When Dr. Timothy Quill decided to describe in a medica journal earlier this year how he made it possible for a cancer patient to choose the time of her death, he knew the story would stir strong reactions.
He also knew that the subject of how we die is one of those taboo topics that desperately needs public discussion.
A reader's response to Dr. Quill's story is an example of the strong feelings the subject evokes -- and helps explain why public interest in the issue of physician-assisted suicide is growing. She writes:
"I am a 50-year-old woman with multiple sclerosis, and I say God bless Dr. Quill for giving a patient the right to decide about her quality of life. I watched my father suffer with cancer for a year. He had seven operations and when they were done he had no tongue, no cheek bones, no bottom lip. He begged us to give him an overdose. He had to write everything down. I think if he could have talked he would have screamed from the pain and the indignity. I feel everyone has the right to live and die in peace and with grace. After seeing what he went through, if I ever reach a point in my life where I can no longer do for myself and I am in that kind of pain, I will do whatever it takes to end my life in peace and with dignity."
A.M., Dundalk, Md.
This desperate cry for a dignified death is a symptom of an age in which we have lost touch with what it means to be mortal -- with what it means to die and, equally important, how to do it. The notion that we can or should meet death calmly and with dignity has largely disappeared from our culture.
That shift represents a major change in human history, as the French social historian Philippe Aries pointed out in a fascinating study entitled "Western Attitudes Toward Death" (Johns Hopkins University Press, 1974)
Until relatively recently in Western societies, death was a public event with its own rituals and customs. The dying person himself presided over the occasion.
The gathering brought together family, friends, neighbors and children. (Up until the 18th century portrayals of deathbed scenes always included children.) The rituals usually involved the dying person's expressions of sorrow at the end of life, a brief summary of people and things he loved, the pardoning of those around the deathbed for any unintentional offenses and, finally, prayers and absolution.
After the last prayer, death was expected to come swiftly. If it did not, the person simply waited in silence -- more words were not needed and would, in fact, disrupt the ritual nature of the moment.
These rituals were solemn, but not emotionally overwrought. In Alexander Solzhenitsyn's novel "Cancer Ward," a character recalls that the "old folk" died "calmly ... And they departed easily, as if they were just moving into a new house."
Now, as Aries points out, death is more likely to occur in a hospital and to be a lonely, isolated event essentially a "technical phenomenon." In many cases, Aries says, "Death has been dissected, cut to bits by a series of little steps, which finally makes it impossible to know which step was the real death .... All these silent little deaths have replaced and erased the great dramatic act of death."
In earlier centuries, people were more physically vulnerable to death. Yet by providing a context for death that placed it squarely within everyday life, they had an emotional and spiritual protection that seems lacking today. That affects survivors as well, since without the ritual context of death, the process of mourning becomes as lonely and isolated as a technologically managed death.
The modern era has brought enormous benefits, few of which we would want to do without. But with all this progress we seem to have forgotten something that even animals instinctively know -- how to accept the inevitability of death and, when the time comes, how to meet it with quiet dignity.