In the event we were very lucky. It was a quick, almost painfree and ecstatic labour for Josefine, and all the preparation helped - the Raspberry Leaf tea, the natural birth books and classes, the visualisations and breathing exercises - and the doctor and midwife were like guests in our home for this Leboyer-style birth of low lights and quiet.
In 1988, my father died at home and his death triggered in me a realisation of the need for a natural death movement to parallel the natural childbirth movement, and to spread the tenets of good hospice care to home care for those dying of all causes, not just cancer. It wouldn't suit everybody, but why shouldn't those families who wanted it be fully supported by the NHS in looking after the dying person at home, with generous financial and other help for carers? Wouldn't more people, if it were possible, prefer to die at home amongst friends rather than in the anonymity of a big and noisy hospital? As with birth, could preparation, exercises and rituals help reduce the anxieties that people feel about dying? Could dying at least for a lucky few become as easy and as ecstatic a process as our experience of birth? Granted that no one can be certain what happens after death, could it be that preparation matters, as the Tibetans argue, to enable the soul at the point of death to merge fearlessly with that bright light reported by many who have recovered from Near-Death Experiences? I remembered how a friend's mother insisted on being given her travelling rug to die with; could the process of dying be the labour pains of the soul, with sometimes the same feeling of expectation and transition as at birth?
Just as many people want to experience birth as consciously as possible, so some people want to face death with minds as unclouded as their circumstances permit. It is here that the analogy between birth and death breaks down somewhat, for drugs are more likely to be necessary to relieve pain for the dying, if only because dying can be a much more long drawn-out labour than giving birth - but nevertheless further research is needed into drugs that are strong enough to relieve terminal pain whilst enhancing alertness.
As related later in this book, Aldous Huxley sat by his wife Maria at her death, urging her with hypnotic repetition to 'go towards the light'. Perhaps many people would like an Aldous Huxley-type figure sitting by them as they go. Perhaps there could be a new profession of 'Midwives for the Dying', people skilled in holistic care of the dying patient's practical, emotional and spiritual needs (and the needs of the family), and more intent on creating a calm and supportive atmosphere than on high tech medical interventions to prolong life to the utmost. There is a need for such skills in modern life, for as Aldous Huxley wrote: 'The living can do a great deal to make the passage easier for the dying, to raise the most purely physiological act of human existence to the level of awareness and perhaps even of spirituality.'
Introduction by Nicholas Albery, co-editor of The Natural Death Handbook.
As the sixties-generation Green movement people age, so the natural death movement will inevitably become a force in health politics, bringing about a redirection of NHS and other resources towards home care and proper provision for carers. The Natural Death Centre aims to be in the vanguard of such changes. It will act as a kind of Society for Home Deaths, and will work to implement its long-term plans for Midwives for the Dying, with lay helpers or 'Personal Assistants for the dying' to back up the midwife. In the meantime, it will do what it can to help improve the quality of living and dying. Christianne Heal offers Living With Dying workshops for the general public on preparing for dying. Josefine Speyer gives talks to nurses, doctors and others concerned with looking after the dying and offers individual counselling to the anxious or the bereaved.
At present, dying mostly happens 'off stage', as it were, in old people's homes and hospitals, and many people are superstitious enough to believe that the less they think about the subject the longer they will live. Two thirds of the UK population have not even taken the first step of writing a will, thus potentially leaving additional problems for their survivors. The Centre wants to make death and dying an unexceptional topic for daily meditation and conversation, and to that end is hosting a series of large dinner discussions with candlelit tables and gourmet food and wine on subjects ranging from care of the dying to Near-Death Experiences. It is also organising an English Day of the Dead celebration for the third Sunday in April each year, inspired by the Mexican Day of the Dead festivities.
Once a family has looked after a dying person at home, they are more likely to want to take care of the dead body themselves too. But whatever the reason, the Centre has found itself submerged in mail from families wanting Green, inexpensive funerals, without using undertakers. A great deal of research later, the material for the two chapters in this book, 'D-i-y Funerals' and the 'Good Funeral Guide', was assembled, not only on how to run a funeral without using an undertaker, at a fifth of the normal average cost, but also on who are the best professionals to approach, should you want help.
The Centre now acts as a sort of 'Which?' type body, available by phone or letter, giving for the first time an in depth consumer's perspective on the whole funeral trade. It also perforce has had to campaign on behalf of the public with the National Association of Funeral Directors, the Office of Fair Trading and the Department of Trade and Industry, to try to ensure, for instance, that itemised price breakdowns on funerals are available to the public and that coffins are sold to those people who want to organise a funeral themselves. The kind of changes in policy that seem necessary are outlined in the chapter 'Manifesto for the Dying' which also includes a Declaration of Rights for the person dying at home.
The Centre is financed on a shoestring and has survived to date mainly thanks to financial help from the late Nicholas Saunders and his Neal's Yard DeskTop Publishing Studio, and thanks to two small grants, one from the Gulbenkian Foundation and another during the writing of this book from the Network for Social Change. The Centre has no full-time staff and has only shared office space. It will rely in part for its continuation on members of the public becoming Friends of the Natural Death Centre by filling in a banker's order, normally for £20 a year. If you can afford this or any other sum on a regular basis please make contact. This Handbook too requires your assistance if it is to become ever more useful in future editions - if you have a recommendation, update, correction, tip or experience you are willing to share with others, please send it in.
The purpose of this book is not only to collect together all the information that the Centre has gathered to date, but also to introduce readers to the great pioneers of the natural death movement and to the ideas in their writings. Some of the very best books on the subject (marked [***] in the Resources chapter) have been published in the United States but deserve a wider readership in the UK. Information for ordering them is at the back of this book and, if not available through your local bookshop, most can be obtained either from the publishers or via the Centre itself (if urgent, by phone call quoting an Access or Visa credit card number).
What have these other writers had to say about the need for a natural death movement? Douglas Harding has emphasised our resistance to thinking about our own mortality:
Reproduced by permission of Penguin Books Ltd from 'The Little Book of Life and Death' by D. E. Harding.
For fuller details of all main book references see the Resources chapter.
Ivan Illich in 1975 wrote about the torments inflicted on the dying in some hospitals:
From 'Medical Nemesis: The Expropriation of Health' by Ivan Illich,
The isolation of the dying and the bereaved in a centralised society that has lost almost all sense of neighbourhood has been highlighted by Tony Walter:
Nor is this true only when the deceased is elderly. In a relatively isolated nuclear family in which outsiders have played little if any role in child care, the death of a child may be a uniquely isolating experience. Contrast this account by Miller after the destruction of the primary school in Aberfan: 'One bereaved mother told me that when she lost her child the company she sought was not that of other bereaved mothers but of her neighbours. They might not have lost a child themselves, but she realised they had lost her child. It was the neighbours who had helped to bring him up, who had minded him when she went out, had watched him grow and had taken pride in his achievements. In a very real sense they shared her grief.' Usually though, friends and neighbours may be sympathetic, but they do not know the child well enough truly to share the loss. Friends in their thirties or younger may never have experienced any close bereavement.
So the bereaved today often are isolated, and may well report being treated as lepers.
From 'Modern Death: Taboo or Not Taboo?' by Tony Walter, Sociology, Vol. 25, No. 2.
Tony Walters shares the Natural Death Centre's perception that the Green movement and the natural childbirth movement will tend to lead to the acceptance of death and dying as natural processes to be shared with our family and friends:
This new attitude surely underlies the natural childbirth movement. Giving birth may be painful, but it is part of the natural human experience, and many women would not wish it anaesthetised away. Nor do they want to be socially isolated; they want to share this miracle of nature with their partners and their other children.
Death is also a natural part of being human, and therefore I do not wish to be drugged into oblivion: I want the pain to be controlled, but I would like to be conscious and in control as far as is possible. And I would like to share this unrepeatable and important event with my partner and my children.
From 'Funerals and How to Improve Them' by Tony Walter.
There are, however, many kinds of natural death. It is just as much a part of nature to die abruptly or in agony, through accidents or violence or illness, as it is to die with ease and dignity. But even in such circumstances, to feel prepared for any eventuality may help. Gandhi was assassinated, but his almost automatic reaction to the bullets was to chant the name of God. He was prepared, in his own way.
From 'The Soul and Death' by C. G. Jung in 'The Collected Works, series XX, vol. viii, translated by R. F. C. Hull, Princeton University Press, 1969.
Many people ask: Is it not morbid to think about death and dying earlier in life? No, it is necessary, for preparing for dying is half a lifetime's work. The main preparation is that which the Dalai Lama advises: 'For most of us ordinary people who lead busy lives, what is important is to develop a kind, generous heart to others. If we can do that and live accordingly, we will be able to die peacefully.' And for those who have the opportunity and the necessary circumstances, he adds, there are higher spiritual preparations available through religious and yogic practices. But above all, an awareness of death can sweeten every remaining living moment. Yeats is not the only poet to warn:
The trivial days and ram them with the sun ...
No longer in Lethean foliage caught
Begin the preparation for your death
And from the fortieth winter by that thought
Test every work of intellect or faith,
And everything that your own hands have wrought,
And call those works extravagance of breath
That are not suited for such men as come
Proud, open eyed and laughing to the tomb.
From 'Vacillation' by W. B. Yeats
Ageing to Yeats was a growing of the soul:
An aged man is but a paltry thing,
A tattered coat upon a stick, unless
Soul clap its hands and sing, and louder sing
For every tatter in its mortal dress.
Stephen Levine sees death as the graduation ceremony for this cocoon-abandoning soul:
Death is another transformation through which we move, an adventure to surpass all adventures, an opening, an incredible moment of growth, a graduation.
From 'Who Dies?' by Stephen Levine.To adopt this new outlook, we have first to rid ourselves of a great deal of cultural conditioning. Paula Hendrick has surveyed the natural death movement from an American perspective and concludes that our technological mastery of nature and our focus on personal autonomy and self-development have made it very hard for us to accept the inevitability of death:
In the world of nature, death provides a service because it makes room in an ecological niche for a young one. People are part of nature, too, and when people die, they make room for more people. In a time of population explosion, it would be useful to be able to die without making too much of a fuss about it. But we humans, particularly in the affluent cultures of the first world, face the final journey of life with a load of weighty baggage. We avoid talk of death, and we dread the realities of the aging process.
We as individuals don't necessarily create and lug around this excess baggage on our own. Something pervasive in our society moulds our collective choices. Michael Ignatieff, writing in 'The New Republic', offers this explanation: 'Cultures that live by the values of self-realisation and self-mastery are not especially good at dying, at submitting to those experiences where freedom ends and biological fate begins. Why should they be? Their strong side is Promethean ambition: the defiance and transcendence of fate, the material and social limit. Their weak side is submitting to the inevitable.'
We have become victims of the health care system that our cultural values have created. The dying process has been transformed into a series of wrenching choices. A woman, getting along pretty well after a stroke at age eighty - some confusion, but lots of independence and zest for life - develops increasing heart problems. She has no family support, just a few friends who do the best they can. The doctor recommends a pacemaker. She says no but he persuades her. There are complications during surgery. Now she's totally disorientated and can barely walk even with assistance. Her pacemaker keeps her going.Out of the apparently needless suffering of countless people has grown a strong movement towards patients' rights and natural death - that is, death with a minimum of medical intervention. Advances are continually - albeit slowly - being made in legislation and public education. The Patient Self-Determination Act, which went into effect in the States in December 1991, requires health care facilities to inform patients of their rights to refuse treatment and to formulate advance directives such as a living will or health care proxy. Difficult moral dilemmas are also being debated on the topic of 'aid-in-dying', or physician-assisted suicide. The goals of the broader 'natural death movement' are to guarantee choice for individuals and to bring about a large-scale cultural shift. An article in The Economist of London describes such a large scale shift this way: 'To civilise death, to bring it home and make it no longer a source of dread, is one of the great challenges of the age ... Gradually, dying may come to hold again the place it used to occupy in the midst of life: not a terror but a mystery so deep that man would no more wish to cheat himself of it than to cheat himself of life.'
Excerpted from In Context magazine No. 31 (subs. $31, airmail $42, from PO Box 11470, Bainbridge Island, WA98110, USA, tel 0101 206 842 0216).
May this present Handbook prove a useful contribution to the contemplation of all aspects of this magnificent and awe-inspiring subject. Above all, may it help allow people to 'die in character' as Elisabeth Kübler-Ross puts it. Dr Buckman in his book on how to support a dying person is rightly adamant on this point:
It should be your objective as friend and supporter - as it is my objective when I'm looking after dying patients - to help your friend let go of life in his own way. It may not be your way, and it may not be the way you read about in a book or magazine, but it's his way and consistent with the way he's lived his life. You can and should help your friend achieve that.
From 'I Don't Know What To Say - How to Help and Support Someone who is Dying' by Dr Robert Buckman.
Published online by the Natural Death Centre whose e-mail address is rhino@dial.pipex.com.
There are other more recent books (also available online without charge) by the Natural Death Centre.
Or order Natural Death Centre books in print form (including the Natural Death Handbook (4th ed), which replaces this old online edition).