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Describes wrestling with how we respond to hearing from an old friend that he had inoperable liver cancer – and why silence will not do. Summarises what is covered in the rest of the book.

Philip Giddings

What could I say? My old schoolfriend Duncan had just rung to tell me the bad news. I knew he had not been well, but it was a shock to hear that, after many tests and treatments, the doctors had concluded he had inoperable liver cancer, and only months to live. He was very matter-of- fact. I could not help ondering what he was really thinking, and whether he was prepared for death. Typically, he did not want to discuss it, and expressly forbade me to tell friends we shared since school.

As the months crept by, I wrestled with what to say to Duncan, his wife, and our friends. Should we visit him and, if so, for how long? Yes, we did – but briefly. What to say at Christmas – probably his last? How could we support his wife? We are of a generation in which men ‘don’t do feelings’. In our society, there continues to be a wall of silence around the subject of death and dying. All kinds of euphemisms are used to avoid the plain truth. Even medical and caring professionals struggle with how to put it. Too often, we say nothing at all. So after the death of a friend or relative, we find ourselves saying, ‘I wish I had been able to say or do . . .’

We are easily put off by fear – our own fears, and the ones we guess would trouble the dying, or others close to them. So we take refuge in talking about trivia and banalities because to introduce the subject of death might seem morbid or demoralizing. We collude with the assumption that the best way to deal with dying is to ignore it – to hide our anxieties and sorrow in diversions which we hope will numb our own pain at the prospect of losing someone we care about.

This book has been written from a shared conviction that silence will not do. We need to talk about dying and death. It is an unavoidable part of human life: death comes to us all. We can try to ignore its coming, but sooner or later it comes. And before we face our own death, most of us have to deal with the pain of losing someone close to us – the brute fact of separation from that person. Our own life, and the lives of those close to us, will all come to an end.

To talk about dying and death will often be helpful to the dying person, and to their relatives and friends. This is especially so if, as is often the case, talking leads to action on our part or the part of others. We should take opportunity to show care and love, in word and deed, when we can. ‘Talk about’ means, of course, listening as well as speaking, and even sharing silence together. Many of us find it difficult to share our deepest emotions, and that is when an arm round the shoulder or squeeze of the hand speaks more eloquently than mere words.

There are also practical benefits from talking about the approach of death. There are preparations to be made, such as making or updating a Will, planning the funeral, making contact with folk with whom one has lost touch, perhaps taking the steps to heal a long-standing breach with a relative, friend or neighbour. Discussing these and other matters can help us, and others who are close to the dying person, to deal more positively with the death itself and its aftermath.

Yes, but how? What can we say? It is one thing to feel, as I did when Duncan rang, that we ought to talk about dying and death. It is quite another to know how to go about it. As we have discovered whilst preparing this book, many people want to talk about death and dying, particularly to close relatives and friends – but do not know how. We trust this book will be of help. Let death no longer be the great unmentionable, but something we talk about honestly and constructively.

Chapter 1 looks at the different ways in which people respond to life-threatening illness. Surprising as it may seem, for some, life is enhanced by their diagnosis. They discover and cherish the people and experiences that really matter to them. By contrast, as we shall see later in Chapter 9, some are paralysed by the uncertainty and fear which such an illness brings, even to the extent of refusing to accept what seems inevitable. Whatever our response, there will be difficult decisions to be discussed and taken, especially by those nearest and dearest to the dying person.

In most cases, discussion begins with a doctor or consultant, talking about the diagnosis and how to treat or manage it. That is never easy, so in Chapter 2 we consider how we approach such meetings. Patients and relatives naturally want to continue treatment, and hang on to hope of recovery. Hope is at a premium and can too easily become focused on the doctor. ‘Surely there is something you can do.’ Difficult questions can arise at any point: at the initial diagnosis of terminal illness; during treatment – curative or palliative; in decisions about withdrawing treatment; or not attempting resuscitation. Here we also deal with ‘Advance Decisions’ (also known as ‘Living Wills’).

A recurrent theme throughout this book is that we lack control over the circumstances of our own death. We don’t know when we will die. Neither do we know where we will die, or how we will die. If we have the choice, is it better to die in hospital where medical expertise is at hand, or in the more familiar surroundings of one’s home? Then questions arise on the time-scale of our death. Since mortal disease can often involve significant pain, we may face pressure to shorten that period of pain, for example by ceasing treatment. This has been central to the debate on the controversial questions of euthanasia and physician-assisted suicide. In Chapter 3 we tackle these difficult questions of when, where and how, and draw on some remarkable experiences of the work of palliative care professionals and hospices.

Sometimes, however, death comes unexpectedly, even suddenly. (As I mentioned in my Preface, my wife died completely unexpectedly whilst I was writing my contributions to the first edition of this book.) In such cases, there is no time, or very little time, to talk about dying. Sudden death is the subject of Chapter 4. Such death may be the result of a car accident, or an accident at work, or at home, or during a holiday abroad. It may be the result of crime or war or a so-called ‘natural disaster’. All of a sudden we are confronted with the stark reality of living without our loved one, our neighbour, our colleague. Do we go into denial, and try to carry on as if nothing has really changed? Or do we try to find someone who understands, with whom we can talk? How do we deal with the difficult questions about who, if anyone, is to blame?

From here we turn to two types of sudden death. In Chapter 5 we address the tragedy of suicide and how to cope with the practical and emotional issues it raises. And in Chapter 6 we consider the death of a baby, either as a result of a miscarriage, stillbirth or, as in the case of my own son Andrew, during the very early hours or days of life.

After a suicide, or the death of a baby, we often find ourselves having to talk to children as well as adults. In Chapter 7 we should the child be told? When is the time to ‘let go’? What about the different stages of childhood – from infancy to adolescence? What do we say to other children – siblings, friends, classmates? And to parents struggling with their own advance grief? Here we are privileged to draw on the expertise of the children’s hospice movement and other agencies for dying and bereaved children, which have done so much to transform children’s (and parents') experience of dying.

In Chapter 8 we raise the issue of what happens after death. Is death ‘the end’ or is there life after it? We consider a range of views, from the secular world and from the world of faith, and we look from the Christian perspective and what the Bible says about death, about heaven, and about hope. Many people want to avoid talking – or even thinking – about death because they are afraid: afraid of pain, afraid of loss of control, afraid of the unknown, afraid of death itself.

In Chapter 9 we consider how to face up to our fears, in their many dimensions. Our reluctance to engage with reality has to be overcome when a loved one faces a terminal diagnosis. Here we draw on the experience of those in various counselling professions, as well as on the significance of Christian hope.

We follow this in Chapter 10 by considering how healing can come to minds and spirits even as we face the dying of our bodies. In spite of the tremendous advances of medical science in recent decades, there remain limits to what medicine can achieve. So there can come a point when we have to admit there is no prospect of ‘cure’. In that situation, the role of consultants, doctors, nurses and other carers changes. The emphasis moves from ‘cure’ to ‘care’ – making the process of dying as comfortable and painless as possible.

At this point, particular questions may arise for people of faith. For example, what now is the role of prayer? How can we pray? For what can we pray? How can we bring hope to our dying friend and to their loved ones? Will the absence of healing – in the sense of cure – undermine faith?

In Chapter 11 we turn to practical questions – putting affairs in order, making preparations for an expected death, and what to do when someone dies at home. In addition the dying person may need to make, or update, a Will. Then there are questions of speaking to and/or seeing relatives and friends, and perhaps the need to ‘make one’s peace’ with some – and of thinking about funeral arrangements.

In Chapter 12 we return to the question we opened with. How can we help when someone is given the bleak news that they have a terminal illness? We offer some practical advice, and point to a few resources, noting a variety of contexts – spouses, children, parents, other relatives, friends, colleagues, whether they are on their own or members of social groups or churches. How do we introduce the subject? What can we say, and at what point? How do we deal with our own emotions and struggles?

The section ‘Where to find more help’ contains details of print and online resources.

Serious illness, dying, and death itself, pose profound questions, striking at the heart of what life is, and our sense of identity. We cannot provide all the answers. But by encouraging talking, we believe we offer a powerful way to help one another when we face up to these questions and challenges.

We, the authors, trust this book will be a help and source of hope to everyone, whatever your religious persuasion. Many have trodden these paths before us. By de-mystifying the processes and procedures involved, we will offer ways of making sensible preparation.

We ourselves are Christians for whom experience confirms the truth of those ancient words of St Paul, writing to the church in Rome: 'I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all
creation, will be able to separate us from the love of God that is in Christ Jesus our Lord.' (Romans 8:38)