I listened to the last episodes of Andrew Denton’s podcasts – Better off Dead – yesterday. Nitschke was on this episode and I found Andrew’s questions and comments a bit lacking in some crucial dimensions. I felt there was a strong push from Denton to move the conversation to privilege a legal narrative – lets make this legal. Just like it is in Netherlands, Belgium and the US. I appreciate what he is trying to do, I am blown away by what he is doing. Yet death is more than just a physical end of life – and the existential issue surrounding death is merely a category in these pod casts. There is the social dimension to death. It is the death of a social being – relationships, citizen, voice, father, husband. And death can be a social practice – death can be de-medicalized. Will he go there in his podcasts I wonder!
You can follow Andrew Denton’s Pod Casts here.
And so I being writing.
Its been two years now since my participation in a Health Innovation forum organised by a group of doctors. One issue that we talked about at the event was captured in the title – last 18 months. This is a narrative in the medical profession and within the government where a significant proportion of the health care budget of a country are committed to the last 6 months of a person’s life. Its common to encounter statements such as “50% of healthcare costs are incurred in the last 6 months of life”. Posts such as this point to a rethink underway about the medical paradigm of end of life care. One dimension is certainly economic but there are also efforts focussed upon improved quality of life outcomes.
Following the thread of this narrative leads us into the economic problem and solution scenarios of a sustainable future. The direct extrapolation of current practices leads us to imagine that: People will live longer and more people will have dramatic and complicated hospitals deaths. This will cost the state a lot of money.
The recent announcement by the Australian Federal Government to reimagine chronic care as a portfolio solution or a systemic solution is potentially a step in the right direction and is also aiming to spend money wisely . Such thinking aligns well with the paradigm of patient centered health care and we can imagine that this model will in time make use of current and emerging IT solutions such as Health-kit to manage patient health.
Within the discourse of this territory of last 18 months is the work of Dr Angelo Volandes. The article from a few years ago in the Atlantic offers a great introduction to his alternative approach to end of life care. The following paragraph summarises his project – he wishes to show people that certain medical procedures near the end of life can lead to an undesirable hospital death.
On the very first night of his postgraduate medical internship, when he was working the graveyard shift at a hospital in Philadelphia, he found himself examining a woman dying of cancer. She was a bright woman, a retired English professor, but she seemed bewildered when he asked whether she wanted cardiopulmonary resuscitation if her heart stopped beating. So, on an impulse, he invited her to visit the intensive-care unit. By coincidence, she witnessed a “code blue,” an emergency administration of CPR. “When we got back to the room,” Volandes remembered, “she said, ‘I understood what you told me. I am a professor of English—I understood the words. I just didn’t know what you meant. It’s not what I had imagined. It’s not what I saw on TV.’ ” She decided to go home on hospice. Volandes realized that he could make a stronger, clearer impression on patients by showing them treatments than by trying to describe them.
To achieve his goals Volandes uses Videos. I have watched his videos and they are amazingly instructive. He now has a book out and this video.
I began writing this piece to journal my work in the area of death and dying. I have been looking at ‘service design’ solutions at the end of life.
In short we are all going to die one day. And from a consumption and service design perspective we will have the ability to choose the kind of death we find appropriate. In this last sentence I have edited out the words desirable and acceptable – both design values. Yes it is possible to speculate that death too can be designed. And their may be consultants who will specialise in this field of practice. We do have the designed funeral. Funeral Celebrants transform the physical remains of the human (person) into an aesthetic experience to make the greiving process and the ceremony of death a commodity for consumption. The socially mediated nature of practices surrounding death have both a traditional and modern dimension.
Society in Australia though still struggles with an acceptable social practice of dying. On ones side are the campaigners who collectivise death as a collective moral discourse. Within this narrative the ‘taking of life’ is illegal. On another side are the campaigners who are attempting to push the discourse towards the individualisation of dying. That it is a singular act of volition and that there ought to be choice and freedom for the practices of taking ones own life. There is this global transformation of the discourse of dying and it is enriching the understanding that people have of their own choices. It is possible in the future we will look back at this moment in history for its challenge to society to elevate the discourse surrounding death. Its possible we will fail. Its possible the scare mongers win out.
It did not have to be this way.
The taking of ones own life is a supreme act, a pure act and historically even heroic act of the brave. This beautiful piece about Mishima signposts the social practice of taking ones life.
Mishima spoke increasingly of death and lamented the absence in modern times of “great causes” to die for. In his 1970 interview, he described the samurai notion of killing oneself as “brave harakiri,” in contrast to the Western view of suicide as “defeatist.” However, while he was exhorting the young soldiers to rise up against the established order, Mishima was booed and jeered with shouts of “Get down,” and “Go home.” Many Westerners might therefore regard his bloody deed as “defeatist suicide.” Whether the coup attempt was merely a pretext for killing himself is unclear. There is no doubt that it was planned, since he had prepared jisei no ku (traditional death poems) well in advance and made provision for his wife and children. However, did he really believe the soldiers would rally to his call? What is clear, though, is that Mishima considered his act “brave harakiri,” a fitting end for a proud samurai. “Harakiri makes you win,” he pronounced.
To be continued …