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30 Apr 2024

Dearly departed: What does it mean to die well?


Dearly departed: What does it mean to die well?

Who would have thought death could provide a potential growth opportunity? Fresh thinking on what used to be a ‘taboo’ subject suggests we can now have more control, and say, into what it means to die well.  READ MORE

Pivotal final scenes in the Hollywood blockbuster The Last Samurai revolve around the question: “How did he die? Did he die well?” Given the social upheaval at the time, this query received significant airplay.

In the ancient Japanese Samurai world, the criteria for determining the quality of departure were specific. Master swordsman Yamamoto Tsunetomo specified: By setting one's heart right every morning and evening, one can live as though his body were already dead, he gains freedom in the Way.

This guideline may have worked for a group tightly bound by the same codes of behaviour, but the notion of ‘dying well’ in the 21st Century is much more personal and open to engagement.

Thought leaders now promote the idea that dialogue about dying needs to be open, honest, authentic and participatory. This attitude is in stark contrast to some traditional views that people were expected to merely ‘wait for death’ to occur. With the whole subject matter of death purposely shrouded in darkness and even fear.

Fear disappears

London Brunel University's Professor Holly Nelson-Becker has made a study of people entering the final stages of life.  She has a particular interest in sharing her, and others, experience.

Behaviour, and expectations, do change. Based on findings guided by her expertise in Socioemotional Selectivity Theory, she suggests that the ‘rules’ of engagement become quite specific.

“There is motivation to deepen relationships with key people in their lives. People prefer emotionally positive information rather than negative matters but overall, they find information goals less important.”

In short, time is spent in a different way that does not involve punctuality or sticking to routines.

“Spiritual time is not predictable in the sense of a timetable or conventional measures. Nor is it like an arrow of sequences pointing at transitions, endings, or other ways of knowing and understanding events.” The focus becomes very specific on what is relevant, nourishing, and enduring. The actual ‘fear’ of death disappears in the process of redefining time, space, and life.

By opening the discussion, and seeing death as part of a progression, there is substantial room for people to experience new ways that make it clear how they want to ‘live’ as they approach dying. It is an opportunity, says Professor Holly Nelson-Becker for asking questions so that people define how this part of their life’s journey evolves. On their terms but in consultation, and support, from those they choose to have as part of their dying plan.

Redefining life

From a growth viewpoint, this transformation can involve a redefinition of self, a degree of independence and being very specific as to what sort of ongoing investment in life people want.

Others have written about themes related to the way we live determining how we might die. In a ground-breaking work Dying Well: The Prospect for Growth at the End-of-Life physician Ira Byock states that development landmarks take place at the start of life as well as the end. These are, he says, typically accompanied by feelings of mastery, expansion, a sense of wellness and, at times, exhilaration.

“These same feelings are expressed in the stories of patients who may be said to have died well. Often the challenge for family, loved ones and other care givers is to recognize the opportunities for growth and development and help the dying person achieve them.”

Ira Byock observes it takes a willingness to talk about things usually avoided.

From his experience, two questions can be helpful to begin the process of discussion and subsequent planning.

“One way to start the journey is by asking: ‘What would be left undone if I died today?’ and ‘How can I live most fully in whatever time is left?’ These questions can illuminate the tasks, and landmarks, ahead.”

Part of the preparation

What could be an important part of ensuring your life/death plans are carried out as you want them is to utilise Advance Care Planning (ACP). This is the process of thinking about, talking about and planning for future health care and end-of-life care. Advance care planning is important for people, and their families, at all times during the health care journey.

There are 5 Steps to Advance Care Planning:

Step 1 – Think. What are your values, wishes about your care and specific medical procedures?

Step 2 – Learn. Learn about specific medical procedures and what they can and can't do.

Step 3 – Choose.

Step 4 – Talk.

Step 5 – Record your wishes.

For more information about Advanced Care Planning go to: https://www.myacp.org.nz

The final act

Practicing surgeon and adviser to United States President Joseph Biden, Atul Gawande, in his bestselling work Being Mortal, sheds light as to how death is not an event in isolation but rather a final ‘act’ in a life story.

“Medicine has triumphed in modern times, transforming the dangers of childbirth, injury, and disease from harrowing to manageable. However, when it comes to the inescapable realities of aging and death, what medicine can do often runs counter to what it should. The goal is not a good death but a good life…all the way to the very end.”

A road map to dying 

Based on her own life experience with death, writer Katy Butler has written a virtual ‘how to guide’ to the subject entitled The Art of Dying Well:  A practical guide to a good end of life.  Being a ‘road map’ to the end that combines medical, practical, and spiritual guidance.

In essence she says the focus should be about living as well as possible for as long as possible.  Then successfully adapting to change.  She shares insights on many levels, including how to get the best from our health system, and how to make your own "good death" more likely. She explains how to successfully age in place, why to pick a younger doctor and how to have an honest conversation with them, and how to make your death a sacred rite of passage rather than a medical event.

Practical priorities

At a more fundamental level there are said to be five priorities of care for a dying person.  These include:

  • Recognising and realising the person is dying.
  • Communicating sensitively with family/whānau of this fact.
  • Involving the person in all decision making.
  • Supporting them and their family/whānau.
  • Creating an individual plan of care that includes adequate nutrition and hydration.
Orchestrated by the Brain 

Research publisher on open science site Frontiers report that Neuroscientists have recorded the activity of a dying human brain and discovered rhythmic brain wave patterns around the time of death that are like those occurring during dreaming, memory recall, and meditation.

A study published in Frontiers in Aging Neuroscience brings new insight into a possible organizational role of the brain during death and suggests an explanation for vivid life recall in near-death experiences.  The publication contends: 

Imagine reliving your entire life in the space of seconds. Like a flash of lightning, you are outside of your body, watching memorable moments you lived through. This process, known as ‘life recall’, can be what it’s like to have a near-death experience. What happens inside your brain during these experiences, and after death, are questions that have puzzled neuroscientists for centuries. Until recently, findings suggest that your brain may remain active and coordinated during, and even after the transition to death, and be programmed to orchestrate the whole ordeal.


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Published: September 2019

Reviewed: February 2024

To be reviewed: February 2027