The good death - conversations with East Londoners by Michael Young and Lesley Cullen (published by Routledge, 1996, ISBN 0 415 13797 7). Reviewed by Nicholas Albery.
In the olden days, people embarking on a challenging enterprise might consult the Oracle at Delphi. Michael Young's way of writing a book is similar - he interviews a few East Londoners (in this latest book on death and dying, he interviewed 14 in all) and uses their remarks and experience as the foundation for an edifying mix of philosophising and recommendations.
In this book, many of the resulting observations are commonplaces about death and dying and would read almost as clichés, but are saved by his poet's eye and his knack as a social inventor for proposing just the new institution or measure that might help. Indeed, he is unable to stop himself - the preface gives an account of his wife Sasha, dying from cancer, and how he was able to distract himself with social activism "as I am always liable to do". As President of the College of Health, he tries to help save Barts, the hospital where Sasha was being treated, from closure. He had also taken "the almost laughable course of setting up a National Funerals College to improve the conduct of funerals".
He describes Sasha's beautiful funeral in the great medieval church of St Bartholomew-the-Great:
Sasha lay in an open coffin ... The funeral director, Mr Cribb, invited each person to place a single flower on her body. There was music and poetry reading and chanting by brown-robed monks and talks by our two children, Toby as well as Sophie. The last poem of hers to be read was 'The Company of the Birds'
Ah the company of the birds
I loved and cherished on Earth
Now, freed of flesh we fly
Together, a flock of beating wings,
I am as light, as feathery,
As gone from gravity we soar
In endless circles.
Afterwards in the cemetery there was a long silence amongst her friends as Sasha's body was lowered into the grave. The human silence was filled with the singing of what seemed like a chorus of innumerable birds.
Michael Young (and his co-author Lesley Cullen) describe how the imminence of death can induce "a kind of solidarity amongst neighbours ... Death is not only an extraordinary event for the dying but brings out extraordinary behaviour in other people". They adduce this altruism to a latent sense of unity within society:
Underlying all the stronger forces which keep societies in being - the common traditions, the common languages, the common interests, the hierarchies of power - is a weaker but universal force of gravity, of social gravity, which is always acting to hold people together ... It can draw people not only to others who are still alive but to others who have died before.
In view of the book's stress on care for dying at home, I wish there had been space in its four appendices to mention the Befriending Network, founded by the Natural Death Centre, which is trying to encourage priests and doctors and other opinion leaders in any locality to organise rotas of neighbours to care for the dying in their homes and to relieve the carers by running errands.
The authors do at least argue for an expansion of Home Care nursing help "so that present regional and local inequalities can be reduced, and more people in more places (and not just sufferers from cancer) get the benefit of the kind of home service which was available to our [East London] patients".
Michael Young, working with the College of Health, once prepared a scheme for a hospital where patients on their discharge had an interview. They were told why they had been admitted, what had been found and what had been done to them, and what they and their family could do to help them at home. Patients were also sent home with a tape of the conversation, which many found particularly valuable.
Michael Young, as co-founder of the Consumers' Association, is thus well aware of the need to empower the individual consumer. He quotes a research project where 95% of patients wanted to be told if they had cancer. The rights of the individual are clear in this instance.
But it leaves Michael Young in a quandary on the issue of euthanasia - on the one hand, there is "the individual's right to die, the individual's right to know and to decide". On the other hand, families would have to agree to euthanasia. They might feel responsible and guilty, "they would be bound to ask themselves whether the death was the result of their lack of love". It could also "undermine the trust that people feel, and need to feel, in their doctors". (He fails to deal with the more convincing 'slippery slope' argument that acceptance of killing, and killing itself, feeds on killing, just as the Nazis started with killing a few mental patients and went on to gassing millions of Jews, or just as the Roman emperors started with gladiators and ended up, for their entertainment, with blind people in the arena hacking each other to the death with swords.) So although "the main drift of this book is against euthanasia", he and his co-author, after much wavering, come down finally in favour: "It is high time for the most stringent safeguards to be worked out and incorporated in the law".
The book argues for new traditions and for new churches to fill the void that surrounds dying today.
At most contemporary deaths, the mourners and others are actors without any lines, participants in a drama without parts to play. They can be hollow people.
Dying, indeed, sometimes seems easier for the dying person than for the survivors. A quick death, say the authors, "is no boon for the bereaved", leaving no time mentally and emotionally to prepare for the disaster. And yet "a good death (or at least a prolonged death) for the patient may work in exactly the opposite way for the bereaved". The carer becomes so tired, she or he cannot lift themselves up. The authors quote a study which implicates bereavement in the causation of several types of cancer.
How, then, can a 'good death' help?
The dying could help the bereaved by returning the love so that it remained a comfort after the death, and as real (or almost as real) as it had been in life. The person who dies in peace, with acceptance rather than bitterness, bestows a gift upon the survivors which lasts for them, and can quieten their own fears.
The Befriending Network is at Claremont, 24-27 White Lion Street, Islington, London N1 9PD, UK (tel 020 7689 2443; e-mail: info@befriending.net; web: www.befriending.net).
This webpage forms part of the Global Ideas Bank (www.globalideasbank.org).
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