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Living on forever
Dont worry Im not about to suggest cryogenic
suspension or even calling in all your favours from St
Peter. Its about fulfilling your life in a way that you
will know lives on after your death.
I was chatting to someone who is very close to me one night when there was
a shout from the adjoining room. The village, where
this familys elderly father had been born, was being
mentioned on television. It struck me how little we
often know about our parents childhood, their stories. How much more so, our grandparents and their
parents before them. The details of this small village
were suddenly very interesting to all his family.
It happens that the father
was also ill with terminal cancer. He has good days
and bad days. But at the point in our story he is still
pretty active, and very vocal in expressing his views.
I thought of an idea and mentioned it to the rest of the
family without his knowing: next time I came to
visit, I would present him with a beautifully bound
notebook as a gift. I bought one of the range made by
Paperblanks artistically designed, hardbacked,
and with an air of durability. Its to write your
story! I told him.
To my delight, he
became quite excited and embraced the idea wholeheartedly. What he is actually writing in it is
unknown to anyone except himself as yet. It could be
his life story, his memories of relationships with different people, his childhood or his observations and
views on the world today. It might include how his
views have changed after discovering his illness, and
what he thinks about his present situation. Maybe
even his ideas on God. Whatever it is, it will be personal to him and a wonderful legacy to his children
and their children, and maybe passed down through
several generations. Not only is he excited: so is his
family. I would love to read something my
great-great grandfather had written wouldnt you?
I felt at the time it was
maybe a lucky guess. But then I came across a
passage about activities to face death by Pat Furer
and John Walker.2 Write a story about your own
death that includes your worst fears. Use this story
for 30-60 minutes each day to help you vividly imagine situations where you would have to face death.
Controlling the state of mind
The two previous examples serve slightly different
purposes. The psychologists in the second example
Not everyone wants a tranquilliser or anti-anxiety pill or the spectre of Sisyphus being offered a happy pill.
Furer P, Walker J, Stein M, Treating Health Anxiety and Fear of Death A Practitioners Guide 2007 Springer NY.
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When I was 17, I read a quote that went something like: If you live each day as if it was your
last, someday youll most certainly be right. It
made an impression on me, and since then, for
the past 33 years, I have looked in the mirror
every morning and asked myself: If today were
the last day of my life, would I want to do what I
am about to do today? And whenever the
answer has been No for too many days in a
row, I know I need to change something.
Remembering that Ill be dead soon is the most
important tool Ive ever encountered to help me
make the big choices in life. Because almost
everythingall external expectations, all pride,
all fear of embarrassment or failurethese
things just fall away in the face of death, leaving
only what is truly important. Remembering that
you are going to die is the best way I know to
avoid the trap of thinking you have something to
lose. You are already naked. There is no
reason not to follow your heart.9
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Hofmann S, Grossman P, Hinton D, Loving-kindness and compassion meditation: potential for psychological interventions, Clinical
Psychology Review 2011;31(7):1126-32.
There are various formal manuals on this, from both Eastern and Western Buddhist literature, and from secular traditions. e.g. Bennet A,
On the Culture of Mind, International Buddhist Society 1908, reprinted as The Training of the Mind by Ananda Metteya, In: The
Equinox 1911, I(V):28-59. The general philosophy can be found in any book on Buddhism under the first of The Four Sublime States.
There are many online guides, including those by secular Buddhists. For a study more purely based in psychotherapy covering the first
two practices of this chapter in detail, see: Didonna F (ed), Clinical Handbook of Mindfulness, Springer 2009.
Seguin M, A Gentle Death, Key Porter Books, 1994. p.80.
Stanford Report, June 14, 2005, Stanford University News, http://news.stanford.edu/news/2005/june15/jobs-061505.html
Steimer T, The biology of fear- and anxiety-related behaviors, Dialogues in Clinical Neuroscience 2002;4(3):231249.
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This type of exercise is not specific to a particular religion or spiritual practice although it can be found somewhere in most religions. It
is not belief-dependent and equally suitable for atheists and religious persons. A typical and inexpensive guidebook, with more detailed
instructions than given here, can be purchased from Amazon or downloaded free from the Internet::
Basic Practice, in: Sayadaw M, Practical Insight Meditation, Buddhist Publication Society 1971;7-19.
http://www.saddhamma.org/pdfs/mahasi-practical-insight-meditation.pdf accessed 6 May 2012.
George Mason University, Being mindful can neutralize fears of death and dying, ScienceDaily, 28 Feb 2011. Accessed 11 Feb. 2013.
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Pain
Most, but not all, pain can be controlled. But that is
not to say it will be. So it is worth being loud and
insistent to get the best palliative care and pain
control that you can, and also consider how much
pain you are prepared to handle before taking matters
into your own hands. Some problems, real and
perceived, with palliative care, include:16
Lack of staff or finance in hospices and palliative
care facilities
Insufficient beds for specialist care of dying
patients
Over-emphasis on specialty training or
inflexibility within the hospice and palliative care
services
Some people simply dont find the idea of
palliative care acceptable
As with fight or flight, theres a time to demand the
best and a time to just accept, to forgive. To accept
that everybody has done their best, as you have, and
turn the mind to dealing with things yourself. You
may find you want to change your emotional colouring of the pain you experience, or simply embrace
negative emotions.17
Shortness of breath
This might not apply to self-deliverance, but it may
be reassuring to know that, although common at the
end of life, its unpleasantness is usually controllable
using combinations of morphine, benzodiazepine
(such as lorazepam), and breathing techniques. Cool
draughts, changing the persons position, maintaining a calming presence and provision of supplemental oxygen can all help.18
Some concluding thoughts
The tasks facing any one of us on the approach to
death seem to be fourfold . . .19
Lehrer J, The Decisive Moment, Canongate Books 2009;106-107. This provocative book details many examples of how the prefrontal
cortex can assist our mental states or even enable us to save the lives of others. For a more clinical and less controversial study of these
mental states however, see Kristeller J, supra.
Roeser S, The Effects of Metacognition, in: Emotions and Risky Technologies, Springer 2010;28.
and: Niemec C, Brown K, Kashdan T et al, Being Present in the face of existential threat: the role of trait mindfulness in reducing
defensive responses to mortality salience, Journal of Personality and Social Psychology 2010;99(2):344-385.
and: George Mason University, Being mindful can neutralise fears of death and dying, ScienceDaily, 28 Feb 2011, accessed 9/2/2013.
An excellent book that describes the course and symptoms of various terminal illnesses is Sherwin Nulands How We Die: Reflections
of Lifes Final Chapter Vintage Books, 1995. For methods of self-deliverance, see Five last Acts II or Five Last Acts The Exit Path.
This list is paraphrased from Seguin M, A Gentle Death, Key Porter Books 1994.
Both approaches have quite good scientific support. Lumley M, Cohen J, Borszcz G et al, Pain and emotion: a biopsychosocial review of
recent research, Journal of Clinical Psychology 2011;67(9):942-68.
Pharmacological methods are well-established. For non-pharmacological methods, see Taylor J, The non-pharmacological management
of breathlessness, End of Life Care 2007;1(1):20-27. Online at:
http://endoflifecare.co.uk/journal/0101_breathlessness.pdf accessed 5 Jan 2013.
Classifications found in Copp G, A review of the current theories of death and dying, Journal of Advanced Nursing 1998;28(2):382-390.
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Further reading
! Furer P, Walker J, Stein M, Treating Health Anxiety
and Fear of Death, Springer 2010.
! Halifax J, Being with Dying: Cultivating Compassion
and Fearlessness in the Presence of Death, Shambala
Publications 2009.
Long A, Sedley D, The Hellenistic Philosophers Volume 1: Lucretius 3.830 911, Cambridge University Press 2011: pp. 151 2.
Moore C, Williamson J, The Universal Fear of Death and the Cultural Response, In: Bryant C, Peck S (eds) Handbook of Death &
Dying, Sage Publications 2007.
Docker C, Making the Memories that Matter, Exit Newsletter 2003;23(1).
Deeley P, The Religious Brain Turning ideas into convictions, Anthropology & Medicine 2004;11(3):245-267.
In neuroscience terms, engage in prefrontal cortex processing (although this is now thought to be something of a generalisation for the
locus of the activity.)
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