The new year is a booming time of year for preventative medicine. With everyone awash in noble resolutions and good intentions, the gyms are packed and yoga studios are tight with sweaty mats.
Lettuce prices are skyrocketing. The realization that self-care is important instead of self-indulgent has innumerable positives, but for some it is driven by a dark motivation - the fear of growing old and dying.
As a physician in a busy intensive care unit, and as a Canadian physician who has provided patients with Medical Assistance in Death (MAID), I've spoken to countless people about their impending death or the death of a loved one. It’s clear that, as a culture, we are unaccepting and often in denial about the only real certainty (because taxes, at least, can be avoided).
For some it’s the death of a parent or close friend. For others it is a health crisis or a ‘near-miss,’ but ultimately, we all face the reality of our own decline and inevitable death.
Advantages of acceptance:
There are definite advantages to coming to terms with your own mortality. Two groups of people who are often farther down the path of considering their own mortality are those who have had a brush with death, and those who are seeking death.
People who've had a near-death experience (NDE) often describe it as a trigger for positive change in their lives. The experience brings them face-to-face with the reality of their own mortality in a very tangible way, and often leads to a fundamental shift in priorities. There’s a realization of what (and who) they’ve been taking for granted.
Patients who apply for MAID are almost always in the late stages of a terminal illness. They've been living with their disease for a period of time, and they've accepted that they are going to die. Although their stories are often tragic, to be in the presence of these people is a profoundly calming experience. They have a peacefulness and sense of resolution that is deep and intense, and their gratitude is astonishing. What a gift it would be to achieve that peace with more time to enjoy it.
An acceptance of death also leads to better preparation. You may not be able to choose when you die, but there may be choices that determine how you die (or more importantly, how you continue to live). Acceptance of death helps you prepare for those who depend on you, through your will and advanced directives. This preparation requires careful thought and communication, things that you'll generally not be capable of around the time of your death.
Coming to acceptance – the Stoic approach
Acknowledging your own death doesn't require a bad car accident or the diagnosis of late-stage cancer. An appealing approach to accepting the inevitability of decline and death comes from the ancient Stoics. Stoicism was one of the dominant philosophies of ancient Greece and Rome, a school of thought that grew from the teachings of Socrates. Its teachers included Seneca, Epictitus and Marcus Aureleus.
“Let us prepare our minds as if we’d come to the very end of life. Let us postpone nothing. Let us balance life’s books each day. The one who puts the finishing touches on their life each day is never short of time.”
- Lucius Annaeus Seneca
Stoics advocate spending considerable time thinking about death. One regular practice, ‘Momento Mori’, involves consciously remembering that our death is inevitable, and that the one thing we control is our response to the process. They found that instead of feeling depressed, frequently considering and accepting death leaves us empowered and appreciative.
“Think of yourself as dead. You have lived your life. Now, take what’s left and live it properly. What doesn’t transmit light creates its own darkness.”
- Marcus Aurelius
Here are a few exercises to empower you and help you ‘own’ your mortality:
1. As a journaling or thought exercise, imagine you’ve received the news that you have a terminal illness and have less than six months to live. What would you most want to spend your time doing? What would you stop doing? Who would you want to be with? Who would you share the news with, and who would you feel reluctant telling? Who could you count on for support to the end? What would your legacy be?
2. Hold a Death Over Dinner party. Death Over Dinner is a movement to reduce the stigma of discussing death, offering a process that helps stimulate a death conversation with the people who mean the most to you. Details can be found at https://deathoverdinner.org/
3. Write your ideal obituary. How different is it from the obituary that would be written about you today?
4. Plan for your death. Write or update your will. Put your end-of-life wishes in writing, and most important: tell them to your people.
Dan Howes is a Canadian physician and Stoic who has a passion for end-of-life issues. A serial entrepreneur and expert in the evolution of hiccups, Dan dances with his family in Kingston Ontario after discovering the magic and joy of late adulthood through MEA.