Death

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Hello. Now, religious instruction was not really my best school subject. I mean, even as I say these very words, memories of the classroom surface. Taylor, what are the four last things ever to be remembered? Heaven? Hell judgment and and and death, Taylor, you missed out death. Well I was only thirteen at the time, but I really shouldn't have forgotten death. How to die well, how to ensure a good death by dying in a state of grace, and thus ensuring a primrose path to heaven.

Well, in my recent and rather more well, rather more secular years, I haven't given much thought to ways of dying, Until I was confronted by a new encyclopedic survey which promised to bring, can I quote, the art of death to life. Ac yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw'n yw.

Mary, we we we do have a lot I suppose to be thankful for when we start to talk about death. child mortality has plummeted and fewer of us will die of infectious diseases or or workplace accident. Yet you argue we've got much to learn from the past in terms of the way we deal with death. I mean that's the starting point of your book, isn't it?

That's certainly one of the starting points and whilst obviously historically we've made lots of progress, as you say, with things like child mortality because Yn y 18th and 19th centuries, yn ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud. Yn ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud. Yn ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud.

Mae'n ymwybodol yn ymwybodol yn ymwybodol yn ymwybodol ac yn ymwybodol ac yn ymwybodol ac yn ymwybodol ac yn ymwybodol ac yn ymwybodol. So there is still much to fight for and we're actually seeing the resurgence of some Victorian diseases again, cases of rickets and children um contracting measles and so on. So Mae'r prif o'r prif o'r prif o'r prif o'r prif o'r prif o'r prif o'r prif o'r prif o'r prif o'r prif o'r prif o'r prif.

ymwneud â'r ymwneud â'r ymwneud â'r ymwneud â'r ymwneud â'r ymwneud â'r We did better in the past, around engaging with death, around caring for the dying and so on.

And I felt like there were lessons that we could learn from the past. Yes, let's go into some of those now'cause I mean you you chart the enormous differences between dying and death today and the past. I mean, even just a few generations ago. I mean t tell me about some of the main differences you spotted.

In the past people tended to die at home. So well into the twentieth century most people died at home. That's an aspiration for many of us these days to die at home, but we tend to die ymwneud â phobl yn ymwneud â phobl yn ymwneud â phobl yn ymwneud â phobl yn ymwneud â phobl yn ymwneud â phobl They might be washed and dressed and prepared for burial by family members, sometimes displayed in the parlour in a coffin. Local community might come round and and and visit and pay respects.

So those were things that sort of normalised death. They domesticated death, if you like. Death was very much part of the household and therefore... Mae'n ymwneud yn ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud ymwneud. I was interested in the way you write about the moment of death, pinpointing the moment of death. I suppose in a way we take it for granted now that we know it, but...

All kinds of interpretations. That's a really interesting point that you raise. Yes. The stethoscope wasn't invented until eighteen sixteen. So in the past people would sit with the dying and and and and watch, you know, they would watch for the key signs of the end of life and that might be

changes in breathing. If you're familiar with the play King Lear and the tragic scene where Cordelia he's holding his dead daughter, he holds a mirror and a feather to her lips to see if they move, and that was one of the early ways that people might be able to tell that someone had died. Often people would employ watchers, someone to to kind of sit with the dying. Um, there's a story in the book about a lady called Mary Yen.

who was a nurse but also a watcher and she she lived in the late eighteenth to mid nineteenth century in Southwark in London and people might pay her to sit with their dying, to read to them, to comfort them, and to watch for these signs and this key moment of death. Unfortunately Mary, like many older people in the nineteenth century, ended her life in poverty and she was actually in in in a poor law record and then I traced her through the census.

It's quite hard. The the stories in the book that I tell are ordinary I'm using sort of quotes around ordinary because their lives were anything but ordinary but I found them mostly in census, Paula Records, Parish Records and so on. fed into debates that I've been having recently about how long one should grieve, you know. I mean with my age, other people around, old friends, comrades, colleagues die. How long should one grieve for? And you talk about

morning rituals and how long they should be and how extreme they should be. I mean give me a sense of some of these rituals from the past and and how we might view them from a contemporary point of view.

Mae'n unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw unrhyw Mae'r high point yw'r mid-19th century a lot of us think of the high point of mourning ritual as Victorian ladies swathed in bombazine and crepe and wearing Whitby jet beads and so on. And I appreciate this was very much a middle class and upper class custom and can look a little absurd to us uh today.

But on the other hand, people did use visual signifiers to to show and demonstrate what point of grief and bereavement they were they were in. And that could be quite helpful. One of the big motivations behind my book was How much grief shaped people's lives in the past?

Um so most people from quite a young age might have lost siblings, parents and so on. So bereavement, grief, loss surrounded them and and I think from that point of view it sort of helped to formalise mourning structures because because so many people had to sit with grief for such a quantity of their life. And so yes, that could lead to things that might seem a little formal and absurd to us today, but it

It did h hold a visual space for people. You know, these days we might feel a bit awkward when when somebody has lost a relative or a l or a lover or a partner. We might not know what to say. But I think in some ways, and I'm not advocating for a second that we swathe ourselves in crepe uh for two years after a death, but in some ways it created it carved out a very visual important societal space for people who were experiencing loss and grief.

Let's move on in a way to after death because I want uh you write very interestingly about talk about the ways they can protect the soul, ensure the soul leaves the body to go to a satisfactory place. Tell me more about those uh routines, those practices which went on the moment of death.

Felly mae'r moment o'r amlwg wedi'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i'i' So various rituals arose around death, some of them ymwneudol. Ymwneudol ymwneudol. Ymwneudol ymwneudol. Ymwneudol ymwneudol ymwneudol. Ymwneudol ymwneudol ymwneudol. Ymwneudol ymwneudol ymwneudol.

Now some communities, perhaps famously the Irish, uh developed very elaborate rituals around waking, for example. It might include um drinking, um games. Smoking games, yes, tobacco is often consumed awaits celebratory playful, extremely playful, perhaps you know, we might find them slightly shocking. Certainly many nineteenth century reformers did. And there was the idea that really these wakes, these revelries that you're talking about in various ways

Perhaps we're going too far. The idea came to be that we needed to do something about reforming burial that as a result, if you like, of the extravagance of some of these post death rituals. Reform happened in in the from the mid nineteenth century really. Imagine sort of Britain was heavily urbanizing during the late eighteenth and nineteenth centuries, so so what had hitherto been small parishes were becoming intensely populous and crowded.

a lot's of people often sharing the same house, even sharing the same room. So having a death within the house caused some public health campaigners uh quite a lot of anxiety, particularly after the eighteen thirties, after the first cholera outbreak, because

Some public health campaigners believed that the the smell of bodies was one of the reasons, one of the things that actually spread cholera. So in eighteen forty three a civil servant called Edwin Chadwick published a report about the problem of burial in towns, and part of the report

he identified was the problem of people retaining bodies in the home for too long. He thought it was unhygienic and unchristian. It was kind of a a veiled attack on the Irish community who tended to hold the longest wakes actually in some ways.

But but this led to a a a campaign to move burial out of the city, but also to shorten the time between death and burial. Let's talk a little bit about what was buried, because I mean some people insisted that it was right important that the whole body was buried, wasn't it?

there was also like a a problem about burying the body because of Grave robbers. I mean I hadn't I'd m heard of these before, but I hadn't realised that this was a significant and serious problem. It was a very serious problem and uh it was a very lucrative trade.

Often you will find people who worked for hospitals or surgeons would be quite heavily involved in grave robbing. They would take bodies that had been freshly buried. The problem was that medical schools and anatomists couldn't get their hands on enough bodies because As you've rightly said, for a lot of communities, being buried intact was really important for them for religious reasons. The day of resurrection they wanted to rise whole, they didn't want to rise in part.

Um so it was a very, very sort of important emotional thing for people to be buried whole. You can see if you go into cemeteries and graveyards, you might see graves with very heavy slabs or metal cages over them called mortsafes. And that was because people were genuinely quite anxious about being disinterred. Yes, well I mean that was completely new. I hadn't thought about that. I always been impressed by the monumentality of many graves.

But the idea it was really to keep the bodies inside them. Absolutely, to keep to keep the body intact. It was a thing of great fear for people. To be anatomized on a slab was was a fate worse than death. The Crown allowed a certain limited number of bodies and then after 1752, the government passed a Murder Act, which meant that anatomists could claim the bodies of people who'd committed a murder after they'd been executed.

But actually the the number of murders were g were going down in the eighteenth century so they weren't getting enough bodies to supply the number of students and anatomists who wanted to study this subject. This is the age of enlightenment, you know, people want to explore the body and really learn how it works.

but not enough people were willing to donate their body to science then. As I've said, it was considered by many a fate worse than death. So they resorted, I have to say, to some some fairly dodgy practices and Mae llawer llawer llawer llawer llawer llawer llawer llawer llawer llawer llawer llawer llawer

of murdering their victims and handing them on to the the famous medical schools up there in Edinburgh. Let's go for the present day. We've got a medicalised approach now to the end of life and you say Of course, paradoxically, that's almost resulting in a resurgence of interest in some of the

old ways of managing mortality. Modern medicalised death is is hugely comforting for many people. You know, we have amazing palliative care teams that that offer great care for people at the end of life and it's it's really important to to pay tribute uh to their work. But on the other hand, most of us want to die at home, um, statistically, um and so that's may not be practical for everybody, you know, at the end of life when we're very frail, when we need round the clock care.

So one of the things that is emerging is a death doula movement. So death doula, doula, comes from the Greek. It means sort of serving maid, but men and women are doulas. And these are people a bit like the watcher I talked about, Mary. They will sit with the dying, they will listen to them, they will try and understand what they would like, you know, at the end or after their life. They they might undertake practical tasks like shopping or walking the dog.

So I think Death Deelers can we can find their sort of antecedents in in in watchers like Mary. There's also the death positive movement, which is actually encouraging people to get involved with the rituals around death and round the body. So rather than have the undertaker, you know, whisk the body away after somebody has died, encouraging families if they f want to and they feel able to to wash the body, to prepare it for burial

And there's quite a lot of research now that shows that that helps people begin their grieving process. It helps the the journey of acceptance that we have to go through when somebody has died. I'm not s sure I should ask you this last question, but I mean you know I know you're a bereavement counsellor, you've written a very fine book. Tell me what I might take away from your book in terms of my

I can share my personal philosophy. I call it the grandiose name but for a simple concept, I call it liberation phonatology. And I call it that because I think if we can learn to sit with the prospect of our own death, we're all going to die. As my counselling tutor said, it's in the post. It's coming for all of us at some point. If we can learn to radically accept it It means I think we can we can assess the way we live our lives, you know. So so for me a really important thing is

So I think it's about thinking about the sort of life you want to have now. We don't know when and when we're going to die. A kind of approach that says Uh you know, I don't want to be obsessed with stuff. I I I have now, I have right now in this lovely conversation with you, this is the moment that we have.

And I'm grateful for that. So I think it's about reassessing our relationship to stuff and the time that we have and using it wisely. Molly Collinsby, thank you. Thank you very much. For the moment at least. Now's the time for a great deal on a new Honda. It's time to take an adventure. With rugged capability and commanding style. It's time for powerful performance, plus plenty of room in Start your journey in a brand new vehicle. Check out the Honda Ridgeline, pilot, passport, or CRV.

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Well it's time to turn to my next guest. He is Chao Fang, co author of a paper in social science and medicine entitled Exploring Good Death in China. a qualitative study from the perspectives of a family member. Well, you do talk about the way in which the idea of a good death runs perhaps against the predominance of Confucianism, which prioritizes Life over death. In Confucian uh traditions we try to emphasize More on life rather than death.

So we have good sayings living with suffering is still better than dying in a peaceful and dignified way. And that's why in China traditionally and also in contemporary Chinese society People still try to do a lot in order to prolong the dying patient's life, no matter what kind of costs they would have on to the dying individual. So in that way people s want to live as long as they can, but very often they would overlook the quality of life and also the quality of dying.

I mean you quote official data twenty twenty three shows over ten million deaths annually. I mean this has put a big increase, hasn't it, on the demand for high quality end of life care but Ond mae'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'n rwy'. Can receive palliative care. And like care in China is still in its very early stage. In many areas in China, palliative care equals

pain relief. So practitioners is still very much focused on the physical dimension rather than the holistic dimension of the dying process. You conducted thirty one interviews at a large Shanghai cemetery. It's part of what's called the Shanghai Quality of Death Project. This is sensitive research, isn't it? I mean how did you go about it? Yes, because we haven't had established model for palliative care, often practitioners they would heavily rely on Western centric models.

And uh people often talk about we need to achieve good deaths and in order to do so we need to respect patients' independence and autonomy. But independence and autonomy are defined in quite different ways in China compared to the Western context. The the data collection wasn't very smooth and uh one uh overall I have to mention is death and dying in China are heavily tabooed. So people would avoid talking about death.

as much as they can for so for example, at weddings during the Chinese New Year, normally we are not allowed to talk about anything in relation to that because that will bring bad luck. And that's why when we try to approach people for this project A lot of people don't want to talk about their loved one that And that's why we choose to uh approach people at cemeteries actually doing some traditional Chinese festivals, because tradition in China.

uh there's one festival called teaming festival, we would go to the grave to pay respect to our ancestors and our loved ones. So that's why we saw, you know, this time and this location would be a idea complex. to invite people to share their experiences and stories about death and dying. And of course, you know, in order to help people to understand our projects, we need to be empathetic. I mean one of the aims of your study was you were looking at

Uh one theme which emerged related to family authority, the authority they had over the autonomy of the dying person. You've got some words, I think, here that the words of one son who's Father died from old age. Could you read that for me? He was in hospital for four years. In the last two months he was in great pain and very angry. He told us

Prolonging my life is prolonging my suffering. And he said before he didn't want intubation, but we couldn't bring ourselves to remove the tube. This is just not what family do to a loved member. Yeah, that's very often the case. So I think one of the most important findings from our project is family uh support or family involvement can be a double edged sword because autonomy in China is always

uh relational decisions about treatment, decisions about the dying process are often collectively met by family members. So of course patients themselves as individuals, their interests and their preferences would be considered. But very often is interest of family as whole would be the priority. family members would consider so adopt children they wouldn't remove treatment for the elderly parents because in China traditionally this is not a good way to show filial piety.

for individuals to be cared for. And to die at home. Yeah, traditionally they would prefer to die at home because home is kinda more familiar, comfortable environment and also being surrounded surrounded by family members is always kind of key thing for achieving a good Even nowadays.

uh around thirty to eighty percent people in China nowadays, they still die at homes and th the figure would be even higher in rural areas. Yes, you're stressing the importance of the family, the way in which they may have a jurisdiction actually over the dying person. In this respect I wonder can you read me the words of one daughter in law describing her mother in law's funeral, because I think this gives us a good insight into the role that family members took.

The eldest son led the grave digging, while the younger son and I hosted guests. Descendants burned paper money and bowed to the altar of the ties priest at Chanted. We share stories during the video on the barrier day, one son carried her portrait, the other carries soul guiding banner with poor barriers following. At each crossroad the son knelt and others followed.

the priest performed the final rites as everyone bid a farewell. I mean here we have a family very, very much involved in the funeral. I mean there's the idea, the importance that a funeral does somehow bolster, increase family solidarity Jews for those purposes. Yes, so in China a funeral is a very important opportunity for family to come together to support each other.

From the inside But in the same time, the funeral can also be a good opportunity for the family as a whole to show their solidarity, to show to show their bones. to outsiders as a way to show them uh we are a good family. Let's introduce an economic element here now because healthcare isn't free in China. Yeah, finance is still a very big concern for many people in China when they are trying to deal with uh death and dying matters.

So I would say if this interview was conducted by a twenty years ago, the vast majority of people they would have big worries about their finance. But nowadays things have uh improved quite significantly. So now we have national health insurance. We haven't talked about the ideas of the afterlife. These influence the ways in funerals

are marriage, you know, in the West. What goes on in China? Yeah, I think this is a a very interesting question. So in China we don't have any kind of predominant religion. So people have freedom to believe in religions, but in the same time we don't have traditions like Christianity which have been with people for for thousand years. because we don't have any kind of predominant forms of religions.

people they have developed their own ways to find meanings about uh afterlife. So so some people they would tend to like Taoism, Buddhism, but some other people they would tend to something like they would create some kind of memory box for their family members. So I think uh in terms of how people understand what would happen after that, uh people actually have quite diverse ways

You point out that the idea of what might be a good death vary a great deal, I mean as Molly was uh talking about before. How would you characterize the approach to dying in Western cultures? Compared to the Chinese one? Okay, I think uh to me uh Western dying is very much individual centred. So you know in palliative care in an people often talk about how we will respect

patients autonomy, independence and their dignity. And the importance about dignity and autonomy is universal, but in China the way how people to interpret dignity, autonomy are quite different. Another w thing I would say as Molly has also mentioned, the dying in the West it has been very much medicalized. In China, dying has started being uh materialized but hasn't reached the level in the Western context. And the final point is again

dying and and black care in the UK are still very much medical. And in China of course the medicine has is also playing a very big role in shaping the dying process. But in the same time, you know, we also have some alternative medicine such as traditional Chinese medicine. So I'm seeing in some co community hospitals in Shanghai they would use candles sound therapy or a tai chi or many other kind of you know holistic to support the dying patients.

I would say the channel down where can be more holistic. Okay, there we must stop. Chao Fang, thank you very much. Um Molly, what sort of response do you make to Chao Fang's research? I mean, from the point of view of your own work. Really fascinating to hear about his research. Rydyn ni'n mynd i mewn gwirionedd yw'r hyn o'r hyn o'r hyn o'r hyn o'r hyn o'r hyn o'r hyn o'r hyn o'r hyn o'r hyn o'r hyn o'r hyn o'r hyn o'r hyn o'r hyn o'r hyn o'r hyn o'r hyn

continuity of the family but also celebrate the life that was. So in some ways there are lots and lots of similarities. I'm really struck by those last observations um around individualism and how that sits with palliative care in the West.

Palliative care is designed to be holistic here as well and I think more and more engages with people's perhaps spiritual and emotional needs as well as their medical needs. Over here the dying person presumably yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw'r yw.

So there is a question about how much agency somebody uh at that stage at the end of their life has over the decisions made to to kind of keep them alive or keep them going or not. So it's a really very interesting issue because it touches on history and culture and ethics and values and morays and how those are changing over time. Molly and of course her choice very much.

Well, it's not surprising, is it, that so many moralists and novelists and philosophers have sought to characterize the nature, the essence, the meaning of death. but sometimes too many words can stink up the place, which is why I'll give Pride of Place To these resonant few words from WH Orden. Death, Orden wrote, is the sound of thunder at a picnic.

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