to despair; repentance is necessary, and forgiveness is always available through Christ. Erasmus dramatizes the deathbed scene in a dialogue between the Devil and the dying Man. The Devil offers temptations to which the Man replies clearly and confidently; having mastered the arts of living and dying, the Man is well prepared for this confrontation. While recognizing the importance of sacramental confession and communion, Erasmus says not to worry if a priest cannot be present; the dying may confess directly to God who gives salvation without the sacraments if "faith and a glad will be present" (Atkinson 1992, p. 56).

The Ars Moriendi tradition in England has been especially well documented. It includes translations of Roman Catholic works by Petrus Luccensis and the Jesuit Gaspar Loarte; Thomas Lupset's humanistic Way of Dying Well; and Thomas Becon's Calvinist The Sick Man's Salve. But one literary masterpiece stands out, which is Jeremy Taylor's The Rule and Exercises of Holy Dying.

When Taylor published Holy Dying in 1651, he described it as "the first entire body of directions for sick and dying people" (Taylor 1977, p. xiii) to be published in the Church of England. This Anglican focus allowed Taylor to reject some elements of the Roman Catholic Ars Moriendi and to retain others. For example, he ridicules deathbed repentance but affirms traditional practices for dying well; by themselves the protocols of dying are "not enough to pass us into paradise," but if "done foolishly, [they are] enough to send us to hell" (Taylor 1977, p. 43). For Taylor the good death completes a good life, but even the best Christian requires the prescribed prayers, penance, and Eucharist at the hour of death. And Holy Dying elegantly lays out a program for living and dying well. Its first two chapters remind readers of their mortality and urge them to live in light of this awareness. In the third chapter, Taylor describes two temptations of the sick and dying: impatience and the fear of death itself. Chapter four leads the dying through exercises of patience and repentance as they await their "clergy-guides," whose ministry is described in chapter five. This bare summary misses both the richness of Taylor's prose and the caring, pastoral tone that led Nancy Lee Beaty, author of The Craft of Dying, to consider Holy Dying, the "artistic climax" of the English Ars Moriendi tradition (Beaty 1970, p. 197).

Susan Karant-Nunn, in her 1997 book The Reformation of Ritual, documented the persistence of the Ars Moriendi tradition in the "Lutheran Art of Dying" in Germany during the late sixteenth century. Although the Reformers eliminated devotion to the saints and the sacraments of penance and anointing with oil, Lutheran pastors continued to instruct the dying and to urge them to repent, confess, and receive the Eucharist. Martin Moller's Manual on Preparing for Death (1593) gives detailed directions for this revised art of dying.

Karant-Nunn's analysis can be extended into the eighteenth century. In 1728 Johann Friedrich Starck [or Stark], a Pietist clergyman in the German Lutheran church, treated dying at length in his Tägliches Hand-Buch in guten und bösen Tagen. Frequently reprinted into the twentieth century, the Hand-Book became one of the most widely circulated prayer books in Germany. It also thrived among German-speaking Americans, with ten editions in Pennsylvania between 1812 and 1829, and an 1855 English translation, Daily Hand-Book for Days of Rejoicing and of Sorrow.

The book contains four major sections: prayers and hymns for the healthy, the afflicted, the sick, and the dying. As the fourth section seeks "a calm, gentle, rational and blissful end," it adapts core themes from the Ars Moriendi tradition: the dying must consider God's judgment, forgive others and seek forgiveness, take leave of family and friends, commend themselves to God, and "resolve to die in Jesus Christ." While demons no longer appear at the deathbed, the temptation to despair remains as the dying person's sins present themselves to "frighten, condemn, and accuse." The familiar remedy of contrition and forgiveness through Christ's passion comforts the dying. Starck offers a rich compendium of "verses, texts and prayers" for bystanders to use in comforting the dying, and for the dying themselves. A confident, even joyful, approach to death dominates these prayers, as the dying person prays, "Lord Jesus, I die for thee, I live for thee, dead and living I am thine. Who dies thus, dies well."

Ars Moriendi in the Twenty-First Century

Starck's Hand-Book suggests what became of the Ars Moriendi tradition. It did not simply disappear. Rather, its assimilation to Christian "arts of living" eventually led to decreasing emphasis on the deathbed, and with it the decline of a distinct genre devoted to the hour of death. The art of dying then found a place within more broadly conceived prayer books and ritual manuals, where it remains today (e.g., the "Ministration in Time of Death" in the Episcopal Church's Book of Common Prayer). The Ars Moriendi has thus returned to its origins. Having emerged from late medieval prayer and liturgy, it faded back into the matrix of Christian prayer and practice in the late seventeenth and eighteenth centuries.

The Ars Moriendi suggests useful questions for twenty-first century approaches to dying. During its long run, the Ars Moriendi ritualized the pain and grief of dying into the conventional and manageable forms of Christian belief, prayer, and practice. In what ways do current clinical and religious practices ritualize dying? Do these practices place dying persons at the center of attention, or do they marginalize and isolate them? What beliefs and commitments guide current approaches to dying? Although the Ars Moriendi's convictions about death and afterlife are no longer universally shared, might they still speak to believers within Christian churches and their pastoral care programs? What about the views and expectations of those who are committed to other religious traditions or are wholly secular? In light of America's diversity, is it possible—or desirable—to construct one image of the good death and what it might mean to die well? Or might it be preferable to mark out images of several good deaths and to develop new "arts of dying" informed by these? Hospice and palliative care may provide the most appropriate context for engaging these questions. And the Ars Moriendi tradition offers a valuable historical analogue and framework for posing them.

Bibliography

Ariès, Philippe. The Hour of Our Death, translated by Helen Weaver. New York: Knopf, 1981.

Atkinson, David William. The English Ars Moriendi. New York: Peter Lang, 1992.

Beaty, Nancy Lee. The Craft of Dying: A Study in the Literary Tradition of the Ars Moriendi in England. New Haven, CT: Yale University Press, 1970.

Bellarmine, Robert. "The Art of Dying Well." In Spiritual Writings, translated and edited by John Patrick Donnelly and Roland J. Teske. New York: Paulist Press, 1989.

Comper, Frances M. M. The Book of the Craft of Dying and Other Early English Tracts concerning Death. New York: Arno Press, 1977.

Duclow, Donald F. "Dying Well: The Ars Moriendi and the Dormition of the Virgin." In Edelgard E. DuBruck and Barbara Gusick eds., Death and Dying in the Middle Ages. New York: Peter Lang, 1999.

Duffy, Eamon. The Stripping of the Altars: Traditional Religion in England, c. 1400–c. 1580. New Haven, CT: Yale University Press, 1992.

Eire, Carlos M. N. From Madrid to Purgatory: The Art and Craft of Dying in Sixteenth-Century Spain. Cambridge: Cambridge University Press, 1995.

Karant-Nunn, Susan C. The Reformation of Ritual: An Interpretation of Early Modern Germany. London: Routledge, 1997.

O'Connor, Mary Catharine. The Arts of Dying Well: The Development of the Ars Moriendi. New York: AMS Press, 1966.

Rylands, Harry W. The Ars Moriendi (Editio Princeps, circa 1450): A Reproduction of the Copy in the British Museum. London: Holbein Society, 1881.

Starck [Stark], Johann Friedrich. Daily Hand-Book for Days of Rejoicing and of Sorrow. Philadelphia: I. Kohler, 1855.

Taylor, Jeremy. The Rule and Exercises of Holy Dying. New York: Arno Press, 1977.



4. THE GOOD DEATH - by ROBERT KASTENBAUM

http://www.deathreference.com/Gi-Ho/Good-Death-the.html

What is the good life? Most people would prefer health to illness, affluence to poverty, and freedom to confinement. Nevertheless, different people might have significantly different priorities. Is the good life one that is devoted to family affection or individual achievement? To contemplation or action? To safeguarding tradition or discovering new possibilities? There is a parallel situation in regard to the good death. Not surprisingly, most people would prefer to end their lives with ease of body, mind, and spirit. This unanimity dissolves, however, when one moves beyond the desire to avoid suffering. Societies as well as individuals have differed markedly in their conception of the good death. The long and eventful history of the good death has taken some new turns at the turn of the millennium, although enduring links with the past are still evident.

Dying is a phase of living, and death is the outcome. This obvious distinction is not always preserved in language and thought. When people speak of "the good death," they sometimes are thinking of the dying process, sometimes of death as an event that concludes the process, and sometimes of the status of "being dead." Furthermore, it is not unusual for people to shift focus from one facet to another.

Consider, for example, a person whose life has ended suddenly in a motor vehicle accident. One might consider this to have been a bad death because a healthy and vibrant life was destroyed along with all its future possibilities. But one might also consider this to have been a good death in that there was no protracted period of suffering. The death was bad, having been premature, but the dying was merciful. Moreover, one might believe that the person, who is now "in death," is either experiencing a joyous afterlife or simply no longer exists.

It is possible, then, to confuse oneself and others by shifting attention from process to event to status while using the same words. It is not only possible but also fairly common for these three aspects of death to be the subject of conflict. For example, the controversial practice of physician-assisted suicide advances the event of death to reduce suffering in the dying process. By contrast, some dying people have refrained from taking their own lives in the belief that suicide is a sin that will be punished when the soul has passed into the realm of death. It is therefore useful to keep in mind the distinction between death as process, event, and status. It is also important to consider perspective: who judges this death to be good or bad? Society and individual do not necessarily share the same view, nor do physician and patient.

Philosophers continue to disagree among themselves as to whether death can be either good or bad. The Greek philosopher Epicurus (341–270 B.C.E.) made the case that death means nothing to us one way or the other: When we are here, death is not. When death is here, we are not. So why worry? Subsequent philosophers, however, have come up with reasons to worry. For example, according to Walter Glannon, author of a 1993 article in the journal Monist, the Deprivation of Goods Principle holds that death is bad to the extent that it removes the opportunity to enjoy what life still might have offered. It can be seen that philosophers are talking past each other on this point. Epicurus argued that death is a matter of indifference because it is outside humans' lived experience. This is a focus on process. Glannon and others argue that the "badness" of death is relative and quantitative—it depends on how much one has lost. This is a focus on death as event.
A World Perspective

From terminology and philosophy, one next turns to the rich heritage of world cultures as they have wrestled with the question of the good death within their own distinctive ways of life. Many of the world's peoples have lived in fairly small groups. People knew each other well and were bonded to their territory by economic, social, and religious ties. These face-to-face societies often contended with hardships and external threats. Community survival was therefore vital to individual survival. Within this context, the good death was regarded as even more consequential for the community than for the individual.

The good death was one that did not expose the community to reprisals from angry spirits or stir up confusion and discontent among the survivors. Personal sorrow was experienced when a family member died, but the community as a whole responded with a sequence of rituals intended to avoid the disasters attendant on a bad death.

The Lugbara of Uganda and Zaire do not practice many rituals for birth, puberty, or marriage, but they become intensely involved in the funeral process. Death is regarded as an enemy, an alien force that raids the village. Nobody just dies. Much of Lugbara life is therefore devoted to controlling or placating evil spirits. The good death for the Lugbara encompasses the process, the event, and the state.

* • The Process: Dying right is a performance that should take place in the individual's own hut with family gathered about to hear the last words. The dying person should be alert and capable of communicating, and the final hours should flow peacefully without physical discomfort or spiritual distress. The dying person has then prepared for the passage and has settled his or her affairs with family and community. It is especially desirable that a lineage successor has been appointed and confirmed to avoid rivalry and perhaps violence.
* • The Event: The death occurs on schedule—not too soon and not too much later than what was expected. The moment is marked by the lineage successor with the cre, a whooping cry, which signifies that the deceased is dead to the community both physically and socially, and that the people can now get back to their lives.
* • The State: The deceased and the community have performed their ritual obligations properly, so there is little danger of attack from discontented spirits. The spirit particular to the deceased may linger for a while, but it will soon continue its journey through the land of the dead.

A death can go bad when any of these components fails. For example, a person who dies suddenly or away from home is likely to become a confused and angry spirit who can become a menace to the community. A woman who dies in childbirth might return as an especially vengeful spirit because the sacred link between sexuality and fertility has been violated. The Lugbara deathbed scene shows compassion for the dying person and concern for the well-being of the community. Nevertheless, it is a tense occasion because a bad death can leave the survivors vulnerable to the forces of evil.

In many other world cultures the passage from life to death has also been regarded as a crucial transaction with the realm of gods and spirits. The community becomes especially vulnerable at such times. It is best, then, to support this passage with rules and rituals. These observances begin while the person is still alive and continue while the released spirit is exploring its new state of being. Dying people receive compassionate care because of close interpersonal relationships but also because a bad death is so risky for the community.

Other conceptions of the good death have also been around for a long time. Greek, Roman, Islamic, Viking, and early Christian cultures all valued heroic death in battle. Life was often difficult and brief in ancient times. Patriotic and religious beliefs extolled those who chose a glorious death instead of an increasingly burdensome and uncertain life. Norse mythology provides an example made famous in an opera by the nineteenth-century German composer Richard Wagner in which the Valkyrie—the spirits of formidable female warriors—bring fallen heroes to Valhalla where their mortal sacrifice is rewarded by the gods.

Images of the heroic death have not been limited to the remote past. Many subsequent commanders have sent their troops to almost certain death, urging them to die gloriously. The U.S. Civil War (1861–1865) provides numerous examples of men pressing forward into withering firepower, but similar episodes have also occurred repeatedly throughout the world. Critics of heroic death observe that the young men who think they are giving their lives for a noble cause are actually being manipulated by leaders interested only in their own power.

Some acts of suicide have also been considered heroic. The Roman commander who lost the battle could retain honor by falling on his sword, and the Roman senator who displeased the emperor was given the opportunity to have a good death by cutting his wrists and bleeding his life away. Japanese warriors and noblemen similarly could expiate mistakes or crimes by the ritualistic suicide known in the West as hara-kiri. Widows in India were expected to burn themselves alive on their husbands' funeral pyres.

Other deaths through the centuries have earned admiration for the willingness of individuals to sacrifice their lives to help another person or affirm a core value. Martyrs, people who chose to die rather than renounce their faith, have been sources of inspiration in Christianity and Islam. There is also admiration for the courage of people who died at the hands of enemies instead of betraying their friends. History lauds physicians who succumbed to fatal illnesses while knowingly exposing themselves to the risk in order to find a cause or cure. These deaths are exemplary from society's perspective, but they can be regarded as terrible misfortunes from the standpoint of the families and friends of the deceased.

The death of the Greek philosopher Socrates (c. 470–399 B.C.E.) shines through the centuries as an example of a person who remained true to his principles rather than take an available escape route. It is further distinguished as a death intended to be instruction to his followers. The good death, then, might be the one that strengthens and educates the living. The modern hospice/palliative care movement traces its origins to deaths of this kind.

With the advent of Christianity the stakes became higher for the dying person. The death and resurrection of Jesus led to the promise that true believers would also find their way into heaven—but one might instead be condemned to eternal damnation. It was crucial, then, to end this life in a state of grace. A new purification ritual was developed to assist in this outcome, the ordo defunctorum. The last moments of life now took on extraordinary significance. Nothing less than the fate of the soul hung in the balance.

The mood as well as the practice of Christianity underwent changes through the centuries with the joyful messianic expectation of an imminent transformation giving way to anxiety and doubt. The fear of punishment as a sinner darkened the hope of a blissful eternity. Individual salvation became the most salient concern. By the fifteenth century, European society was deeply immersed in death anxiety. The Ars Moriendi ("art of dying") movement advised people to prepare themselves for death every day of their lives—and to see that their children learned to focus on the perils of their own deathbed scene rather than become attached to the amusements and temptations of earthly life. The good death was redemption and grace; everything else was of little value.

This heavy emphasis on lifelong contemplation of mortality and the crucial nature of the deathbed scene gradually lessened as the tempo of sociotechnological change accelerated. Hardships continued, but earthly life seemed to offer more attractions and possibilities, drawing attention away from meditations on death. And by the seventeenth century a familiar voice was speaking with a new ring of authority. Physicians were shedding their humble roles in society and proudly claiming enhanced powers and privileges. In consequence, the nobility were more likely to be tormented by aggressive, painful, and ineffective interventions before they could escape into death. The emerging medical profession was staking its claim to the deathbed scene. It was a good death now when physicians could assure each other, "We did everything that could be done and more."
The Good Death in the Twenty-First Century

In the early twenty-first century, as in the past, humans seek order, security, and meaning when confronted with death. It is therefore clear that not everything has changed. Nevertheless, people's views of the good death have been influenced by the altered conditions of life. To begin with, there are more people alive today than ever before, and, in technologically developed nations, they are more likely to remain alive into the later adult years. The most remarkable gains in average life expectancy have come from eliminating the contagious diseases that previously had killed many infants and children. The juvenile death rate had been so high that in various countries census takers did not bother to count young children. Parents mourned for their lost children then as they do now. The impact of this bad death was tempered to some extent by the knowledge that childhood was perilous and survival in God's hands. The current expectation that children will certainly survive into adulthood makes their death even more devastating. Parental self-blame, anger at God, stress disorders, and marital separation are among the consequences that have been linked to the death of a child.

Childbirth was a hazardous experience that many women did not long survive. Graveyards around the world provide evidence in stone of young mothers who had soon joined their infants and children in death. Such deaths are much less expected in the twenty-first century and therefore create an even bigger impact when they do occur.

In the late twentieth and early twenty-first centuries, many Mexicans died while attempting to cross the desert to find employment in the United States in order to feed and shelter their families. Are these "good deaths" because of the heroism of those who risked—and lost—their lives, tragic deaths because of their consequences, or senseless deaths because society has allowed this situation to develop?

It is far more common to assume that one has the right to a long life and therefore to regard an earlier demise as unfair or tragic. Paradoxically, though, there is also more concern about not dying young. Many people remain vigorous and active through a long life. Nevertheless, gerontophobia (fear of growing old) has become a significant problem in part because more people, having lived long, now die old. Younger people often fear that age will bring them to a lonely, dependent, and helpless preterminal situation. The distinction between aging and dying has become blurred in the minds of many people, with aging viewed as a slow fading away in which a person becomes less useful to themselves and others. It is a singularly prolonged bad death, then, to slide gradually into terminal decline, in essence having outlived one's authentic life. This pessimistic outlook has been linked to the rising rate of suicide for men in older age groups. In reality, many elders both contribute to society and receive loving support until the very end, but the image of dying too long and too late has become an anxious prospect since at least the middle of the twentieth century.

Two other forms of the bad death came to prominence in the late twentieth century. The aggressive but mostly ineffective physicians of the seventeenth century have been replaced by a public health and medical establishment that has made remarkable strides in helping people through their crises. Unfortunately, some terminally ill people have experienced persistent and invasive medical procedures that produced suffering without either extending or restoring the quality of their lives. The international hospice movement arose as an alternative to what was seen as a futile overemphasis on treatment that added to the physical and emotional distress of the dying person. The hospice mission has been to provide effective symptom relief and help the dying person maintain a sense of security and worth by supporting the family's own strength.

Being sustained indefinitely between life and death is the another image of the bad death that has been emerging from modern medical practice. The persistent vegetative state arouses anxieties once associated with fears of being buried alive. "Is this person alive, dead, or what?" is a question that adds the pangs of uncertainty to this form of the bad death.

The range of bad death has also expanded greatly from the perspective of those people who have not benefited from the general increase in life expectancy. The impoverished in technologically advanced societies and the larger part of the population in third world nations see others enjoy longer lives while their own kin die young. For example, once even the wealthy were vulnerable to high mortality rates in infancy, childhood, and childbirth. Many such deaths are now preventable, so when a child in a disadvantaged group dies for lack of basic care there is often a feeling of rage and despair.

A change in the configuration of society has made it more difficult to achieve consensus on the good death. Traditional societies usually were built upon shared residence, economic activity, and religious beliefs and practices. It was easier to judge what was good and what was bad. Many nations include substantial numbers of people from diverse backgrounds, practicing a variety of customs and rituals. There is an enriching effect with this cultural mix, but there is also the opportunity for misunderstandings and conflicts. One common example occurs when a large and loving family tries to gather around the bedside of a hospitalized family member. This custom is traditional within some ethnic groups, as is the open expression of feelings. Intense and demonstrative family gatherings can unnerve hospital personnel whose own roots are in a less expressive subculture. Such simple acts as touching and singing to a dying person can be vital within one ethnic tradition and mystifying or unsettling to another.

Current Conceptions of the Good Death

The most obvious way to discover people's conceptions of the good death is to ask them. Most studies have focused on people who were not afflicted with a life-threatening condition at the time. There is a clear preference for an easy death. The process should be mercifully brief. Often people specify that death should occur in their sleep. Interestingly, students who are completing death education courses and experienced hospice care-givers tend toward a different view. When their turn comes, they would want to complete unfinished business, take leave of the people most important to them, and reflect upon their lives and their relationship to God. These actions require both time and awareness. Drifting off to sleep and death would be an easy ending, but only after they had enough opportunity to do what must be done during the dying process.

Women often describe their imagined deathbed scenes in consoling detail: wildflowers in an old milk jug; a favorite song being played; familiar faces gathered around; a grandchild skipping carefree in and out of the room; the woman, now aged and dying, easy in mind, leaving her full life without regrets. Conspicuous by their absence are the symptoms that often accompany the terminal phase—pain, respiratory difficulties, and so on. These good deaths require not only the positives of a familiar environment and interpersonal support but also a remarkably intact physical condition. (Men also seldom describe physical symptoms on their imagined deathbed.) Men usually give less detailed descriptions of their imagined final hours and are more likely than women to expect to die alone or suddenly in an accident. The imagined good death for some men and a few women takes place in a thrilling adventure, such as skydiving. This fantasy version of death is supposed to occur despite the ravages of a terminal illness.

What is the good death for people who know that they have only a short time to live? People dying of cancer in the National Hospice Demonstration study conducted in 1988, explained to their interviewers how they would like to experience the last three days of their lives. Among their wishes were the following:

* •I want certain people to be here with me.
* •I want to be physically able to do things.
* •I want to feel at peace.
* •I want to be free from pain.
* •I want the last three days of my life to be like any other days.

This vision of the good death does not rely on fantasy or miracles. It represents a continuation of the life they have known, and their chances of having these wishes fulfilled were well within the reality of their situation. Religion was seldom mentioned as such, most probably because these people were secure in their beliefs.

Society as a whole is still reconstructing its concepts of both the good life and the good death. Studies suggest that most people hope to be spared pain and suffering, and to end their days with supportive companionship in familiar surroundings. Dramatic endings such as heroic sacrifice or deathbed conversion are seldom mentioned. There are continuing differences of opinion in other areas, however. Should people fight for their lives until the last breath, or accept the inevitable with grace? Is the good death simply a no-fuss punctuation mark after a good life—or does the quality of the death depend on how well people have prepared themselves for the next phase of their spiritual journey? Questions such as these will continue to engage humankind as the conditions of life and death also continue to change over time.

Bibliography

Bondeson, Jan. Buried Alive. New York: W. W. Norton, 2001.

DuBruck, Edelgard E., and Barbara I. Gusick, eds. Death and Dying in the Middle Ages. New York: Peter Lang, 1999.

Epicurus. Epicurus: The Extant Remains, translated by Cyril Bailey. Oxford: Clarendon Press, 1926.

Glannon, Walter. "Epicureanism and Death." Monist 76 (1993):222–234.

Goody, Jack. Property and the Ancestors: A Study of the Mortuary Customs of the LoDagas of West Africa. Stanford, CA: Stanford University Press, 1962.

Kastenbaum, Robert. Death, Society, and Human Experience, 7th edition. Boston: Allyn & Bacon, 2001.

McManners, John. Death and the Enlightenment: Changing Attitudes to Death in Eighteenth-Century France. New York: Oxford University Press, 1981.

McWhiney, Grady, and Perry D. Jamieson. Attack and Die: Civil War Military Tactics and the Southern Heritage. Tuscaloosa: University of Alabama Press, 1982.

Paxton, Frederick S. Christianizing Death. Ithaca, NY: Cornell University Press, 1990.

Weinberger-Thomas, Catherine. Ashes of Immortality. Chicago: University of Chicago Press, 1999.


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