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Ira  Byock, MD was the Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire and is currently Professor of Anesthesiology and Community & Family Medicine at Dartmouth[…]

Dying is a part of living. Yet our inability to imagine death is a limiting factor. Confronting death allows us to complete relationships, tell our stories, and make peace with the reality that life is coming to a close.

Question: How should we face death as a society?


Ira Byock: We have a remarkable posity [phonetic]of ability to imagine what a positive end-of-life experience would look like. We can only imagine death and suffering and its avoidance. That’s about the brightest we can get is, oh I hope I die quickly, I am hope I am hit by a truck or die in my sleep, and I don’t suffer. If I ask people what a good death looks like for them, they will often say, “I don’t want to suffer and I don’t want to be a burden to my family.”

“I don’t want to die in pain, I don’t want to die gasping for breath, Doc, I don’t want to die lying in my own filth, I don’t want to end up in a nursing home, and I don’t want to be a burden to my family.” If you think about it, it’s as if our vision of the good death was a photographic negative, there is nothing there, there is no tone or texture or color, it’s as if was a whole bordered by the things that we fear.

That is the main problem, death feels like it’s falling of a cliff, and similarly dying in death are equated, we often use the two words interchangeably. In reality as hard and as unwanted as it is, dying is a part of living. And it has its own intrinsic challenges, risks certainly, but also its potential value. For many people the reality is that this time of life we called dying is often an exceedingly important time in their lives and their families lives, but our inability to imagine is really a limiting factor.

We know, if you only know what you want to avoid, you still don’t have a direction toward which to head. And so I think it’s really important not as a – it almost sometimes seems unseemly to talk about people we know who have died well, but I submit it’s culturally critically important to explore the stories of real people who have in their own words or their own experience died well, because it provides us with some cultural orientation, a diversity of positive experience toward which we could being to imagine a path ahead that for ourselves and our families feels like something of value morally and tangibly and culturally of value despite the inherent sadness that this time entails.


Question: Who has died well?


Ira Byock: Art Buchwald recently died, well he was a hospice patient, interestingly went to hospice care thinking that he was dying in a few days to weeks, ended up living, I don’t know 15 months, graduated from hospice care, wrote a bestseller while he was a hospice patient, I think that’s pretty good, but also if you read his book talks about the importance of this time, in from my perspective they were discernable developmental tasks that he was able to accomplish revealing his life, completing relationships, telling his stories, making some inner peace with the reality that his life was coming to a close and being able to look forward into a future where he would not be physically present all of those things.


Recorded on: March 21, 2008