Volume 3, Issue 2 - May 2011
Frank Gonzalez-Crussi, MD
Northwestern University, Chicago, Illinois, United States
Photography by Jenny Wright
Is there a good death? I contend that there is no answer to this question. There is indeed a rare species of questions that are unanswerable, and this is one of them.
Those who have escaped from a near-fatal accident, or recovered from a serious illness, or somehow realized that death was near, often say: “It is good to be alive!” This expresses the conviction that life is good in itself. Indeed, not only do most people believe, and have always believed, that “all things considered” life is good in itself, but they further maintain that life is the supreme good. A corollary of this attitude is that no greater misfortune can befall us than the deprivation of life; for if life is the supreme good, death must surely be the supreme evil. For those who hold this opinion, there can be no such thing as a “good death.” That the supreme evil might be good in any way is simply unthinkable.
This opinion has been championed by some intellectuals. Some have castigated the various forms of “romanticization” of death. There is no such thing as a “heroic” death, said one author. By the same token, he denied that there could be a “romantic” death, or a “peaceful” death, or a death glorified in any other way. Death, he stated, is usually unwelcome. And because it comes from outside and is imposed upon us against our will, it has all the character of a forced and brutal impressment or violation, “like torture, rape, capital punishment, kidnap, lobotomy and other degradation ceremonies.”1
Many physicians adhere to this way of thinking. Death is the enemy, which must be fought at all times. There is no noble death, no quiet fading away in the autumnal light of a man’s last cycle. Death is always coercive, always an imposition, always despotic and tyrannical. In sum, always the enemy that the physician must be prepared to fight to the end. Hence, there is no “good death.”
However, even when I was young I felt this could not be true. For when people say that life is the supreme good they don’t mean metabolism, digestion, or blood pressure. They mean action, thought, pleasure, or desire. Life in the raw, without emotions, thoughts, projects, and interactions with other human beings cannot be the precious gift that must be defended at all costs. But doctors are not preoccupied to answer the metaphysical question of whether life is intrinsically valuable, or whether its value resides in consciousness and relational existence. If one asks them, they say that they want to do “what is best for the patient.” But that is begging the question, because it implies that they already know, and the real problem is precisely to define, with perfect clarity, what is good and what is bad for each individual. From medical doctors, I am afraid, we do not really gain a true understanding.
So we turn to poets and philosophers, mystics and visionaries, and scientists. We hope to gain from them some insight on what death might mean to us, and whether it is good or bad. We place our hopes in the deep meditations of thinkers, wholly abstracted in these difficult questions. But soon we realize that there is no such thing as a meditation on death. What we find are dirges, sentimental speeches, lyrical lamentations, and beautiful words on the brevity of life. We find deep sighs of nostalgia and touching expressions of melancholy. But a sigh is not a meditation. We soon realize that we are worse off in this company. So we listen to what the mystics and visionaries have to say. That life is a continuous dying. That the body is unimportant. That this life is only a preparation for death and the real life awaits us after this one. That in this world we must learn to die well. But how can one learn to die well? When it comes to death there are no rehearsals and no trials: it is a single and final shot. And then we find the scientists equally unhelpful. They talk about cells, and molecules, and enzymes, and DNA. They say that life is a delicate macromolecular equilibrium, held in place by the laws of thermodynamics. Death, they tell us, appears when the energy content of the molecular systems of the cell and that of the environment equals zero.
So I am beginning to feel that with respect to the main question we are not better off. Because we wanted to know whether life is good or bad for us, as individuals. But we realize there is always a chasm between the beautiful scientific formulations and the aspirations of the individual. For instance, what do we care if a disease has a 75 percent chance of mortality? If we catch it and we survive, the mortality for us is zero percent; if we catch it and we die, it is, for us, 100 percent. What do we care to know that life is a delicate equilibrium of molecules, enzymes, DNA and energy forces? If we die, it is, for us, the end of all molecules. For us, as individuals, it is the end of all enzymes, and all molecules, and all DNAs, and all energies. It is the end of everything.
In conclusion, the question of good or bad death cannot be resolved. No physician can answer it; no scientist can clarify it. No great thinker will come to solve the riddle of death, for no one can really meditate on death. We talk about it by periphrasis, by allegory, in parables, always tangentially, obliquely, but never going directly to the core of the problem, which indeed suggests that the best way is not to think too much about it. As in many other major existential questions, it often comes down to a choice between becoming anguished and becoming sleepy. Personally, I would rather take a siesta.
FRANK GONZALEZ-CRUSSI, MD is an emeritus professor of Pathology at Northwestern University. Since 2001, he has retired from his post as Head of Laboratories at the Children’s Memorial Hospital of Chicago. In the medical field, he has written over 200 articles published in peer-reviewed journals, became Chief Editor of Pediatric Pathology for a time, and authored two books on the pathology of specific types of pediatric tumors. In the literary field, he has written 16 books (5 in his native Spanish), most in the essay genre. Translations of his work exist in seven languages. Dr. Gonzalez-Crussi has been the recipient of numerous awards, including a Fellowship of the John Simon Guggenheim Foundation (2000-2001). His latest book is Carrying the heart (Kaplan Publishing, 2009).
About the artist
Jenny Wright, MA is currently a PhD student at the University of the Arts London where she is researching drawing and medical practice. She is currently the honorary artist at Moorfields Hospital London and has been a visiting examiner on the Anatomy for Artists course at University College London. You can see more of her work at www.jenwright-art.com.