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Dare to Be 100: How to Die

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Death and dying have been receiving a lot of coverage lately. Our California Assisted Suicide Initiative was front page news for a week. My blog of last week celebrated its passage. Atul Gawande's best-selling book Being Mortal has received much critical acclaim for its tender rendering of the myriad currents that surround the end of being alive, both for the individual and importantly for all persons concerned with this transition.

Erica Jong has updated her view of life in her new book Fear of Dying that is both clever and profound.

My personal favorite among the new dying books was written by Stanford colleague Irvin Yalom, eminent psychoanalyst. His book Staring at the Sun conveys his yearning for a scientific analysis of Death's moment.(1) In it he dismisses any metaphysical attempt to explain death. He discusses his yearning for a reconciliation of the fact that our body atoms and molecules eventually lose their order and are consigned to the cosmic trash bin where they arose. Yet we reject the notion that the world can and will get along without us. Oblivion is not something that we can accept. We cling as a reflex to a desire for immortality despite any shred of supporting evidence. Yalom assures us that oblivion need not be ours to accept because of the RIPPLES that we have caused to happen, the lines of force that are created by our lives, the myriad effects that our actions, small and large, generous and selfish have impacted all of our surroundings. Ripples are forever.

I endorse fervently this view as it corresponds precisely to my own affiliation with the paradigm inherent in the Laws of Thermodynamics, the Conservation of Energy ( First Law) and the Redistribution of that Energy (Second Law). Our lives, yours, mine, everyone's energy extend our reach into immortality.

My first book title We Live Too Short and Die Too Long expresses the torments of a long protracted death that is unfortunately still too common in our hospital- centric Exodus. My great physician father insisted that there are lots of worse things in life than dying. Dependency trumps death in my list of "Avoid This" es. In this regard Woody Allen's famous remark, " I'm not afraid of dying I just don't want to be there when it happens" means that much of our anxiety about death concerns the mode of death. Not so much the "if" or "whether" as "how". To me a "good" death is that one without pain, tubes, or loneliness.

Death should lose its sting by means of a very simple, rational, painless, and cheap way to die. Almost all of the above attention is directed to the "if", not the "how". Not dying is not an option.

Life has only a few basic requirements. Temperature, oxygen, and fuel exert certain physical limits to all of life. Roasting or freezing are not viable alternatives. Lack of oxygen is simply not available as a rational choice. Holding one's breath is not an option. Not eating, thereby denying the body fuel for its metabolism remains a reality. Death by starvation has a huge historical tradition. However death by starvation simply takes too long. Depending on the amount of body fat starvation deaths take weeks to months to occur.

So what remains is dehydration. This is a logical, rational, safe, cheap, pain-free way to die. I was first aware of this technique by the work of eminent geriatrician Dr. Joanne Lynn of Washington. For several decades she has been advocating the death by dehydration option. Dry Exodus is a viable strategy. Joanne continues to write on this technique and describes the steps that one takes when this choice is taken. What is required is that the lips and tongue of the person are strictly tended by regular moistening. With appropriate attention to this need death will occur in about a week, give or take a few days, as the body slowly shuts down, urine output ceases and potassium and other body poisons accumulate, so that vital functions cease.

Unconsciousness occurs in about a week. No pain is evident. Another advantage of death by dehydration is a lack of involvement of the medical system, physician or any other representative is not necessary.

In my view this is the way to die that is fully rational and deserves much greater awareness. There is almost nothing written about it. We need a much expanded discussion in order to raise our collective consciousness of this "best option." Death by dehydration is natural, cheap, and pain free. Who could ask for anything more? This is the right way to die.

Reference: Yalom, I, Staring at the Sun, 2008 Jossey Bass, San Francisco