While most clinicians have experience discussing resuscitation, talking about dying requires the patient and family be willing to think about the medical treatment not working. Clinicians hesitate to bring up dying because they worry it will raise strong emotions, and they’re not sure what to do. Like REMAP, discussing code status requires a shared understanding of the “big picture”, responding to emotions, eliciting values, and making a recommendation about code status based on the medical reality and the individual patient’s values even if they differ from our own. The frame of “hope for the best, prepare for the worst” may help with the discussion. As people near the end of life, there are often questions that are hard for patients and families to ask, like what dying looks like, issues brought up by trauma or stigma, spiritual or existential concerns, or when the dying process is longer than anticipated. When clinicians create space for these sorts of concerns, we can address uncertainty and suffering that would have otherwise gone unspoken. Finally, being able to say goodbye to a patient requires insight and skill, but can be deeply meaningful for all involved.

A minority of countries or parts of countries have thus far accepted the legal practice of Medical Assistance in Dying (MAiD) (euthanasia and assisted suicide), but legalising MAiD is expanding worldwide. More countries are debating legalisation of euthanasia or assisted suicide, but the nature of laws and legal practices vary greatly and both ethical and empirical assessments of current practices are the subject of much controversy. We examine the premises and evidence in the rhetoric of assisted suicide and euthanasia. We illustrate the trend with the rationale and political concerns that led to the legalisation of euthanasia in Quebec as “Medical Assistance in Dying” (MAiD), and its subsequent expansion in Canada to include persons who do not suffer from a terminal illness, including persons who suffer only from a mental illness. The values of autonomy, “dying with dignity“ and their ethical and legal bases for justifying MAiD are critically analysed. The implications of practicing euthanasia, as opposed to assisted suicide are discussed, as well as proposals for a duty to die in some circumstances. We conclude by proposing that besides debating the legal, moral and practical concerns with MAiD, we should also focus on the psychological roots of our fears and ways to reduce those fears in individuals and societies.

This chapter examines Tolstoy’s treatment of mortality – from his earliest published works to his last, and in letters, diaries, and conversations – as a long preparation for his own death. It draws especially from his later period, when he drew nearer to death and became increasingly focused on it, often reminding those around him, and his reading public, of their need to do the same. Thus, while Tolstoy anticipated death as a personal sacrament, he also created a context for the public to consider his passing as a collective examination of his values. The chapter concludes with Tolstoy’s death at Astapovo railway station in 1910, where he attempted to meet his own expectations for this moment within the spectacle created by a public bent on treating it as its own rite of passage.

Sherman argues that Marvell contributes to the secularization of the ars moriendi by exploring problems of taste in scenes of death. Sherman situates Marvell’s interest in taste by glancing at French and Italian forays into literary aesthetics and by Marvell’s own disquisitions on offensive style in his prose polemics. It is no surprise then to find Marvell experimenting with problems of good and bad taste in poems describing death like 'An Horatian Ode', 'The Unfortunate Lover', 'The Nymph Complaining for the Death of her Fawn', and in the tableaus featuring the demise of Captain Douglas. Sherman suggests that Marvell taps into Catholic iconography associated with the arts of dying to overstep the bounds of aesthetic and rhetorical decorum. He appropriates the sensuality of the Counter-Reformation’s aesthetic exalting the martyred body and the literature of tears (ars lachrimandi). With his focus on moments of sudden death, Marvell casts doubt on the value of preparing for a good death, instead preferring to observe how beauty is cut down in its prime. In this way, Marvell’s poetry of memorialization aestheticizes mortality and the work of mourning.

Key Learning Points

1. 1. Recognise and overcome the barriers to good communication.

2. 2. Treat patients as individuals.

3. 3. Work in partnership with patients.

4. 4. Listen to the patient’s concerns.

5. 5. Be honest and open, and act with integrity.

While the stories and hidden histories of the dead stand at the heart of this book, it is important to frame these narratives against the restrictions and permissions of the ‘laws’ that governed matters of consent, harvesting and research in modern British medical research. This seemingly simple endeavour is considerably complicated by the fact that as well as direct legislation on these matters, medical practice and the ‘rights’ of the dead and dying are shaped by legislation in other areas of criminal, civil and administrative law. Official and unofficial ‘guidance’ and long-established customs also have purchase on these matters. In turn, the fact that much ‘law’ merely clarified or amended previous legislation rather than repealing it, means that ‘the law’ becomes ‘the laws’. Thus, there is often considerable scope for differential interpretations of legal permissions at any chronological point. In this sense, law matters very much for the interpretation of the stories that we will go on to encounter in the rest of this volume. This second chapter therefore explores complex issues of legality, legislation and informed consent

This chapter asks where and how Rome (and, by extension, polemics self-consciously characterized as reactions against Rome) figures in efforts to determine what the living owe to the dead, and what the dead can do for the living. Latin occupies a controlling position within this inquiry; so, too, do texts that cast the world of the living as the home of the dead; so, finally, do Reformation-era debates about the soteriological stakes of praying for the dead. These topics span a period of time in which Rome is the gravitational centre of a sequence of massive upheavals in vernacular piety and attendant debates about the relationship between the living and the dead. The chapter argues that interpreting these debates as facets of the fact of Rome alerts us to the role that the human voice plays in probing the limits of mortality and the nature of the human as such.

There is no second chance to improve the quality of life of a dying patient. Getting it right allows a good death and leads to an uncomplicated bereavement for the family. However, there is much more to palliative care prescribing than just instituting a syringe driver: this chapter provides important information on opioid use (including how to calculate breakthrough doses and converting oral morphine to subcutaneous formulations), antiemetics and other commonly used drugs in palliative care.

In chapter 9 I use Ivan Ilyich’s life, as told by Leo Tolstoy in The Death of Ivan Ilyich, to answer the question of the chapter, how should we live so as to die well? One answer is to be open to knowing our inner lives, to what is good, and to God. Another is to develop character traits opposite to those of Ivan Ilyich, which were delight in the power to crush his inferiors, pleasure in trivialities, and excessive self-regard. The chapter also describes the moral agony that Ivan Ilyich experienced as a result of his dying, his resistance to examining his life, and the openness he needed to have to be aware of his inner life. The chapter ends with a conversation between an imagined, transformed Ivan as he lay dying and a friend of his.