End of life care, dying and death
These resources have been used as catalysts for discussion in learning events about the ‘art of a good death’ and are linked to these five questions:
■ How do we see death?
■ How do we talk about death?
■ How are those who care for the dying seen?
■ Can death ever be as natural as being born?
■ What might the future look like?
How do we see death?
Think about art you have seen that depicts death.
Have you noticed that death is frequently personified and portrayed as something sinister?
Death in art can be portrayed as an individual experience or something that ‘visits’ whole communities.
What other images or symbols of death are you aware of?
Death often occurs in hospitals where the use of life-saving equipment can add to the feeling that death is not natural.
This disturbing image is one of a collection, Medical Records, by Giancarlo Vitali. More of his work can be found on the website Artemedicina.com, when art meets medicine.
Maesha Elm Elahi a fouth year medical student reflects her experience of observing dearth in her poem, Where did she go? (I don’t know, I don’t know, I don’t know) published in Intima, a journal of narrative medicine
Even when death is portrayed in the beauty of the natural world the image is not often peaceful.
The subject of the painting is Shakespeare’s character Ophelia, who committed suicide after her father was killed by her lover, Hamlet. The creation of this picture by Millais was not without drama as his model Elizabeth Siddal nearly died from exposure after posing for hours in an inadequately heated bath of water.
Death come to everyone, but I wonder if those who are dying feel connected as described Helen Dunmore’s final poem. Helen died of terminal cancer, her poem makes me wonder what her experience of dying was like.
I hope reading this you will be encouraged to explore more of Helen Dunmore’s poems and literature.
This poem is published in her book Inside the Wave
My people
My people are the dying,
I am their company
And they are mine,
We wake in the wan hour
Between three and four,
Listen to the rain
And consider our painkillers.
I lie here in the warm
With four pillows, a light
And the comfort of my phone
On which I sometimes compose
On the words come easily
Bubbling like notes
From a bird that thinks it’s dawn
My people are the dying.
I reach out to them,
A company of suffering.
One falls by the roadside.
And a boot stamps on him
One lies in her cell, alone
Without tenderness
Brutally handled
Towards her execution.
I can do nothing.
This is my vigil: the lit candle,
The pain, the breath of my people
Drawn in pain
How do we talk about death?
What words about death and dying do you use in your conversations with patients?
What words do you hear your colleagues use and what do you hear used in the media?
In the UK we are often reluctant to use the words ‘dying’ and ‘death’. Is there a reason for this?
Rachel McCoubrie, a Consultant in Palliative Medicine reflects this beautifully in her poem which is published in the wonderful anthology of poems, These are the Hands- Poems from the Heart of the NHS.
The ‘D’ words
Let’s just say Jim didn’t fix it.
She’s toast, brown bread;
Bought it, croaked it,
Pegged it, snuffed it.
Any of these, but don’t say dead…
With the angels now
Passed on, passed over,
Gone to sleep,
At peace, we’ve lost her,
Pushing up daisies,
Living in a box.
She’s kicked the bucket,
Got wings and flying,
Thrown a seven,
Gone to heaven,
But nobody ever said dying….
Deteriorating, crook, unwell,
Going downhill,
Paid her final bill,
On a one-way track,
No way back.
Poorly,
Really poorly,
Really, really poorly,
Going to get better surely?
Quite unlikely to recover,
It’s getting serious now my lover.
She’s struggling to catch her breath
But let’s not talk about death…
Euphemisms and clichés
What trite we all say.
Death, Dying, Dead
They’re easily said.
We know what they mean
When we’re setting the scene;
So just use the ‘D’ words instead.
In the film, The Farewell (2019) any mention of dying and death is avoided.
How are those who care for the dying seen?
If you provide care for someone who is dying, how do patients see you?
Read more about this photo.
Reflections on Art, Voicelessness, and the Patient Experience.
Conversations about death and dying are commonplace for every healthcare professional. Those clinicians involved in organ transplants will have conversations with families and patients that are particularly complex and harrowing. Rachel Clarke’s sensitive book narrates the stories of everyone involved in the transplant of a heart from one dying child to another.
Read more about this extraordinary story in the Guardian review.
Can death ever be as natural as being born?
Death is the only certainty in life.
For those who live neither with religious consolations about death nor with a sense of death (or of anything else) as natural, death is the obscene mystery, the ultimate, affront, the thing that cannot be controlled. It can only be denied’. Susan Sontag
Maybe the fear we hold about our own death is what inhibits us from talking more openly about what a good death might look like.
As clinicians we need the skills and language to be able to discuss death sensitively and help people make sense of what is going to happen in the context of their culture, health beliefs and traditions.
Here are some warmer, kinder, more gentler resources.
Film
What we did on our holidays (2014)
Grandad (Billy Connolly) has just died while in sole charge of his grandchildren on the beach. They decided to give him the Viking burial they often heard him speak about.
Departures, is a beautifully moving film which explores the rituals surrounding death in Japan.
Poetry
Julia Darling is a wonderful poet from the Northeast who used her poetry to help people manage illness, death and bereavement, to change the way that hospital systems and doctors deal with their patients, to break the mould, and to change the vocabulary. She also used her words in her poems to express her own experience of illness. Julia died from metastatic breast cancer. She leaves behind a legacy of beautiful poems that you can explore in more detail on her website.
This is her final poem.
End
Eventually, I was placed on a bed like a boat
in an empty room with sky filled windows,
with azure blue pillows, the leopard-like quilt.
It was English tea time, with the kind of light
that electrifies the ordinary. It had just stopped raining.
Beads of water on glass glittered like secrets.
In another room they were baking, mulling wine.
I was warm with cloves, melting butter, demerara,
and wearing your pyjamas. My felt slippers
waited on the floor. Then the door opened
soundlessly, and I climbed out of bed.
It was like slipping onto the back of a horse,
and the room folded in, like a pop up story
then the house, and the Vale. Even the songs
and prayers tidied themselves into grooves
and the impossible hospital lay down its chimneys
its sluices, tired doctors, and waiting room chairs.
And I came here.
It was easy to leave.
Music
Might there be a piece of music that evokes the feelings of a peaceful death?
Maybe it is The Armed Man, a Mass by Welsh composer Karl Jenkins, subtitled “A Mass for Peace”. The piece was commissioned by the Royal Armouries Museum for the Millennium celebrations, to mark the museum’s move from London to Leeds, and it was dedicated to victims of the Kosovo crisis.
What might you choose?
What might the future look like?
In 2003 the BMJ published a series of articles exploring this question, two decades later the subject of death is very much in the news as the debate about assisted dying is on the political agenda.
What do you think is a good death, and how do you explore this with your patients?
What role will AI play in end-of-life care?
Does Kashio Ishiguro’s science fiction book, Never Let Me Go, imagine a possible future?
Never Let Me Go takes place in a dystopian version of late 1990s England, where the lives of ordinary citizens are prolonged through a state-sanctioned program of human cloning. The clones, referred to as students, grow up in special institutions away from the outside world. As young adults, they begin to donate their vital organs. All “donors” receive care from designated “carers,” clones who have not yet begun the donation process. The clones continue to donate organs until they “complete,” which is a euphemism for death after the donation of three or four organs. Sparknotes summary
Do share any resources you have found that have helped you learn more about ‘the art of a good death’.
Resources to explore grief and loss are in the next section.
Page created 2019 and updated 2025