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It has been said that the only certainties in life are death and taxes. Most people, at least those in the civilized world, view both with fear, even horror but perhaps death has a bit of an edge because it deals with the continued presence of a person on the physical plane and delves into the realms of the unknown.
Moore and Williamson state that there is much about death that humans fear because it is so often accompanied by pain and suffering for themselves, for those whom they love, even for strangers for whom they feel sympathy and empathy. (3) It is accepted that death is inevitable but for many people, it is not something they want to dwell about openly although may think about it constantly, especially when they or people they know are in the midst of it as in terminal illnesses or even just old age.
It has been suggested that the fear of death is a natural response shared by most sentient creatures. Even for animals that are presumably ignorant of death as a concept, self-preservation is paramount to all other considerations, except perhaps the preservation of offspring in some species. For humans, eight kinds of fear relating to death were identified. These are fear of premature death, fear of the idea of death, fear of the dying process, fear of the death of significant others, fear of the unknown, fear of being destroyed, fear of the body after death, and fear of the dead. (Moore and Williamson, 3)
Of these dimensions, perhaps the most significant in human history is the fear of the unknown, or what happens to a person after death, and fear of the dying process. Because the former is the aspect of death that remains largely undiscoverable and unprovable in any practical way, it has been the subject of much philosophical debate. This paper will discuss some of the arguments regarding this particular dimension of death and dying and how helped shape religious practices and society. It will also touch on the fear of the dying process, how medical practitioners regard terminally ill patients, and the ethics of withdrawing treatment.
Platoon death and the soul
Phaedo is part of the Middle Dialogues, a series of conversations that are considered to be one of the most dramatic and intense of Plato’s works, and this particular section dealt almost entirely with death and dying (Cooney).
The dialogue begins after the death of Socrates from poisoning, in which Phaedo recounts to Echecrates the views of the dying Socrates’ on the meaning and nature of death. Phaedo describes Socrates as “his mien and his language were so noble and fearless in the hour of death that to me he appeared blessed” because he believed that “…he who has lived as a true philosopher has reason to be of good cheer when he is about to die” and that “the body is a source of endless trouble to us …introduces a turmoil and confusion and fear … experience shows that if we would have pure knowledge of anything we must be quit of the body, and the soul in herself must behold all things…after death” (Plato).
The passages are much longer than have been presented here, but the gist of Plato’s arguments propounded on the dualism of the soul and the body. He believed that death was the release of the soul/mind from the prison of the corruptible and susceptible corporeal body that clouded wisdom with the fruitless pursuit of wealth and pleasure.
But Plato went one step further. He argued, through Socrates, that there is life beyond death: “I do not grieve as I might have done, for I have good hope that there is yet something remaining for the dead”. He goes on to argue that life and death are opposites that generate each other, which brings to mind the concept of reincarnation. Plato argued that life comes from death, because the soul is indestructible and that only the enlightened soul, which has gleaned all the knowledge, it can from the corporeal world has no need to return and is free to exist in pure and untainted form (Plato).
However, for the “… soul which has been polluted, and is impure at the time of her departure, and is the companion and servant of the body always… depressed and dragged down again into the visible world… certain ghostly apparitions of souls which have not departed pure, but are cloyed with sight and therefore visible” Plato describes what is commonly referred to as restless spirits, those who are unable to leave the corporeal world. In popular fiction, there have been some creative interpretations for the nature of such spirits, which is not to say is inaccurate, but perhaps not what Plato had in mind.
The arguments in Phaedo are compelling, albeit quite lengthy and covering substantial ground into the nature of the soul and the consequence of death. However, near the end, Plato discomposes the reader by admitting quite clearly that he was in no way confident of his arguments. He states through Socrates that “For if what I say is true, then I do well to be persuaded of the truth, but if there be nothing after death, still, during the short time that remains, I shall save my friends from lamentations, and my ignorance will not last, and therefore no harm will be done.” He is quite clever about this because he knows that such claims are not to be proven or disproved. Belief is all that matters because faith is the one thing that will give meaning to death.
Some parallelisms of this philosophy are reflected in The Tibetan Book of the Dead, a manual if you will for the dying based on Mahaayaana Buddhist thought when Buddhism was in the early stages of development. In it, the concept of death is that of release, in which the enlightened and prepared to realize the true nature of reality and descend to what is referred to as Voidness, the emptying of the consciousness into pure truth. However, it does prescribe lifelong preparation for the event or barring that, faith in the directives of The Tibetan Book to prevent the turning away from Voidness, inevitable for those who may are unprepared and disbelieving. This parallelism is significant because it provides significant insight into the universality of such concepts, occurring as it does in disparate cultures (Cohen, pp. 323-324).
Good and evil: religious implications
Plato stated in Phaedo “…. these must be the souls, not of the good, but of the evil, who are compelled to wander about such places in payment of the penalty of their former evil way of life; and they continue to wander until the desire which haunts them is satisfied…” referring to tainted souls.
This brings the discussion to the rise of religious beliefs concerning death and the afterlife. Perhaps the greatest fear that humans have of death is the absence of the meaning of their lives and of being forgotten once they shuffle off this mortal coil. Religion offered humans a connection between the living and the dead in various ways. Early human religious systems included ancestor worship in which they believed the long-departed watched over those who followed. Christians believed that death would allow the pious to live forever in the presence of an almighty God, while the impious will be condemned to Hell. Eastern religions pandered to the idea of reincarnation in which the pursuit of nirvana was the ultimate enlightenment while the Greeks used rational arguments and philosophy to seek how death could be the gateway to ultimate knowledge. In each of these systems, the belief in life after death helped humans retain hope that their physical death would not be all that there was and nothing more (Moore and Williamson, p. 4).
In most organized religious systems, the emphasis is on following a set of rules according to socially and culturally prescribed moral and ethical codes. Transgressions had their equally prescribed set of sanctions, the ultimate punishment being sent to an undesirable place or state. This compelled adherents to follow the religious rules or face the consequences when the time comes. In essence, humans are unable or unwilling to believe that death is the complete annihilation of being and subscribe to a belief system that precludes such a notion (Moore and Williamson, p. 4).
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The treatment of dying patients
The rise of modern medicine pushed the specter of death further from daily life for most societies. Death became something that could be avoided and people began to believe that science could solve everything eventually. Death and dying were often portrayed in mass media and discussions had become open about how death is a daily occurrence in life, but very few had the first-hand experience of the actual process of dying. It became routine to send the dying to be cared for by health or medical professionals in the hopes of prolonging life, palliate pain and discomfort, or affecting a cure. (Moore and Williamson, 9) However, this created a set of situations that brought to the fore what has become a controversial issue of late: the care and treatment of the terminally ill or persistently vegetative state patient.
It was Swiss doctor Elizabeth Kübler-Ross who brought the world’s attention to the detached and uncaring attitude adopted by physicians and other medical professionals towards those who were terminally ill. Such patients emphasized the fact that doctors were fallible, and death was seen as a failure. Many sought refuge in the belief that they could be of more use gearing their efforts to patients with a better chance of survival but they were neglecting to properly care for these patients. Kübler-Ross made a study of the terminally ill and concluded that those who came in contact with death either as someone who is dying or who was close to someone who had died or was dying went through what she referred to as the Grief Cycle.
A good illustration of this patient-physician state is the play by Margaret Edson “Wit” which dealt with the suffering of successful middle-aged seventeenth-century English poetry scholar Vivian Bearing battling with stage four ovarian cancer. It relates how during her illness, she is reduced to being a set of symptoms and treatment protocols that seeks only to investigate just how much she can withstand before death rings down the curtain. She is treated as a case rather than a person and no effort is made to prepare her for what is to come.
In an interview about consoling and easing the plight of the terminally ill patient, Kübler-Ross asserted that each patient has different needs depending on their cultural and religious constructs but two things remain constant and go hand-in-hand: the need for loving support and faith. The support can come from family, from people who know the patient, or people who provide care. Faith must come from a firm belief in what life after death will bring. The absence of one or the other or both indicates a less than a full life, which makes the caring attention of medical professionals even more important. Babies and children with terminal illnesses have been known to make surprising recoveries when given warm, loving care. In dealing with the dying, doctors, nurses, and hospice attendants can best help ease the pain and fear of death by offering hope of better things to come even as the end draws near. Medical attendants should answer the patient’s questions as truthfully as possible without eliminating all hope. Kübler-Ross stated that no one person could state for sure what will happen and that there was always a chance of recovery, even one percent that can sustain the spirit of the patient.
Another important aspect of caring for dying patients is considering their best interests. A terminally ill patient may wish to end their days in their own homes although there is a chance they may live longer in a hospital. Kübler-Ross emphasized that in the Grief cycle, the ideal state is that of accepting serenity. The quality of living will improve immeasurably even as death becomes imminent when patients are given some control over the circumstances of their death. They may take comfort in having their family around them rather than tubes and machines, and if they can articulate such wishes it is often best to acquiesce to such wishes. In Edson’s play “Wit” Vivian learns through eight months of suffering that pride and her callow treatment of other people had isolated her in her time of need. (Sykes) Dying a “good death” is not only a state of physical preparedness but also that of psychological and spiritual contentment. (“Is there such a thing as a good death?”) However, this also raises the issue of just how far medical professionals can go to assist in acceding to a dying patient’s requests.
The extent of treatment
Health care providers are bound by two ethical considerations: beneficence and nonmaleficence. These translate to keeping the patient’s best interests foremost and doing no harm. In cases where there is nothing else that can be done for a patient based on existing treatment protocols, and the continued administration will result in unnecessary pain and distress to the patient, then it is a clear violation of nonmaleficence. If upon consultation with the patient, who is found to be competent and consent or the desire is expressed is given, then treatment can be justifiably withdrawn. In cases where the patient is no longer able to articulate a personal preference and the surrogate insists on continued treatment, there is a need for medical professionals to seek to withdraw treatment through legal means. In many cases, however, health providers are compelled to continue providing palliative care and treatment. Without exception, patients should be accorded humane, compassionate care (Baumrucker, pp. 170-172; Braddock).
Death and dying is a concept that has been a subject of much speculation in human societies, nearly universal in its ability to inspire fear. In preliterate societies, the initial response to death is the flight from its presence. Social development has resorted to philosophical rationalization and religious dogma in attempts to find meaning in life by conceiving of an afterlife, but in essence, the desire to escape death is still very evident.
Even the achievement of longer life spans due to advances in medical knowledge has failed to eliminate the fear of death and dying as evidenced by medical, ethical, and legal issues surrounding the plight of terminally ill patients. However, the attempts of philosophical and religious scholars to alleviate some of the anxiety of a meaningless life has produced some of the best moral groundwork and the most admirable intellectualization for the human condition called life that could well pave the way to what can be considered a “good death” whether there truly is an afterlife or not. In the words of Plato “….no harm will be done.” Perhaps in the process, humans will truly exorcise the Hitler referred by Kübler-Ross as existing within each person. (Redwood)
- “Is there such a thing as a good death?” Palliative Medicine 18:5 (2004): 404-408. SAGE Publications.
- “The Kübler-Ross grief cycle.” Changing Minds. (n.d.) 24 2007. Web.
- Baumrucker, Steven. “The Ethics of Withdrawing Treatment: How Should the Choice Be Made?” American Journal of Hospice and Palliative Medicine. 23. (2006): 170-172. SAGE Publications. Web.
- Braddock, Clarence. “Termination of Life-Sustaining Treatment.” Bioethics Education Project. (1999) Web.
- Cohen, Maurice. “Dying as Supreme Opportunity: A Comparison of Plato’s Phaedo and The Tibetan Book of the Dead.” Philosophy East and West. 26:3. (1976): 317-327. University of Hawaii Press, Hawaii, USA.
- Cooney, William. “Plato.” Macmillan Encyclopedia of Death and Dying. (2003) FindArticles. Web.
- Moore, Calvin and Williamson, John. “The Universal Fear of Death and the Cultural Response.” Bryant. 1:1. (2003): 3-13. SAGE Publications. Web.
- Plato. “Phaedo.” Trans. Benjamin Jowett. The Internet Classics Archive. (n.d.) Web.
- Redwood, Daniel. “’On Death and Dying.” HealthWorld Online. (1995)
- Sykes, John. “Wit, pride and the resurrection: Margaret Edson’s play and John Donne’s poetry.” Renascence. (2003) FindArticles. Web.