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Talking about death in a stark, honest, even desperate way is something all of us may need at some point
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Over the last weekend of August, two small experiences took me back to contemplating the nature of talks the old, the dying and the terminally sick may want to have about their death. But seldom get to have. An episode of the teleserial The Buddha on Zee TV tuned into one of Gautam Buddha’s disciples on his deathbed who requests his master to help allay his enveloping fear of death. The Buddha counsels him to take his concentration beyond his body, his breath, his existence by focusing on nothingness. “I am not what I see, hear or am. Neither was I born with my body nor can death destroy who I am…" The disciple locks himself into these thoughts and lets go of both—his fears and his last breath.
The next day, I read a piece in The New York Times on how private medical insurers in the US are bypassing the political process to reimburse doctors for conversations with their patients on “advance care planning". With life expectancy on the rise, people are living longer with illnesses and “many want more input into how they will spend their final days." Called “end of life conversations" such exchanges include whether a person wants to die at home or in a hospital, whether he or she wants full-fledged life saving interventions, just pain relief or short-term efforts to revive them. While insurance for such care may need some political debate, the purpose behind such care is both compassionate and pragmatic.
Talking about death in a stark, honest, even desperate way is something all of us may need at some point. For those at the brink, it is perhaps the most important conversation. Not just expressing fears about the final moments or the unsolved mysteries of after-life but discussing practicalities. Where will I die? Should I bother my family with terminal care or should I elect for the lonely and frightening environs of an intensive care unit or a hospice? Should I be resuscitated despite brain death if my heart stops or should I sign a Do Not Resuscitate (DNR) directive? What is life like on a ventilator? What if I end up signing my death warrant by signing forms, thus stamping out chances of surviving a medical crisis? Even further: where should I be cremated? Should my family make it a public event of grief or do I want to disappear quietly?
Making a choice between handling death with philosophic detachment or interventionist medical help may seem like a choice between Buddhism and a sterile modern way of life but the truth is that most people could do with a bit of both. Psychological and spiritual counselling for the terminally sick or the aged is known in all parts of the world and in hospice care. But conversations that make room for a patient’s choice in how she will die have largely been debated only in the US, only to be vetoed out even there in the past as “death panels".
Any of us who have been beside a loved one who is dying knows how gut wrenching and complex that process is. Very few just pass away in their sleep or suddenly collapse never to get up. In most cases, death comes after a series of organ failures and dragging, directionless illness. It involves medicines and doctors; ventilators and life-saving treatments, comas and end of life complications.
Any which way, survivors or caretakers of those who pass away are left with numerous doubts and layers of guilt about the decisions they took. Nothing is black and white; there is always a chance that we did wrong—morally or medically.
Which is why, end of life conversations with medical practitioners for the dying person make complete sense. Like the Buddha’s teachings on the karmic churn of life and death, a list of directives where one takes responsibility for one’s manner of death could be empowering and fear busting, because it leaves the patient with a modicum of control.
Yet despite hundreds of options in India for reassuring satsangs, religious or spiritual talks and a culturally ingrained fatalistic attitude, there are no conversations on the medical manner of dying. Superstition, awkwardness and fear prevent such open dialogues. Hospitals have no provisions for death counselling from a medical point of view. Doctors aren’t even trained perhaps to deliver such care. The entire emphasis of modern medicine is on diagnosis and prevention. But there is nothing on the inevitable cessation. Isn’t that odd considering this is the home of karmic realism, which is now being sold as a New Age interventionist concept?
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