How and Where to Die?

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Heartbeat end of life

As we celebrate Halloween, derived from the ancient Celtic festival of Samhain where the dead were believed to return as ghosts, it seems fitting to pose a question that applies to all of us. Given the choice, how and where would you prefer to die? I can already hear some in my social circle accusing me of waxing morose, but that’s not how I look at death. It is, as we always say, an inevitable part of life, and pretending otherwise by not thinking about it seems like whistling in the graveyard.

Like some of you, I’m no stranger to life’s final act. At various times throughout my career, I’ve worked in hospice, oncology and health psychology. Combining those experiences with the deaths of family members I witnessed firsthand, it’s no stranger to me. I’m sure there are many in healthcare who can say the same, and then some. 

The kinds of deaths one witnesses, if any, certainly play a part in shaping one’s attitudes toward this opaque passage into who-knows-what. As such, many of us find death frightening, even terrifying. Others view it as terribly unfair, even cruel, a reason to rage against fate or God. In dire circumstances, it can seem a blessing, a way out of pain and suffering. In my own case, I’ve inhabited each of these perspectives at various times.

Your Preferences?

There are several prominent stereotypes about our preferences around dying. One is the “die in my sleep” idea, meaning passing away while unconscious. This echoes Woody Allen’s quip: “I’m not afraid of dying. I just don’t want to be there when it happens.” However, some people prefer the opposite. They want to be conscious and aware when standing at death’s door. Famously, Aldous Huxley, philosopher and author of Brave New World, took LSD on his deathbed. That’s certainly leaning into the “be aware” mindset when exiting existence.

Another stereotype claims that most of us want to die at home. While surveys show about two-thirds express this preference, it can clash with a greater concern among the dying. Pain. When asked, most indicate that dying pain-free is more important than the location of one’s passing, so, for many, wherever that can be accomplished takes priority over being at home. One exception was my paternal grandmother. After a nasty fall at home and a visit by her physician (yes, they made house calls back then), despite her discomfort, she declined going to a hospital, was placed in her bed and passed in the night.

Nonetheless, in facing death, the tug-of-war between pain/distress and comfort/peace figures prominently. It’s safe to say nobody wants to die in agony. Which brings us to the mode of death itself. Given the choice, many would opt for a quick demise. One client of mine, in describing her husband’s sudden passing via a massive coronary, said, “At least he didn’t suffer.” This is a common refrain. Often, the question of how and where to die is driven by the desire to avoid suffering.

Obviously, some who decide to take their own lives intentionally choose the how and where of their passing, while those who suicide impulsively put far less thought into it, if any. For the rest of us, fate often intervenes to decide on our behalf, perhaps via a sudden tragedy or a terminal illness. Which poses the question: How much actual choice is truly involved? For many of us, not much. Nonetheless, we can still state our preferences for the final item on the proverbial bucket list, if you will.

So, what about you? Given the power to determine the how and where of your dying, what would you decide? Whenever possible, proponents of euthanasia, a highly controversial subject, want to empower you to make that choice. We humans are big on control, but that capacity often eludes us in determining our way out of this world.

As prolific author Isaac Asimov put it, “Death is peaceful. It’s the transition that’s troublesome.” 

For more, visit philipchard.com.