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The Good Death: Some Reflections on Dying Well
Every one of us is going to die, and, for the majority of us, this is going to be a bad thing. There may be some people for whom death would be a good thing, and others whose deaths would be a good thing for us, but, on the whole, I take it as a bit of common sense that death is a bad thing.
Nevertheless, some of us will have better deaths than others, and given that each one of us is guaranteed to die, it seems in our best interest to have a good of a death as possible. But what does it take to have a good death?
Part of this question can be answered by thinking about what it means to have a bad death. Here we can point to a multiplicity of factors that seem important. Some such factors involve our bodily integrity and psychological wellbeing: we don't want to die a prolonged, painful death, nor do we want to die afraid or completely unaware of where we are or what's happening.
Other factors, however, involve considerations about our values. For example, we don't want to die having forgotten about the things or people that mattered in our lives. This is true even if we know that we won't realize that we've forgotten or if we know that forgetting such things won't be disturbing to us. I take it this is part of what makes the final stages of dementia so disturbing to those who observe them. Not being bothered by the fact that one can't remember the face of one's child seems to make that death worse rather than better, and there are few people (if any) who both love their children and would choose to die in this way.
Not only do we want to remember the good things that have happened in our lives, but we also want to be remembered for the good things that we helped bring about. Part of why so many of us don't want to die alone is, I believe, because to die surrounded by loved ones is to die knowing that one was worthy of being loved and that one will continue to be loved at least for a while. If it matters to us that we're loved while we're alive, it seems to also matter to us that we're loved while we're dying and after we've died.
Likewise, it seems to matter to us that we die in a way that aligns with what we valued in life, or, at the very least, that we don't die in a way that goes against what we valued. The revolutionary who dies betraying the revolution does not have a good death; the one who dies in service of it arguably does. Similarly, we tend to think that there are cases in which it would be better to die without compromising certain values rather than continue to live having done so (Sophocles' Ajax is one example; Sartre's Garcin is another, though for slightly different reasons).
Finally, it seems to make a difference to how we evaluate its quality whether our death is arbitrary or senseless. As it relates to the last point, whether a death is senseless seems to at least sometimes be a factor of whether one died in a way that is relevant to what one valued in life--the death of a Resistance fighter in Nazi France may be regrettable, but because the cause for which the life was given was not senseless, so the death itself also does not appear senseless. The contrast is clear to see when compared with the death of someone trampled during a Black Friday sale or a person who's killed by a falling tree during a storm.
[There is related sense in which a death can be arbitrary or senseless that has more to do with whether or not it is expected. We do not necessarily think that the death of our very elderly relatives (late 80's and 90's, for example) is senseless because we partially expect that it's simply a matter of course that people of that age die. This is not to say that their deaths do not affect us, and we might think that it's senseless or arbitrary that they should die rather than someone else of a similar age. But we don't tend to think that this kind of arbitrariness makes their death worse. By contrast, our intuitions on the matter are radically different when we talk about the death of a child or very young person. There, we can rarely muster any semblance in which the death makes sense or doesn't appear arbitrary and I think it's partially due to the fact that we simply don't expect such people to die.
There are other cases in which deaths seem senseless because although they are expected we have a sense that they could have been avoided. One might think of wartime deaths as such.]
It also seems right to say that all things being equal, the addition of one or more of these factors to another makes a difference to the goodness or badness of the death. All things being equal, a death that is painful and arbitrary is worse than a death that is only arbitrary, and one that is painful, arbitrary, and goes against what the person valued in life is worse than the other two.
How things play out in middling cases is more complicated: for example, all other things being equal, is a painful death better or worse than a lonely death? Is a death accompanied with extreme dementia better or worse than a death accompanied with extreme fear but done for a cause that is in line with one's value? I don't know that there's an easy or straightforward answer to those questions. My suspicion is that our intuitions on the matter will depend on how these features are related to questions about what the person valued in life and those, in turn, will be a matter of what we think is valuable in life.
Consider, for example, the question of whether it is better or worse to die a painful death than a lonely (but painless) one. If we consider the death in question to be that of a miserly misanthrope who never derived an ounce of happiness from the company of others, then it makes sense to say that the better death for him is the lonely and painless one since, all things considered, we can imagine that the loneliness wouldn't be a source of distress for him. Pain, on the other hand, is by definition something that is distressing to anyone who experiences it, so, given the choice between one kind of death that is not distressing and another that is, it's better to pick the former rather than the latter.
Nevertheless, we might still think that despite the fact that a lonely death would be better for him given the kind of life he's lived, it still doesn't constitute a good death tout-court since we might hold that the kind of life that would lead to that kind of death being good one is itself not a good one. To put the matter another way, certain courses of action may be preferable if one finds oneself in certain terrible situations that would not be preferable at all if one had never been in that situation in the first place.
Note, this is not to say that there are cases in which it's good that one dies in pain, but rather that there might be cases, given how one has structured one's life, in which it would be preferable to die painfully, but not alone rather than the other way around. In such cases what would make one death better than another is not that pain becomes a 'good-making' feature for that person where it's not for another, but that dying alone would simply be much worse than dying in pain and, hence, that dying in pain would be better.
The same considerations can be extended to the second question. Namely, given how committed one is to a certain cause, it might be preferable to die for something one believes in while extremely afraid than to die without fear without having any commitments to anything whatsoever. Where we land on that question will be a matter of what kind of life we can imagine the person having and what they valued during it--a person who valued much of anything (if there are indeed such people) other than being distressed might find a death without fear to be preferable to one with it. Nevertheless, even if we accept that this is the case we might still wonder whether having such a good death is worth it if its goodness is only contingent on having a bad life.
I don't mean for these arguments to be decisive in settling all difficult cases on the subject. There may be some cases in which the grounds for preferring one kind of death over another have nothing to do with the kind of life one has lived or what one has valued in life. There may simply be just horrible ways to die regardless of any such considerations--the agony of dying of rabies, for example, seems to have everything to do with how awful the process is and not with anything about what matters in life (the appeal to the fact that we value not being in agony goes some way here, but it feels like it's one thought too many). Likewise, just because I've pointed out that in some terrible situations one way of dying may be preferable to another doesn't show that those preferable choices are good. Given the option between a cup of poison and old, moldy bread, it's preferable to eat the moldy bread, but that shouldn't make us think for a second that it's good to eat moldy bread. Likewise, the fact that it might be preferable to die in pain than to die alone shouldn't make us think that there's something good about dying in pain (I made this point above, but I'm repeating it so that I'm not misunderstood).
Nevertheless, the fact that the arguments are not decisive with respect to some of the hard cases does not mean that there isn't something important in general about the connection between what makes for a good death and how one has lived. The simple point is that, I believe, in very many cases what counts as a good death and whether one will be able to have a good death is a function of whether one has had a good life.
If one has not lived a good life, as our misanthrope above has not, then what makes his death good will be limited in certain ways. It could not, for example, be a reflection of how much he is loved or how much he will be missed. If he valued nothing but his own comfort and well-being, then his death cannot be good in the sense that it constitutes a commitment to anything else that might be of value. He might still be able to have a death that is not as bad as it can possibly be if, for example, he avoids dying painfully or under extreme duress, but this doesn't mean that it will be an unequivocally good death. Indeed, it might be possible that given certain kinds of lives the avenues to such a death are simply closed off (aside: the promise of salvation at one's deathbed by Christianity leaves always leaves open one such avenue--that this is actually open is something I've always been skeptical of, but then again, I've never been a believer).
What should we say about the person who has lived a generally good life? Does it follow that if some avenues for a good death are closed off by having a certain kind of bad life that things are better off for the person who has lived well? Sadly, I don't think that it does. In the first place, it's not clear that an increase in possible paths towards a good death necessarily translates into a higher probability that one will end on one of those paths. Indeed, if it's true that one has an unqualifiedly good death only by reaching the end of those paths--i.e. if one achieves a good death not only by valuing certain things, but by having their death constitute an affirmation of those values--then perhaps this only multiples the ways one can fail to have a good death.
Perhaps more troubling, and somewhat related, is the fact that many people think that what makes being dead bad is the fact that death deprives us of whatever is good in life. Thus, it seems to follow that the better our lives go, the more good things death deprives us of and the worse it is for us. If that's true, then perhaps we can still achieve a good death, but only at the expense of our being dead being much, much worse.
Ain't that some shit?