‘I exist, therefore I die’ is a statement from Descartes of universal truth. Death is the certainty that no one can doubt. When and how we die are equally uncertain. One can guess, but no one can know about their own death. As long as we live, we live with fear of death and dying. When we are driving or crossing the street, fear of death is ever in the background. Obviously, it’s why we are careful and vigilant. Not only at the individual level is this fear of inevitable death, but also in the collective psyche. Fear of pain associated with dying is far more powerful than the fear of death itself. We all want to live long and then die peacefully. This is perhaps the strongest desire we all have in common. All our actions and choices are directed toward the goal of long and abundant life.
No one dies because of aging. There is almost always a natural cause of death when we die, even in very old age, such as diseases or infections. Major causes of natural deaths are heart attacks and heart diseases, diabetes, diarrheal disorders, respiratory/lung diseases, cancer, Alzheimer’s and other kinds of dementia. According to World Health Organization statistics from 2015, the top 10 killers, many of which are lifestyle-related, account for 51.4% of all deaths globally. Ischemic heart disease and heart attack/stroke are the world’s biggest killers. Such deaths are, for the most part, painful and traumatic. On the other hand, many succumb to a silent heart attack, while sleeping. Among the worst, “ways to go,” certain kinds of cancer can be the most painful of all.
We all want to experience a “good death” after living to the fullest. Looking into what constitutes a successful or good death, an important study by researchers at the University of California, San Diego School of Medicine, came up with some answers. The study identified 11 core themes of a good death: preferences for a specific dying process, pain-free status, religiosity/spiritualty, emotional well-being, life completion, treatment preferences, dignity, family, quality of life, relationship with healthcare provider, and “other.”
The top three themes across all stakeholder groups were preferences for a specific dying process (94% of reports), pain-free status (81%), and emotional well-being (64%). People want to die not only peacefully, but with some measure of control. No one wants to suffer pain, which is the biggest fear of all, To eliminate suffering, euthanasia (the painless killing of a patient suffering from an incurable and painful disease, or in an irreversible coma) or palliative care (specialized medical care for people living with a serious illness) are becoming popular worldwide.
The top concerns for aged people facing imminent death are first, that their death be painless ; second, that they not become a burden on others ; and thirdly, that they are not alone near or at their death. Loneliness is a great concern for many senior citizens. Sadly, most people do not want to talk about death. To discuss one’s own death is generally taboo, especially in India. Even family members and close friends of terminal patients don’t dare to discuss this delicate subject. The fact is, by not acknowledging and discussing death, we cause more harm to ourselves. Our quality of life would be improved considerably if only we could embrace death gracefully. We must take death and dying as a natural phenomenon in life, and work on removing our inhibitions.
Being mindful of death can have a positive impact on our health and well-being. Our whole perspective on life will change when we keep the inevitability of death at the back of our minds. Our worries and fearful ruminations will become insignificant. We will always keep meaningful goals in mind. Quality of life improves if we think about death for at least a few moments before we start each day. This can be possible by way of mindfulness. Awareness of death will lead to greater self-awareness and more power of acceptance. This then opens the heart to more compassion and empathy for others.
Facing our own death when it becomes a certainty, as happens in cases of advanced cancer, is greatly eased by the practice of mindfulness. It can also be extremely helpful in alleviating pain. Rather than resisting and automatically reacting to pain, people can, through mindfulness, be aware of pain and accept it nonjudgmentally. In addition to strong pain- relieving medications and palliative care, mindfulness can be a very effective approach to preparing patients for death. Through mindfulness, one can accept death more gracefully and peacefully. Of course, mindful acceptance does not completely remove the suffering, but it can reduce the pain and fear of death. Through acceptance, not only can we calmly acknowledge the onset of death, but also the feelings and thoughts associated with death.
There is also a Buddhist meditation practice called Maranasati, which uses various visualization and contemplation techniques to meditate on the nature of death. This is also known as mindfulness of death or death awareness. When we forget that we will die, we tend to lead a habitual and complacent life. We may even start doing things that we don’t really approve of or wish for ourselves. Through this meditation practice, we become more aware and accepting of death as a natural ending to our life. In Maranasati, practitioners learn to accept impermanence and suffering, while also becoming more closely and intimately aware of death.