What is a good death: can science and medicine tell us?

Saturday 17 October, 17.30 until 18.45, Frobisher Auditorium 1, Barbican Battle over Life and Death

In his bestselling book, Being Mortal, surgeon and Reith lecturer Atul Gawande queried whether his profession had become so fixated on attempting to ‘stave off death’ that it had ‘no idea when to stop’ for terminally ill patients who may not benefit from expensive and intrusive end-of-life treatments. Earlier this year, Richard Smith, former editor of the BMJ, provoked heated discussion by suggesting cancer represented ‘the best death’ for most patients. Last year, a report by the Royal College of Physicians concluded that large numbers of patients were ‘dying badly’ in hospital.

In the medieval period there was a clear prescription for what constituted a good death, set out in manuals known as Ars Moriendi, centred around the necessity of being spiritually and materially prepared to die ‘gladly and wilfully’ at God’s choosing. From the Ancient Greeks through to ‘Dulce et decorum est…’ the concept of a noble death in battle for one’s country held an equally powerful cultural influence. Gawande notes that the twentieth-century trend for death to occur in the hospital – away from the home, family and loved ones – is being slowly reversed, as patients seek palliative care at home or in hospices. Movements such as the Order of the Good Death, run by US morticians, seek to demystify ‘the death anxiety of modern culture’ in order to encourage us to see ‘death a part of your life.’

Nevertheless, the strength of opposition to assisted dying indicates that for many a ‘good death’ represents more than the avoidance of suffering. And while mental-health campaigners argue that removing the stigma around suicide is a vital tool for prevention, in Japan there are concerns that a cultural validation of ‘honourable suicide’ accounts for its startlingly high incidence. Meanwhile, debates about presumed consent for organ donation and the display of human remains indicate that taboos around mortality have proven remarkably robust, even in more secular times.

Where do these trends leave us, in terms of deciding whether a particular death is good – or indeed, bad? Health officials have long used the measure of the ‘quality-adjusted life year’ to allocate limited resources when avoiding and deferring deaths – if our response to death is equivocal, will such stark calculus enter wider policy and everyday life? What becomes of our mortality and our morality in a world where death is thought of as a legitimate option?

Chrissie Giles
senior editor, Wellcome Trust; commissioning editor, Mosaic

Dr Jules Montague
consultant neurologist, Royal Free Hospital

Dr Richard Smith
chair of trustees, ICDDR,B; former editor, British Medical Journal; chair, Patients Know Best

Dr Kevin Yuill
senior lecturer, history, University of Sunderland; author, Assisted Suicide: the liberal, humanist case against legalization

Helen Birtwistle
history and politics teacher, South London school

Produced by
Sandy Starr communications officer, Progress Educational Trust; webmaster, BioNews
Recommended readings
The narcissism of assisted suicide

A shocking case shows that assisted suicide is about more than alleviating suffering.

Kevin Yuill, spiked, 11 August 2015

Why doctors get it wrong about when you will die

Doctors use data and experience to give their best prognoses for fatal illnesses – but patients can live for months or even years. Here, a consultant explains why

Jules Montague, Guardian, 2 June 2015

Breaking bad news

How do you tell someone that they’re seriously ill, or even dying? Chrissie Giles explores how doctors learn and how they deal with the stress and trauma, for both their patients and themselves.

Chrissie Giles, Mosaic, 13 January 2015

Dying of cancer is the best death

Stay away from overambitious oncologists, and let’s stop wasting billions trying to cure cancer, potentially leaving us to die a much more horrible death.

Richard Smith, British Medical Journal, 31 December 2014

follow the Academy of Ideas


Keep up to date with Academy of Ideas news and events by joining our mailing list.

Next year's festival will be packed with more debates like this one. If you would like to come, get your ticket now via our 2016 tickets page.
Session partners