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Countering our fear of dying

By Alex Penk March 12, 2019

Last week, I was struck by the fear of dying. Not my own, mind you. I was chairing a panel discussion with three experts in palliative care, and the fear I could sense from some audience questions was confronting. But it was probably also unnecessary. It turns out that much of what we think we know about normal dying is wrong.

That was the message of Dr Kathryn Mannix, a pioneer in palliative medicine and author of a best-selling book, With the End in Mind: Dying, Death, and Wisdom in an Age of Denial. It’s a hugely important subject, because our attitudes and beliefs about death not only shape the way we die, but the way we live. It’s also a timely conversation. The End of Life Choice Bill before Parliament is raising questions, and not only about euthanasia and assisted suicide. The discussion is revealing, and possibly changing, our attitudes towards death and dying.

It turns out that much of what we think we know about normal dying is wrong.

So we invited Dr Mannix to New Zealand to share her expertise. She told us that there’s a common, but wrong, fear of dying. Most of us have very little or no experience of dying, unlike past generations where people were more likely to die at home amongst their family. This knowledge gap, she said, is filled by pop culture which has an interest in sensationalising death to capture viewers and so we come to expect death to be a difficult and traumatic experience.

But while sick and dying people have symptoms that need management, Dr Mannix told us that the process of normal dying is natural and can even be so gentle that the family sitting by a dying relative’s bedside don’t realise when it’s happened.

Of course, there are bad deaths, but thanks to good palliative care they’re much rarer than you’d think. If this sounds odd, Dr Mannix explained that most of us don’t understand what’s happening when someone dies; we may think that we’re hearing distressed groaning or choking when we’re actually hearing unusual but painless breathing because a deeply unconscious patient has relaxed their vocal chords.

Dr Mannix told us that the process of normal dying is natural and can even be so gentle that the family sitting by a dying relative’s bedside don’t realise when it’s happened.

This highlights the importance of maintaining, and improving, our palliative care services. New Zealand has excellent standards of palliative care, but there’s also room for improvement—for example, delivery is patchy in some regions. One of the other panellists, Professor Rod MacLeod, also expressed concern that legalising euthanasia and assisted suicide would undermine the palliative care we need, for example by destroying the trust that needs to be at the heart of the doctor-patient relationship.

Reflecting on the event, I see a real danger that the euthanasia debate distracts us from all the ways we could care for people at the end of life. Even worse, an unnecessary fear of dying might make people want a way out that they don’t actually need. With all the risks associated with euthanasia and assisted suicide, it would be a tragedy if that fear burdened our society with the End of Life Choice Bill.

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