Living & Dying Well | Lydia Dugdale & Alua Arthur

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Living & Dying Well | Lydia Dugdale & Alua Arthur

March 19, 2020

Dr. Lydia Dugdale of Columbia, Dr. Raymond Barfield of Duke, Alua Arthur, attorney and "Death Dula" discuss the meaning of death and living with the weight of our mortality. On stage at Ohio State University. Moderated by Ashley Fernandes. • Like, share, subscribe to, and review this podcast. Thank you!

Transcript

Welcome to the Veritas Forum. This is the Veritas Forum Podcast. A place where ideas and beliefs converge.

What I'm really going to be watching is which one has the resources in their worldview to be tolerant, respectful, and humble toward the people they disagree with. How do we know whether the lives that we're living are meaningful? If energy, light, gravity, and consciousness are a mystery, don't be surprised if you're going to get an element of this involved. Today, we bring you a special episode from our archives titled Living & Dying Well.

Living in the light of our mortality. In this episode, you'll hear from a panel of speakers that includes Dr. Lydia Dugdale, a medical doctor and biomedical ethicist, as well as Dr. Raymond Barfield, medical doctor, theologian, and philosopher, and Alua Arthur, lawyer and death doula, end of life planning. On the stage at Ohio State University.

[Applause] My name is Alua Arthur, and I am an attorney, a death doula, and the founder of Going With Grace, which is an end of life planning and support organization. We exist to support people, as they ask for the question, "What must I do to be at peace with myself so that I may live presently and die peacefully?" And no matter the answer to that question, our organization supports people. For some, it's about getting clear on their relationships, reconciling who they loved and how they loved in their lifetimes.

For other people, it's about getting clear on their meaning that their life has or their ideas on their afterlife, and for many others, they're still about getting their practical affairs in order. So no matter what the needs are, my organization supports people to carry out. I'm also currently an adjunct professor at the University of Philosophical Research.

I teach a course called The Art of Dying, which explores who dies, what dies, and how we die in the 21st century. And I'm very honored and excited to be here to all of this evening. [Applause] I'm Ray.

I'm a pediatric oncologist. And I am someone who has moved over the course of my career from a very standard, sort of, science-y, look for cures, kind of, television career, St. Jude, commercial career, finding cures, saving children, that kind of thing. Which I'm still very interested in.

But I have, in the last ten years or so, become intensely interested in the things that I tend to avoid in my practice. I'm comfortable conversations with people who are facing something I don't know how to fix. Staying in the room with people who are facing something that I don't understand, death.

Not running away from questions that I don't have an answer to. And so I have become, my career is half doctrine of a pretty predictable kind with patients who have cancer. And the other half is learning the kinds of surprising things that happen when you don't run away from other people's very, very hard questions and very, very hard things happening in their life.

And that turns out to be a powerful philosophical call from, no matter what background a person comes from. And so in their questioning, in their doubts, in their sometimes astonishing, sudden illumination about the meaning of their life. I'm challenged.

I'm challenged to grow as a person. I'm challenged to ask my most cuttives, sort of, how do we help onto beliefs? I'm challenged to grow into being as a whole human being as I could be. So that's become my most active research question.

Basically what my grandma used to say. I would grow up and be a good boy. What does that mean? What is a good life? That's my interest.

Hello, I'm Lydia D'Arguil from New Haven, Connecticut, originally from Michigan, so it's nice to be back in the Midwest. Do you guys count this in the Midwest? Yes. All right, all right, good.

And I think on behalf of Iluen, right, I can also say thank you to all of you for your hospitality. It's just been really warm and wonderful here, so we're really grateful. So as you already heard, I'm a general internal medicine doctor, but for those of you who don't know what that is, that's basically like that grown-up version of a pediatrician.

So I'm the one you go to when you're above 18 for your usual stuff. But what that also means is that I end up taking care of a lot of patients. In fact, a majority of my patients are older, 15 above.

And many of them are starting to think about what it means to lose various physical capabilities and to become ill, to potentially face life threatening illness, and then to think about death. And so I think like Iluen Ray, these are questions that I spend a lot of my time thinking about and talking through with patients. And then I've also developed some scholarly interest in this as well, and my work in bioethics often relates to end of life matters.

But that's where I'm coming from, and it's just a delight to be here. So thank you. All right, so we're going to get started here.

I wanted to remind you, it's not going to be an ordinary conversation. People are going to be dealing with things like fear and suffering and love and death and killing people. And he'll be really excited.

Also, one of the purposes is Annalise mentioned. We just want to remind you to really start thinking about this. Most of you in this room are young, and you may think death is very far away.

But of course, in our daily lives, death has an impact. The suffering and death of other people will have an impact. And how you live your life can be as important as how you die.

And preparing for that period of time is really important. The other thing is, and this is my sort of area of philosophical interest that I would love for you to think about, is what does your view, or our panelists views, about death say about the human person itself. So I studied philosophical anthropology when I was in graduate school.

And that's the focus is on how you view the person and how the view of the person impacts issues in bioethics. That's what I do. So the idea of death and how you view death, if you unpack that, says something as much about a person as death itself.

And so what does it mean to be a person in light of the fact that we all die? And so that's where we're going to start our questioning. Today is, we're going to talk about fear. So the British playwright, Robert Bull said, "Even at our birth, death does but stand aside alone.

And every day he looks toward us and muses somewhat to himself, whether that day or the next, he will draw a line." So I'm going to start with Lydia on the end. But here the inevitability of our deaths, how can we best prepare our lives for it? And then a related question, and I want all of panelists to answer this actually. The reality is, should we fear death, knowing it's inevitable, knowing it's common.

Why would we? So I'm going to start with fear. The second question for us. Sure.

Some of us were talking about this over dinner. So in my experience of being here, people who are aging and looking toward death and/or dying, I'm struck by the fact that some people seem not to fear death at all, and others seem to be ambivalent, and others seem to have a lot of fear. And my sense in observing this over time is that some of this might have to do with the work that has been done prior to the moment of staring one's mortality in the face.

So it may be that you have come to a particular religious or philosophical framework or decision that makes sense, and you feel like you've made your peace or you have some sort of eternal security, or frankly that when you're dead as the philosopher, the Yale philosopher Shelley Kagan says, "When you're dead, you're done, you're like a broken machine," and that's all there is. So there are these various views, and Shelley Kagan, based on my conversations with him, he's very comfortable with this view. It's the view he teaches at Yale, the body is just like a machine, and that's it.

So some people have worked out over the course of their lives what they believe, and so as they stare their mortality in its face, they are not fearful. Or at least they say they're not fearful. Other people, even with very well worked out frameworks, and here I think of some highly religious people I know still have a lot of fear.

And the, oh this is going way back now, I think with the methodists were really fixated, and then 18th century, don't quote me on this, don't video record me on this. (laughter) That, on the last words, so there's a lot of effort put into recording last words, and there's also a lot of social pressure to make sure that whatever your last words before you die were, they were the right last words. You wanted to sort of say something uplifting about God and sort of, you know, I'm on my way home or something very heroic and saintly, and there were many people within that religious community who hadn't quite come to peace about it and were very frustrated and in a lot of anguish about this challenge by the community to figure out your last words.

So I don't think that everyone has it, is at peace necessarily no matter how much work you put in. Still, I would suggest that the best way to combat fear at the end of life is to put a lot of thought now, starting now, starting tonight, if you haven't thought about it before, into what you think happens. And by that, I mean not just physically what happens when you die because that's, you know, I can tell you as docs is a very complicated, it can be any number of a zillion different scenarios, but are there questions about life and death and human existence and purpose and questions of meaning that you need to be thinking about now to help mitigate the fear that is often there as death approaches? The thing is really funny, like witty Allen scene, where you're trying to get your last words right and you mess them up.

And then it's too late, you're like, "Oh wait, that one one I was going to say, and then you die." You're terrible. So don't let that happen to you. I had thought about that until you mention it.

I came into the questioning, but I'm keen that I put my last words again. Just in case I die like in the next five minutes. Which could happen? Give it your age.

Give it to my head. She told me, she says, "Yeah, you know old people, like 50." Well, they're good. Come on.

So we've got to do it with my self-esteem, my sense of comfort at the end of life. On my way out. I don't even know.

I don't even know why I have a bob. But I will answer the question if I possibly can. So Socrates was, you know, he famously died by drinking the hymnlock.

He had been condemned to death by the Athenian court. And he had refused to allow his friends to get him out of Athens. He said, "Without Athens, there is no Socrates, and he wanted to stay in Athens." So he drank the hymnlock.

He had a bunch of jokes at the end of his life. His friends were crying, and he was like, "What are you people doing?" I've been talking my entire life about philosophy, telling you that philosophy is preparation for death. And here you are whining and crying and moaning.

And he said basically, you know, so first of all, no matter what happens, we'll be okay. And he seemed to think only one or two things can happen. And one is that he gets to, you know, this is very playtime.

I'm a Christian. So in Christianity, we have a lot of times we smuggle in Plato. Instead of thinking in Christian terms about death.

We think of the body of this moral coil that we shed, and then our spirit sort of goes off somewhere to heaven. Which is a very playtime view of what happens at death. He said, "Maybe that'll happen." And then, I don't know what you're worried about because I'm sort of bloating among the forms and having a wonderful life.

I'm not having to hang around with this body dragging me down. So that's a good thing. Or maybe I'll just disappear.

And then there's nothing to say about that because there's no one to have an experience. So I can't have a good experience or a bad experience. And so from that fact, you can conclude that you can't have a bad experience.

So no matter what, I'm going to be fine. Why would I fear death? He didn't include the possibility that things are lousy after death, but we won't talk about that. As a Christian, I have a view of death that is very different from your friend at the Yale.

I don't view death at the end of the story. But I've also raised the white flag on what it looks like. I personally cannot easily grasp a vision.

None of the visions of heaven that I was told is a kid sound anything before him to me. And the reason is because I can't imagine you after the first two, three, four hundred years, you know, I made this kind of interesting. You start getting around a thousand years or two thousand years, and then you're like, "Who am I? How long does this go?" And eternity.

And so with simplistic visions of what counts as heaven, I've never been personally consoled or relieved of a sense of fear. My only consolation, frankly, has been in my experience as the love of God and the hope that God is greater than my tiny little movie images of what my constitutes life after death. And so I tend to agree with Socrates that no matter what happens after death, unless there is some diabolical strain to the universe and what happens after death is horrible, that it's not the thing that comes after death that motivates my sense of fear.

It motivates, instead, my sense of wonder about what kind of universe it is that I live in. And it motivates my sense that there may be more mystery to this universe than meets the eye. But it also motivates me to recognize that whatever may come after death, whether it's annihilation or whether my own Christian view of it is that there is life abundant.

But I don't know what form. In any case, this life, what I'm experiencing right now, being with y'all, being with my friends here, talking about this stuff, being in this body, having cantaloupe and cheese out there. That ends.

And I like y'all. You know, I'm really happy to be here. I like this whole idea of sitting here and wrestling.

I like this life. Even though apparently my body is old, I still like it. I like going on long runs.

I like doing things. So, death is a radical change, no matter what happens, no matter whether you come here as a non-theist, a Christian, a Muslim, a Hindu, a Socratic, a DDT. It's a radical change.

And so, when I think about the notion of fear and how to live a good life, and whether or not I'll stop talking before all of us are dead. I think about the limit as something that is important to any kind of serious assessment of my life, of valuing my life. Because whether I die tonight, I'm going back to the hotel room, or in ten years, or like my grandmother, at 101.

I still have a fairly short time on this earth. And I need to take seriously the idea that when I trade a day, I'm trading it for something, and I never get that day back. And so, because I don't have very many on this earth, I should take that seriously.

What am I trading my day for? And what death does for me is it says, "They're the lie, and your days are limited." That's a gift to me. So, I take seriously whether or not I want to trade my day for an hour of being with y'all. Two hours of being with y'all.

And I decided, yes, I do want to trade that. I think this is worth it. If I die, I'm going back to the hotel.

I will still be happy that I came here. So, there's that part about it. But I think the second thing is that since you don't know how many of these days that you get, the idea that just because you're 23 or 19, that you're going to delay the decision, that school party, it's not taking seriously the value of your day to day.

Death is giving you a gift. It's telling you your life matters, which means today matters. If today doesn't matter, no other day matters, because now is the only time you'll ever experience.

So, that's the way I see death functioning and helping us to take seriously our own lives, our own what we trade them for. And that seems like a very great thing. The very last thing that I'll say is that how could you not, you know, when I met Mary, right? I knew she was great.

I knew Mary was what I wanted. But still, this is like a big change. I was nervous.

First time I got her in an airplane, I trusted, you know, I didn't know about Bernoulli's principle at the time, but I trusted whatever it is that holds the airplane up in the air. But I was still scared because it was June. Every time when the wheels came up, bam, I was like, does that supposed to happen? Well, don't be surprised if that happens to death simply as a completely unprecedented experience in your life.

You have to die again. This will be a first and only. So, you know, maybe a little nerve-bracket, and that's a bad.

So, some of the other things that I think about when I think about what constitutes a lot of fear I'm dying, I think, of course, the fear of the unknown. That this is what I know. And I know this pretty well at this point.

I've been doing this for 40 years. I know generally when my body feels like when I wake up, every single time there's a change either through health or social status or something, it's an adjustment. And similarly with death, it'll be a ground adjustment.

I think a lot of the fears around death also has to do with the fears around dying. What is the process itself like? Is that going to be painful? Is it going to be exhilarating? Is it scary just the way that it is? The fear around death is sometimes a fear of dying itself, the process of dying. And also, I think of fear around death, around the fomo, one of the fomo, fear of missing out.

Like, this is pretty good. And if I go, that means you, I won't ever be able to go to brain man again. Or I won't ever make it to, or I won't see, my kids grow, or I won't, I won't, I won't.

All the things we're going to miss out on because we're not here. And to continue the philosopher kick, that's a niggle, Thomas Nagle theory, is that the fear of death is a fear of missing out. I mean, niggle the nase fomo.

But, so sorry, going that was fomo. And so I think about the fear of death, the kind of fall on those three camps for me. But lastly also, the fear of life not fully lived, which totally bring with you, Ray, about not getting like all the juice or the richness that is in this life.

I think one of the ways, because I always have to take it to the practical, the lawyer brain can't stop. But one of the ways to kind of work with it, to start to work with it, is by doing some preparations to actually start looking practically at what you've got to do in order to get your affairs together. And that's not a far away thing, that's something that we all can start doing right now.

Because through the process of practicing, we start to uncover some of those bigger questions for ourselves. Think about whether or not you want to be buried or cremated, and what your beliefs are around that. You'll probably, somehow, if you keep thinking about it, get to the root of what you believe about your body.

Are you in the body one, or are they separate somehow? Every time we spend some time preparing for our death in a practical way, or in any other way, we necessarily confront all those other things around death that are challenging for us. I think the fear is normal. I think it's kind of expected.

And I think that there is to work with it also. Okay, can I ask a follow-up then, a little, because I think there are some people in the audience who probably have heard of doulas at the beginning of life that come into the delivery room and help women have their babies. Can you tell us briefly what you do as a death doula? And then after you don't know that, I have a question for you.

Okay. That might be a little provocative, but let's try that. I want to get a chance to explain what you do so the audience understands.

I mean, I'm a pediatrician, and I work in a hospital setting. You're a cancer doctor for children. You work in internal medicine and see other people.

So we've come into contact with medicine, clinical practice, with death and suffering on a daily basis, but I want to go on and see the chance to hear what you do. Sure. So I do all the non-medical care support of a dying person and the family through the process.

I leave the medicine to do all because you are amazing at it and studied very hard and know a whole lot of things and not interested frankly. Thank you. Hi there.

We saw this. What I'm more interested in is how we approach dying, how we do it, how we support people, how we do it. So I work in three primary areas when people are healthy and they've started to come into recognition of the fact that one day they're going to die at no matter the age.

I support them in creating plans for the end of their lives, comprehensive, concise, written plans to carry out affairs when life is over. And then when people are terminal or rather they know what it is that they're going to die from and they know that it's not some far away something, but they've kind of started narrowing down like maybe in the next couple of months. I helped them create a plan to carry out the death as peacefully as possible for them.

And after a death, I helped family members wrap up the practical affairs of life. So, you know, we have obviously two of the panelists are committed Christians. I am as well.

Do you think this here's a provocative question. We were talking about fear in the context of death. Do you think that religion or religious belief from your experience as a death doula, is that something that increases fear in people about death or is that something from your experience that mitigates some of that fear? In my experience, it's neutral.

That either people start to question what their religious beliefs were throughout their lives because now they're worried about whether or not they were wrong or if they did it right, or they dip back into, well, maybe this is all that I've got to hang on to, and so I'm going to hang my hat on this because this is what I believe in this is what I'm choosing as true, and that's going to get me through this experience I'm about to have. So, it comes out pretty neutral. Can I actually ask a little question? I know I'm at the moderator.

Of course. Okay, so I was giving a talk in Michigan, actually, on end of life stuff, and a man came out to me afterwards, and he was probably in his 70s or 80s, and he said to me, and I really struggled with this because I don't think my answer to him was good at all, and so I'm curious how you would make sense of this. He said to me, "I need to ask you something.

I was having open heart surgery, and I died on the table, and they called the code and they resuscitated me there." And I said, "So what do you see?" Because my experience is I resuscitated people for more time than I can count, and almost every single person has seen something. Classically, the white light, sometimes it's somebody they know, welcoming them. I had a patient tell me about going, she was above looking down on the room, and she was watching them resuscitate her while she was being resuscitated.

So, I don't know what these experiences are, and nothing that Ray and I have been taught, and actually as Docs, explains it. And frankly, nothing in Sunday's school explains it, right? You can't open the Bible and read about what's going on when someone is being resuscitated. And I said, "So what do you see?" This guy.

And he said, "I saw nothing. I saw absolutely nothing in it, right? Well, I have heard of that fear before, certainly people having fear that lights out when they die, and that causes them a lot of anxiety. But I think I probably would have asked him how he responded to it.

Was he encouraged by it? Was he terrified by it? It also goes back to this idea that if this is what that is, also, if that is it, if we die and it is actually lights out, then we are no longer having an experience of lights out. He was still experiencing the nothingness, which means that he wasn't actually dead. I probably would have asked him along those lines what he interpreted that as, and the comfort or anxiety it provoked him to get to.

What was the root of that? Probably why I wouldn't have gone. Anybody else have anything else to ask? No, I would just say that as a philosopher, I always think your subjective experience involves a subject. I don't know what as a Christian, I don't know what to make of some of those either, a Christian and a physician.

I don't know what to make of some of those experiences either, but I would say it's interesting that someone has, if they're dead, they're no longer a subject in the strict dissents of the word. Unless we come back to life, we're not a subject, now we're a subject again, but to be our, those aren't a particularly experienced, that's in that medium between are you a subject or not. That's really for me, like the more philosophical question.

Can you, maybe, maybe they were still actually alive and relating an experience as a subject, but on the other hand is there's something transcendent when missing. That's how I think about it. I mean, it doesn't answer the question, but that's what philosophers do.

We just continue to ask questions until we're responsible for another subject of the coffee. What did you actually say to him? I honestly don't remember, I just remember not saying anything very useful. It's really bothered me.

I think it's interesting, though, to think about, I mean, your dad was dead, like, when you resuscitate, you don't resuscitate living people. That's true. So he was dead, and what bothered him is he didn't know one was inviting him anywhere, and he didn't see white light, and there was no other experience, but he was present enough to know that it was absence of everything.

And that worried you, to his relation, so you've had all this evidence, these anecdotes of people saying they saw light, they saw a room from above. And so that adds to your, in a way, a Christian, it kind of confirmed, I don't know, maybe it doesn't for everybody, but the white light is an image that you've been socialized to think has to do with heaven, or we read it in the Bible, this image or this imagery, or that being able to be welcomed by someone affirms these beliefs and doctrine, Christian doctrine. So did it worry you when you next to someone who says, "No, I saw nothing." As if that alternative view of anthropology, like the materialist viewer, when your dad's lights out of that skit, or worm food, could that be real? Well, so I mean, now this conversation is making me wonder what my sense was that he was saying to me, "I saw nothing and I was worried, meaning there was nobody there, there was no white light, it was just the absence that I was present enough to know there was nothing.

I opened the box and it was empty." That's what I thought he was saying, and it did unsettle me, I mean, this is why years later I'm still persevering over this question. It did unsettle me because I had never had somebody, I mean, when you do this stuff, people tell you their stories all the time, I'm sure you can't go anywhere, no cockpover, you always for the best way. It was so interesting and fascinating to me, but yeah, so my sense was it wasn't that he was saying, "You know, Shelley Kagan, you're a philosopher, you're a machine, you're broken, you're done, lights are out." He was saying, "I saw nothing." And I was unsettle because he was so unsettle.

What was he a person's faith? So you know, there's a couple of ways that you might think about that if you ever meet this guy again. One is the meaning of near-death experiences is a place for asking questions. It's not a place for coming to definitive conclusions.

So it is an interesting question like you said to say, "What does this mean for you?" It turns out you're not deaf. So what does this mean for you, this experience that you have? If you said, "Well, that's what I'm asking you, what does it mean?" Then you know what the meaning is. The meaning is this.

You have a quest. That's what a question is. It's a little quest.

You have a quest in your life. You know how this experience, and you do not know the meaning of it, but you are not yet dead. So you have a quest to ask and take seriously, "What is the meaning of this thing in my life? What does this mean for me?" And it means that you may need to dwell with uncertainty for a while, but you may need to feel what it's like to not have an answer.

And that can be a very powerful spiritual experience for a person, no matter what the frame of the universe truly is. The second thing I would say is that if there's a reductionist explanation for these things, then in this story you die and you turn into a worm food. But if there's not a reductionist account of it, you still don't know the meaning of each of these experiences.

If there is a God, if there is some sense that our lives are permeated with meaning because we live in a created universe, then our afterlife would be permeated with meaning because we live in a meaningful universe, and our transition would be permeated with meaning because we live in a created universe. And just because you have one experience doesn't mean that I'm going to have it. And so there may be a purpose behind him having a specific experience.

Maybe he's a man who needs to be rattled. Maybe he needs to become uncomfortable with uncertainty. I don't know.

That's one possibility. And the last thing I would say about that is that in the we know in this world that people have different gifts. Some people are tone deaf.

Other people can hear subtleties in music. Some people are blind. Other people can see subtleties in paintings and things like that.

And maybe there are gifts of seeing or being open at points of transition. You know people who seem to know how to fall in love and relate to other people. You know other people who seem to be sensitive and they're not sure.

They need to make sure they've got their list of attributes that I really like and list the things that I don't like. And I have their list. And then this list.

By the time they finish, the person's already married to someone else. And so maybe something in him that flies. And so we don't know.

The actual actual thing that I would say your little friend of the Yale is that Professor Kate, this isn't important. I doubt the watch. If you get in the frequently positions of when you're dead, your worm food are taken as ultra-arachionalist positions, positions that are supported by the scientific community by evidence that were biological creatures and things like that.

It's actually an anti-scientific view in my opinion. Because if there's literally nothing after death in principle, in absolute principle, in tautologically impossible to refute principle, there can be no evidence for that. Because by its own account, there is no mind or consciousness or presence or anything to ever have experience of what the afterlife is because there is no afterlife.

And so in principle, there can be no evidence for that position. It simply must be assumed. It is the most assumed position ever.

Now, near-death experiences are not death. But it's at least possible that there are peace over the horizon. It's at least possible promenphasia on the face of it up front before we assume anything that this constitutes small, if incredibly perfect and difficult to interpret evidence that there might be something on the other side.

But if the position of there being nothing after death is in principle capable of literally zero evidence, then any evidence in the direction of there being an afterlife is infinitely more than evidence that there is no afterlife. And so the only scientific or logically sound position to take that doesn't depend purely on assumption is that there is something after death. Now, it's fine to believe that there's nothing.

You simply must understand that this is pure faith. If I could achieve faith so pure, I would count myself lucky because it's completely based on an assumption and cannot in principle be based on evidence. So I'll argue through that.

I think that's great. I think that's something for everybody in the university setting to realize that there, when we talk about having an openness to other points of view and respect for diversity, that one cannot dogmatically proclaim that the materialist or empiricist view is the only anthropology that you must accept. Even if you're a mathematics major, we have an astrophysicist, a graduate student.

There are that your discipline or in our case, our discipline focuses on pathophysiology and pathophysiology. But that is not the totality of whom the person should be assumed to be so. I agree with you 100% that you have no access to empirical evidence after death, certainly of your own, or of another's.

You have no empirical access to another person's experience after death and therefore can make no dogmatic assumption about it. It's a faith, it's sort of a faith belief as well. And so when you think about it in that respect, it's okay, I think, to be both a graduate student or a professional student or a professional and have a belief in the transcendent.

It's okay. And I don't think that belief should be ushered out of the public sphere or certainly the academic sphere. And the assumption that you make, that one makes based on how you view a person, do have real life implications for how you live your life, how policy implications, clinical implications and so forth.

I don't know if you want to say anything else before we move on to the next slide. Alright, alright, so we're going to move on and change course a little bit to love, to questions of love. So Michael Angelo said, quote, "death and love are the two wings that bear the good man to have him." So we'll start on this end with a lua.

What role does love have in preparing us for death? When it comes to my work in particular, I almost always ask myself before I head into work with the family. And certainly when I train other students to work with families, what does love look like in the face of death for this person in particular? And it's a question I ask the family members at times, but what would the most loving thing be? What would the most loving thing look like? What does love look like in the face of this thing that we're up against? And most often the answers has to do with allowing natural death to occur, meaning stopping medical intervention earlier or bringing somebody home, allowing them to die gracefully and allowing them to die under terms that feel best to them, provided that it's possible. I also want to be clear before I go any further that I am speaking about a small subset of deaths where we know that it's coming and that there has been some acceptance of the fact that death is coming.

I'm not discussing that either happened suddenly or that people are committed to seeking medical treatment all the way until there's absolutely nothing where they can be done, like where people are dying on the operating table, talking about where folks have some acceptance, some acknowledgement that death is occurring. So I ask the question, what does love look like in the face of death and what would the most loving thing be to do? And in most cases it is to stop medical treatment and to bring somebody home and allow them to die in the way that feels most peaceful and graceful for them, sounds and for the family. So try some follow-up question then, do you think that that love is a purely in a way, I mean it is subjective and it emanates from the subject, but suppose you think, you know you as a person, you as a little, you as a death do love, you suppose a family is saying you know what we want this person to continue to go back to the hospital, we think that's the most loving.

So it's not necessarily allowing you to act, but how do you deal with that? You may disagree that that is the most loving thing, so in your capacity as a death do you try to convince them that that's really not as loving or there's a better way or there's a more loving way? No, let me say my primary philosophy as a death do love is do you boo, do you boo, whatever feels right for you, I'm down with because it's not my death, when it's my turn I'll do it the way that I want, but when it's somebody else who's they do it the way that they want, but if what the person wants is that it's what the family wants, I'm going with what the person wants, do you boo, you get to die your way and they can have their death the way that they want to. In that case I'll go to bat for the individual, but do you do you, it's not my job, it is not on my role to judge anybody else in that experience, the rabbit to give them the experience that's going to be most peaceful for them. And I must say I have a love tattooed on my right wrist and I saw this in the dream once where I kept reaching out to build support somebody with something and this is long before I found death work.

And when thinking about well how do I, how do I, how do I relay what I'm trying to do here, I want to be an advocate, I want to be the experience of love for people that tattoo just constantly reminds me when I go to touch somebody's head or to rub feet or to take back medicine is to do it with as much as possible to continue to be loved in the face of death. Thank you. I think I'm going to get it, do you boo? On my arm.

Yeah, maybe stomach. I love clarifies why we care about death because it shines a light on what's at risk of being lost. You may say well, you know, I love my, my lover and I love my job and I love my car and I love my feeling of life.

But when your lover is dying, all of a sudden you may realize that you love your lover, you just love your car and love your parents. So it's clarifying. I think when it comes to making decisions at the end of life, love makes it death much harder than it would be otherwise.

If you were insulated and neither loved nor were loved, then you know, you can probably just work on making sure that you avoid physical pain, which you can do with good dose of morphine and maybe some anxiolytics. These days some great experiments are being done with LSD, so just take that LSD and it'll be fine. I'm serious.

But love messes all that up and makes it super complicated. And even in situations where I may, where I could be able to achieve complete honesty, say that, well, this person wouldn't want this. The fact where I know is that they gave me three copies of an advanced directive saying, "I don't want this," and then they told me and then they made me promise not to do it.

But I just cannot let go. I cannot accept that to not do this thing means that I will just have to sit there and allow it to die. Even if this thing only keeps blood going round and round and mechanically ventilated air going in and out, at least I have the illusion that they're still here.

And so love makes it complicated. I think it's extremely important at the end of life. And to be perfectly honest, I don't think death is supposed to be super simple, all clean and, you know? I think maybe the complexity that love brings into these end of life things is part of what we want.

I do support advanced directives and frank conversations and honesty and these sorts of things. I do support them. But there is a limit to them because there's something about the messiness of standing on the threshold of this mystery.

And I'm actually acknowledging the weight of the walks, the transition, the change that's about to happen. That this shouldn't just be so easy that it's just like, "Yeah, I got this. No." I mean, we can prepare ourselves and have as a gauge of spiritual maturity of peace, you know? Our calmness in the face of death.

But that's an achievement. That's a spiritual achievement. It's not cheap.

It doesn't come cheap. You can't just pull up the shelf, right? You can't just download something from the computer and then it's going to be easy. And it ought not to be.

It's important. Death is important. Just like our choices of love, marriage, what to do with our sexuality and our bodies and, you know, things like that.

That death is important in that way. I feel like love is in extra glory, in extra glory, sort of connected to the watch of every part of that importance. So, I agree with what you said.

I think I would frame probably what you just said, right? A little bit differently. And that is that I'm not persuaded that one can die alone and also die well. That is, I think that in order to die well, it needs to be a community of fear.

Now, as soon as I say that, I can think of lots of examples where patients of mine have waited until their family members finally leave their hospital room for the night so that they can die. And that's usually a person who spent his or her whole life not wanting to be a burden. And so, dying alone momentarily in that moment doesn't necessarily mean that the dying process has been one in isolation.

Are you following me? So, to, you know, to wait until everybody goes home and just let yourself go, because that's sort of the way you want it to go, which happens all the time, by the way. People will hold on for days until some big event happens or until the family member can find in California or whatever it is. People will hold on.

And then once whatever that moment is they're waiting for, then they'll let themselves die. And so we do see that all the time. But the process of dying, just like the process of living, is one in which we are members of communities, families.

We're relational. We're not just, you know, I'm not just Lydia and Lydia's body, but I am Lydia and Lydia's body and Lydia's family and community and the layers go out and out and out. And it's that, that composite that when I think about love, that's what has to be in place as one lives and dawns.

And so, and I guess just another distinction, I'm not suggesting that, you know, when granny gets sick, that's when we rally. No, we're seeing granny now while granny's still doing okay, and then we continue to be that support as she declines and as she, you know, whatever, whatever the events are. So, I guess that's the way that I would think about love, that really it's the love of the community bearing the one.

There's a model that comes out of the sort of late Middle Ages, which is the dying person is the central actor in a great drama. And everyone in the community has a role to play in that drama. And the dying person is still the central actor, but none of us is exempt from our part in the community as we accompany that dying person to his or her final rest.

If you like this and you want to hear more, like, share, review, and subscribe to this podcast. And from all of us here at the Veritas Forum, thank you.

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