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Spring 2008 Table of Contents

Final Answers

Perspectives on a Good Death

| From Features

As part of the fourth-year geriatrics clerkship at BU’s School of Medicine, students follow a curriculum called Culture, Spirituality, and End of Life Care, designed by Eric Hardt, an associate professor of medicine. Through lectures, readings, and videos, they explore various cultural notions of death and dying, and each student writes an essay on his or her idea of a good death. Several of those essays are excerpted below.

The Importance of Legacy

My views on death are partly rooted in my religion, but also within my cultural/family traditions. I am a practicing Protestant Christian. Therefore, in my view, death is not a means to an end, but the beginning. I expect to be resurrected spiritually, as Jesus Christ was physically.

At my death, I prefer to be free of pain. As physicians, we agree that one of our key responsibilities is to alleviate suffering in death. I also prefer to have completed my mission/purpose for my life. It’s a shame to see so many young people’s lives cut short by violence before they have really lived. In addition, I prefer to be surrounded by my family. I believe legacy is vital in sustaining families. I want to share our history to remind the eldest to carry on and encourage the youngest to make their contribution.

Living an Extraordinary Life

My idea of a good death is:
1. To die with my loved ones. I want my wife and kids to be there. I would hate to die alone. It is a really good feeling to know that those you love are there supporting you in your time of need, helping you go peacefully.

2. Before I die I want to do several things. I want to travel the world, see all of the world’s greatest wonders, go bungee jumping, and make sure my children are financially secure. I will go to great lengths to make sure I have achieved all of this before I die. The reason I want to do those things is that a mundane life is really not worth living. I want to do things that people rarely get to do.

3. I want to die pain-free. If I get cancer or am in pain, I want to be loaded up with morphine and placed on supportive measures only. DNR [do not resuscitate] will be my code status. Suffering is the worst part of any affliction. And I don’t want to be a burden on my family financially if there is no hope of recovery.

Time for Pilgrimage

For me, I worry about who I would leave behind, whether I die early or late in life. A sudden death would not allow my family to say their good-byes. Having time to do things that I had not done before, thank people I forgot to thank in life, and spend time with my family would be important to me.

In Islam, as part of my spiritual goals, there are certain things that one needs to complete before death if one has the means, particularly a pilgrimage to Mecca. This journey gives one the opportunity to reflect on life, meditate and pray with others who share many of the same beliefs, and ask for forgiveness for one’s errors. It would be important for me to complete this pilgrimage before death. 

Like most people, I want to die in decent health so that I can do the things that I mentioned above. There has been much written about suicide and physician-assisted suicide. However, for me, because of my beliefs against any form of suicide, I would endure all the suffering. Life is full of many trials and challenges that are given to us for a reason that we will never fully comprehend. End-of-life suffering is another challenge of one’s character, as terrible as it may be. But it would be a blessing to die without any suffering. In addition, the more that I suffered, the more of a burden I would be on others, including my family. I would not like to impart these difficulties on anyone.

Finally, it would be nice for me to carry out my last days amongst family and friends. I would not want to be in a hospital or a nursing home. It would be important for me to be at home, with all my family members around.

A Comfortable Place

Three personal preferences for death:
1. Pain-free, minimal intervention
This is important for me, as I believe pain and suffering during death can significantly impact my judgment and the level of interactions I wish to have with my loved ones. Nevertheless, I will accept reasonable medical interventions as necessary.

2. Control of my environment
Having gone through several migratory phases in my life, I value the concept of dying in a surrounding familiar to me. A good home, on a comfortable chair, my favorite singer playing on my killer stereo is all I ask for right now.

3. A short and efficient funeral
Contrary to traditional Chinese practice (big funeral precessions, forty-nine days of vegetarian food, etc.), I believe in minimal burden to my loved ones that I leave behind. After all, it’s better to celebrate while one is alive than to show your love when it’s already over.

Making a Smooth Transition

To me, “the good death” would incorporate three main things:
1. A peaceful transition into the next life — in the Hindu tradition: “A good death should be prepared for throughout life and entered into consciously and willingly.” This is meaningful to me, as I would like to end my physical existence in this world after full spiritual and mental preparation. Should my life end abruptly, I would like to be spiritually ready. I believe that this can be accomplished only through constant meditation and self-reflection, in addition to the celebration of life and happiness.

2. The absence of pain and acute suffering. This is important to me both because of its personal implications and because of its effect on my family and friends. Regardless of the specific physiological event that stops my heart from beating and my neurons from firing, I would like to die without agony and without a struggle. I would like my death to be remembered as a spiritual, positive event, and not as a type of “defeat.”

3. The accompaniment of family and friends. I would like them to not mourn, but to celebrate life together and reminisce about the good times that we shared. I want them to share the moment with each other, to forge even stronger bonds. I hope that my passing will bring my family even closer together and to revive any relationships that have become distant or disconnected.

A Good Life

I am a Christian, and to me a good death is one that reflects that I have lived a good life. My family and I believe that life is a test of the human spirit and that to have a good death, one should have made an effort to follow the moral code proposed in the Bible.

The three things that are most important to me for a good death are:
1. To feel as if I lived a good life and contributed to society, helped others, and was as selfless as possible.
2. To be surrounded by friends and family and to have all of my financial and economic matters settled for their sake.
3. To feel calm, peaceful, and ready to pass on.

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