The right to choose how we say our last goodbye still escapes us

IT isn’t a question that anybody would like to have to answer yet it looms in the distance with certainty. It’s a conversation nobody looks forward to but should be undertaken with seriousness, because it lurks in everybody’s future.

Lately there seems to be some form of conversation beginning around this particular topic, but it’s still fair to say you would cripple any sociable chat in the pub if you divert it in this direction.

I refer to the ultimate question, if by ultimate you mean last: given a choice, how would you like to die? This query, or search for what might be termed ‘the good death’, is one which has challenged generations of mankind going back to the ancient Greeks, and beyond. Writers and thinkers have tried to address what makes a good and peaceful passing as a matter of course, with the emphasis on the word ‘try’: Montaigne practically invented a literary form in doing so back in the sixteenth century, the ‘essai’, or attempt, developing into the personal essay we are all now familiar with.

The Frenchman had sharp opinions on the subject of death and was keen to share them (“Let us disarm him of his novelty and strangeness, let us converse and be familiar with him, and have nothing so frequent in our thoughts as death,” he wrote in the essay entitled That to Study Philosophy is to Learn to Die.) We have a conceit of sorts in this country that death is something we do well, something the entire notion of the Irish wake is predicated on. Do we, though? It’s worth pointing out that this is such a broad topic that you can take almost any vantage point from which to view it, but Ireland doesn’t emerge with a glowing reputation from some perspectives.

In a couple of days’ recent travel around the country, for instance, I noticed a wearying number of fund-raisers being advertised on posters, and collection boxes at service station counters, for hospices: wearying because of the necessity to do so privately. It is a welcome development, on one hand, that people feel the need for hospices, because it is physical evidence that there is a growing awareness of the rights of people as they come to the end of life. On the other it is shameful that, in the words of one campaigner I heard recently on the radio, people from her county cannot die with dignity and care in her county.

Then there is the matter of individual choice and freedom, the precise parameters of entitlement to dictate the terms of your life to the very last minute of that life.

The staggering bravery of the late Marie Fleming has forced an entire country to consider what individuals have a right to do when it comes to the end of their lives, and whether they are entitled to end their lives.

Fleming’s biography is now in the shops, and there is a pretty spectacular backstory involving elopements and adulterous politicians, but her aim at the end of her life is described with stark clarity: “I want a dignified death, and I can’t have that without Tom’s help,” she said regarding her partner, Tom Curran.

The Irish experience of what occurs just after death is not always salutary either. The grief of those left behind by a loved one’s passing is something every reader will be aware of, because death stands at every door, as the old Bob Dylan song has it, but not all the consequences are immediate. There are administrative implications to a death in the family which can be painful in their jarring banality.

In a case this writer is familiar with, a financial institution kept writing to a deceased customer for months, upsetting his widow with each letter; it proved literally impossible to speak to the person whose name was written on the letters, and the family concerned grew to believe he didn’t actually exist. The correspondence only ceased, eventually, when the family involved a solicitor.

There is the sheer lack of facilities for those near death in hospitals, with horror stories of people seeing their loved ones’ last moments in a crowded ward, with a flimsy curtain providing a cruel approximation of privacy.

In one case reported recently by this newspaper, a family were denied even that fig leaf when a hospital staff member drew back the partition curtain to ask if the patient wanted dinner.

That kind of Dickensian death, in overheated rooms and narrow corridors, with the sweaty heave of hospital life all around is almost a reverse image, a photographic negative, of what one would expect and hope for a loved one’s passing.

It seems extraordinary that hospitals in Ireland, which often seem to be havens for underemployed arts officers, surly receptionists and mysterious clipboard wielders, are so underresourced when it comes to helping those close to death: after all, the possibility must surely occur to hospital administrators that not all their patients make it home.

The central point here is that unfortunately that is our image now of death: a doctor telling a knot of people very bad news about a relative even as the evening dinners are carried past them. A terrible experience made a million times worse by the limitations of twenty-first century Ireland; the past, when most deaths occurred at home, in familiar surroundings with close relatives to hand, seems a distant paradise.

That’s why it’s at least a little encouraging to see that some interest is gathering in this area. We’ve had the report of the Ombudsman, which yielded the case of the family whose dying relative was offered dinner, referred to above. At around the same time in England doctors called for the equivalent of midwives to help people in their final moments. A former Cabinet Minister in England, Chris Woodhead, now terminally ill, recently wrote a compelling piece arguing for the right to die. There were documentaries on RTE and Channel Four in the last few weeks about dying. During the week we also had the launch of the Oireachtas Health Committee report on end of life hearings.

If you feel I haven’t quite answered the question I posed above, by the way, consider this from the great science fiction writer Terry Pratchett, who is suffering from Alzheimer’s disease: “Rather than let Alzheimer’s take me, I would take it. I would live my life as ever to the full and die, before the disease mounted its last attack, in my own home, in a chair on the lawn, with a brandy in my hand to wash down whatever modern version of the ‘Brompton cocktail’ some helpful medic could supply.

“And with Thomas Tallis on my iPod, I would shake hands with Death.”