I think I have mentioned before my revulsion for some standard practices with dead humans: embalming with toxic chemicals, burial in elaborate coffins, and efforts to isolate corpses from the outside world through concrete burial vaults and similar.
All that runs fundamentally against my self-understanding as one animal in all the multitude of nature. When my time comes — and I hope it won’t be for many years — I would like to be buried in as little as possible, for instance in just a cotton or linen wrapping, in a place where the molecules of my body will become the bodies of plants and animals and return to the great circulation that has been ongoing for billions of years. This would be after any usable organs or tissues have been donated.
Any kind of religious ceremony would be an insult to my conviction that those who think the universe or ethics can only be explained via the supernatural have no evidence to support their case. I would appreciate a gathering of friends which should be pleasant and well-catered, maybe a few musical performances: Pink Floyd’s “Wish You Were Here” has been a long-time favourite and is well suited, as is Radiohead’s “Exit Music”. A bit of Antonín Dvořák’s “New World Symphony” would speak to being Czech and North American. Mourners should have a snootful of a decent whisky, beer, or wine while listening to the music.
If one or more people want to “speak my death” in the Orson Scott Card sense of the words, I hope they won’t choose flattery or comfort over honesty.1
An advance directive to address the horror of being alive but unable to reason or communicate would also be prudent for me. The simple version is: if there is no prospect of a reasonable quality of life and my life is being sustained by external means like a medical ventilator, I would prefer for those means to be discontinued. If I end up in some sort of long-term vegetative state, I would be grateful for a never-ending stream or loop of folk music played at a suitable volume through headphones.
1. Anybody wanting to do this, including my parents and brothers but also any other people who I have met and any strangers to me, should perhaps read the first two books in Orson Scott Card’s Ender series. I definitely do not endorse the author’s politics, but I like his ruthlessly honest concept for a death ritual.
I know it’s macabre and perhaps unfair to discuss this now,
How personalised music can be used in health care
Using personalised music in therapy is cheap and can reap great rewards
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There has been much research on music’s effect on those with progressive disorders like Parkinson’s, where it can help to regulate gait and involuntary body movements, and Alzheimer’s, where music has been found to stimulate positive interactions and help people recall memories. Verbal memory improves among stroke patients who listen to music. For recovering opioid addicts, music listening can lower blood pressure and raise the patient’s pain threshold, often meaning that they require less pain medication. Streaming services now offer range and affordability to healthcare professionals keen to include music in treatment.
How, when and where death happens has changed over the past century. As late as 1990 half of deaths worldwide were caused by chronic diseases; in 2015 the share was two-thirds. Most deaths in rich countries follow years of uneven deterioration. Roughly two-thirds happen in a hospital or nursing home. They often come after a crescendo of desperate treatment. Nearly a third of Americans who die after 65 will have spent time in an intensive-care unit in their final three months of life. Almost a fifth undergo surgery in their last month.
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Most important, these medicalised deaths do not seem to be what people want. Polls, including one carried out in four large countries by the Kaiser Family Foundation, an American think-tank, and The Economist, find that most people in good health hope that, when the time comes, they will die at home. And few, when asked about their hopes for their final days, say that their priority is to live as long as possible. Rather, they want to die free from pain, at peace, and surrounded by loved ones for whom they are not a burden.
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Most doctors enter medicine to help people delay death, not to talk about its inevitability. But talk they must. A good start would be the wider use of the “Serious Illness Conversation Guide” drawn up by Atul Gawande, a surgeon and author. It is a short questionnaire designed to find out what terminally ill patients know about their condition and to understand what their goals are as the end nears. Early research suggests it encourages more, earlier conversations and reduces suffering.
Doctors follow man’s tattoo’s instructions that say “Do Not Resuscitate”