In the end, what really matters?

October 6, 2015 • 9:00 am

In my view there is no good death, but some deaths are better than others. B. J. Miller came close, losing both his legs below the knee, as well as his left forearm, in a foolish stunt as a sophomore at Princeton, climbing on top of the famous “Dinky” train and getting electrocuted by the wires. Since then he’s become a palliative-care doctor and founder of the Zen Hospice Project, which, as described in the New York Times, is a small but immensely empathic facility for the terminally ill.

In this twenty-minute TED talk, Miller proposes ways to bring “intention and creativity to the experience of dying.” His emphasis is on the importance “sensuous, aesthetic gratification”: little but tangible connections with the world (and its inhabitants) that affirm one’s being.

I would hope that I could appreciate such gratifications at the end of life, but, in truth, how do I know? Miller clearly has wide experience in what palliates death, but I can’t help but feel that consuming two baked cookies as one’s about to cross the Styx won’t reconcile me to my fate. And, in truth, this highly-touted video seems to try desperately to make a virtue of necessity. Miller is to be lauded for his efforts, but in the end remains the brute fact of nonexistence.

53 thoughts on “In the end, what really matters?

  1. What really matters isn’t the end; it’s what you did before the end. And by the time you’re on your deathbed, there’s really not that much left to matter.

    Yes, of course, minimize the unpleasantness as much as possible, and you might as well make the most of what little is left. But what really matters is the decades before the final hours….


    1. My mind won’t let me contemplate death, it immediately switches to what is the best way to live now.

      And planning those last minutes are out the window. I guess I will be as curious about new experiences as ever, if I am awake.

      [Ironically I can both plan and stubbornly pursue long time projects. Never mind my mind.]

  2. Well, one might as well try to make a virtue of necessity. It is of course hard not to feel apprehensive about death, and it would be nice to figure out how to ease into this necessary transition.

    I’m guessing that cookies won’t help me much, however. I’m in favor of following my grandfather’s path of going up to bed as normal and then apparently peacefully dying in his sleep. I just wish there were a way of disposing of my body without leaving behind an inconveniently large and awkward lump of dead flesh.

    1. Or inconveniently large bill. I think my advice to my survivors will be “dispose of my body in the cheapest way possible that doesn’t cause any additional guilt or upset.”

      Though I admit that I find some gallows humor in thinking of a spectacularly ridiculous sendoff. Drop me out of an airplane attached to a giant firework or something.

      1. I agree! If you are going to spend some money spend it on having some fun. Like a big party where everyone can share tall tales of how awesome I was.

        When I think of my own death my thoughts on my body are “I really don’t give two shits about what is or isn’t done with my body.” Though I have to admit that sending my corpsicle off on humanities first interstellar probe would be pretty cool.

        But, when I think of my wife or children dying I tend to experience a strong emotional attachment to their bodies. So, I can understand the motivations behind the traditions and attitudes that hold dead bodies in a certain reverence. In my case it certainly doesn’t have anything to do with actual reverence for the dead body, it has to do with desperately wanting the living person to have not died.

      2. We put my son’s ashes into a firework display, sent some into space, blown some up in various experiments and put some in the ink of tattoos, over the past two years

        He has also been to science festivals where scientists have posed for photos with him, to Comic Con to meet and get a photo with George Romero, which has pride of place on the Zombie Wall, where he sits between adventures

        People were initially horrified, but then understood that he would have laughed like a drain at the very idea of the things we’ve done

        1. Sounds like your son was a terrific person with a great sense of humor. I found your story very touching, thanks for sharing.

        2. Very cool indeed! I love what you’re doing. I’m so sorry about the loss of your son, but what a great way to deal with it.

        3. Most of my late wife Isobel went the fireworks way at her request. Some of the rest was distributed in various favourite places, and a small container of what remains travels with me everywhere I go in my vintage MG, which she loved.

  3. I watched that video a while ago and while I admire his adversity in the face of misfortune, I came away from the experience with the impression that what Miller was proposing was that his way was the only good end of life choice and there was the implicit premise that any other choice, specifically doctor assisted suicide, was a bad choice.

    1. I may draw criticism for being insensitive or crass, and that’s okay.

      It seems a fairly common thing that people experience a traumatic event and then come to believe, and others concur, that they are then experts on dealing with that kind of trauma. Usually their method is narrowly limited to whatever helped, or helps, them deal with their trauma. Usually I don’t see any convincing sign of expertise. I don’t here either.

      It is a good thing that this man is determined and dedicated to helping others. I would hazard a guess that the desire to help others that suffered similar trauma, by sharing how you did (do) it, is good therapy for dealing with your own trauma. But how well is he helping others? Are his methods really better than others? Even if his methods work great for some are they perhaps preventing others from achieving peace they might otherwise have found? How can we tell? How does he know?

  4. I don’t think there is a “brute fact of non-existence”. All animals are born, grow, and die. We are no different. The brute fact is the ‘thought’ of non-existence.

  5. I don’t think of it as nonexistence so much as unawareness. Our raw stuff’s there dissolving away, just not in a conscious form. I think that’s why I’ll want to be disposed of in a biodegradable way so my stuff has the best shot of eventually winding its way into another critter’s brain.

    1. I’ll never die – just disperse!

      The whole returning to dust thing is only a bummer if you have a low opinion of dust.

  6. “I’d hate to die twice. It’s so boring.” Richard Feynman

    My read on that: spend the first 99.99% doing what you want, the last bit may likely suck or be immensely boring, so no worries.

  7. A simple thing can be very intensely pleasurable under the right circumstances. I remember many years ago I was hiking waaaay up into the Tetons, and we were pretty short on food (but in no danger). A snack was a slice of store bought cheddar cheese and some jello that was prepared over a fire and chilled in snow. That cheese and jello was the most intense eating experience that I can remember. The cheese especially was the best damn cheese I ever had in my life. I have never had cheese before or since that came even close.

    1. This is the core of Stoic philosophy (as I understand it). It’s not the ingredients that make food taste great, but the circumstances. About five miles from the end of my first 50K (brag) an aid station offered a small cup of bisque that, for a moment, caused me to abandon atheism for a tomato diety.

      1. The finest beer I ever had was half a can of Miller Light, shared with my sister on day 3 of a 5 day backpacking trip. She had packed one can for the trip, and took it out and chilled it in some mountain top snow, and we drank it sitting on top of the mountain, miles away from any sign of civilization. Just amazing.

    2. It must be the region. I remember exiting the eastern end of Yellowstone Park and coming upon a small town (and I mean small as in there were 3 buildings there). It had been several days since we had a hot meal and it was there that I had the best tasting steak of my life, yet I don’t even remember the cut.

        1. That may be a stretch even. I recall 3 buildings, one of which was a post office. The restaurant was connected to some sort of lodge. Perhaps there may have been another building around somewhere but it sure as hell didn’t look like there were any roads other than the road . But TINY is certainly an apt description.

  8. I think it is possible to have a good death (although not always possible to guarantee it) My father had one such.
    I looked after him for five years, from the age of 87 to 92 as his Alzheimer’s and frailty increased to the point where his swallowing reflex and finally his breathing and heart gave out, on 18th July this year. I found the whole process, even his death, to have been satisfying for him and me; I enjoyed using my care skills to help him as he became weaker and weaker, (I had another carer and other members of the family to help me, plus the full co-operation of our magnificent NHS).
    He died in his own bed, in his own home, with me in the house, We had had a full palliative care package in place for the last 5 weeks—brilliant and completely free of charge. When he died, he was not in pain or discomfort, nor had he been. He never went into a care home, except for short periods when I went away.
    For me, that really did constitute a death which could not have been bettered.
    I hate to criticize your view Jerry, but do any other readers have similarly optimistic stories?
    (I also note – confirming my experience, that the survey noted above ranks the UK at no.1 in the world for end-of-life care)
    Anthony K

  9. Death seems to hit people a million different ways and just as many opinions on what we should be doing. I see what it’s like in many general nursing homes in this country and it could certainly be better. Many look at it and say it is a lousy way to go but that is the factory system we have. Again, like everything else the regulations on these places is both state and federal and the good and bad are both out there. A really good look at this system is what must be recognized because that is where most of it happens.

    Not that many people can afford otherwise and the nursing home system is where many of us end up, like it or not.

  10. I think the worst thing that the fact of death caused in sentient beings is religion. Would there be religion without death?

  11. I would characterize good ways of dying as being relatively free of things such as fear, pain and remorse while having a relative abundance of things like comfort and compassion.

    But how people achieve such states of mind can be highly subjective and the paths that can lead to such states of mind are myriad, as are the circumstances of dying (for example sudden death of the ‘never knew what hit you variety’ to the prolonged decline of a hard fought cancer type of death).

  12. I desperately want my dead body to be used for the purposes of practical jokes. If anyone out there has a really good gag in mind that could get a huge laugh, but you need a dead body to pull it off, I’m in! Contact me and we’ll sign the proper paperwork. It better be funny though. I don’t want to die and then die again.

  13. The media loves to tout and lionize people who have endured tremendous loss or suffering but are happy and contented with their lives. But they conveniently forgot to acknowledge the fact that these people are total outliers, a tiny fragment of a huge population of men, women and children, who die and suffer and cannot, for whatever reason, endure the pain and calamities in their lives; what is the message that this media is tacitly conveying about them? That they are cowards, that they lack the will power to overcome their difficulties, that they are weak and deserve our contempt. Shameful.

    1. Yes. This is one of my pet hates, but not one that is easy to express without seeming to denigrate the person who is being lionized.

      1. One of my pet hates too. The media have to have heroes and villains, and whether something gets lauded as brave, or condemned as exceptionally stupid, seems to depend on a flick of the reporters’ coin.

        And sometimes the person didn’t event think of bravery, they were just doing the only thing they could in the circumstances.


  14. I saw this video about a month ago. Before I launched into public health and genetics, I lived at San Francisco Zen Center. Before that, I was an interfaith chaplain (the chaplain for those who don’t believe or believe anything or whatever who cares). I had an oncology floor and a pediatric intensive care unit at Columbia Presbyterian in NYC and was routinely there for the untimely deaths of children and cancer patients. There is no belief system than can meet the sheer pain for loss of life. It just is. So I went on to zen to think. I practiced in the monastery for years. I can vet empirically, at least from the sample size of my own experience, that meditation and simple physical pleasures are balmy. We have many deaths: the death of each moment, of finishing a meal, a saying good night… Sounds trite (I can feel a hairball in my throat). But I do think that a life of practicing letting could help the final letting go, because how we relate to death is a cognitive phenomena. But there is no guarantee; meditation is not magic. And when it comes down to it, the matter is both great and ordinary. But is anything really ordinary about our existence?

    A mentor of mine died in his sleep two nights ago. It’s an ironic tragedy as he died from aggressive prostate cancer and spent his life doing cancer research. The brute reality of his non-existence is imminent. The only good I know from this is that it forces me to value this life and the little time we all have to live it. Deep feelings of respect and reverence and the desire to live and contribute are filling my chest cavity.

    1. So sorry you’re having to confront this head-on.

      I think the common element in coming to peace is a simple recognition that, whether or not you wish it otherwise, it really is what it actually is. That doesn’t mean you can’t work to try to change it to be more to your liking…but whether or not you have the ability to actually effect such change is also part of that set of things that really is or isn’t, regardless of your desires.

      Sounds like your friend’s life is worth celebrating — that he won his lottery, fair and square. You and his other friends will surely miss him…but it seems he got everything he could have reasonably asked for and then quite a bit more on top.

      So…keep on getting the most out of your life, and don’t be afraid to take pleasure in recreating in your mind the past pleasures you enjoyed with your friend. Why should his mere death mean you can’t keep enjoying his life? If nothing else, why let all that potential pleasure go to waste? It’s not going to last, either….


  15. I know I said this back in July when this same subject was brought up, but I’d like to die like Harry Stamper (Bruce Willis’ character) in Armageddon, voluntarily staying behind to trigger the asteroid-destroying bomb that will save all of mankind.

    A sacrifice like that ought to at least merit having an ocean named after you.

  16. As every last molecule including the ones fizzing around in my brain as I type will be recycled and dispersed back into the universe I have long gotten over myself as I find that thought as truth, a pleasure and amusing.
    But, the way I or my near ones depart might be cause for concern but is that not the package of life also, what it means to be human.. to not feel, could mean your dead or may as well be.
    The fear of death is what religion breeds on and it is despicable. It is not what you did with it, that is a trap. e.g. the peasant farmer or Donald Trump, as I can ask, who lived the most honest life? well, you’ll definitely get two different answers to that question. It is, that you had a life, there is no more and that is the brute fact of existence.

  17. “I do not fear death. I had been dead for billions and billions of years before I was born, and had not suffered the slightest inconvenience from it.”
    — attributed to Mark Twain

    When I am 120, I will become the oldest to be accepted at Stanford Medical School. I willed my body there. It is distinctly possible I will save more lives in the afterlife than I have living. Some doctors will know what they are doing before they work on the living.

  18. I’d say that conditions right at the end really do matter, whether it’s a natural death or assisted dying. Wouldn’t everybody rather ‘go out’ on a lawn in the sunshine with friends and family around them, than in some dreary basement?

    On the topic of choosing ones funeral, a colleague of mine told me of a friend of his from the backblocks who (by his decree) had the funeral service on his farm, and painted on the end of the coffin was “Bugger!”.

  19. In my first response, I failed to address the title of this post:

    “In the end, what really matters?”

    Jerry wrote: “but I can’t help but feel that consuming two baked cookies as one’s about to cross the Styx won’t reconcile me to my fate.”

    No, me either. The cookies couldn’t do the reconciling. The reconciling would have to happen before the cookies, because, otherwise, I couldn’t enjoy the cookies.

    The question “in the end, what really matters?” has two meanings:

    1) in the end as in the final moments before death, and
    2) in the end as a general reflection of what’s important in life.

    I feel passionate about meaning number two, though haven’t yet figured out exactly what’s most important. I’ve been focused on contributing, helping, learning, and experiencing. But, I suspect that I could be more systematic about these and more connected to others. I know taking care matters hugely. But the question for me has always been “what’s the best way to take care?” I still don’t know.

    As to meaning number one. I’ll wish the best for my state of mind as death approaches, but the circumstances are too unknown for me to guess what I’d want (Though, while we’re speculating, there are some things that could be fun: a meaningful (even minor) eureka and ability to communicate it would be one.) I do hope I will feel some measure of gratitude and satisfaction before the candle flickers out, but also hope to experience these in advance of the last few moments.

    1. 2) in the end as a general reflection of what’s important in life.

      I feel passionate about meaning number two, though haven’t yet figured out exactly what’s most important.

      Don’t beat yourself up about it. It’s okay if your life doesn’t have some cosmic significance. Are you doing today what you most want to do? Then that’s what you should be doing. If not, you should be working towards figuring out how to spend as much of your time doing what you most want to do. Maybe tomorrow you’ll want to do something else; that’s fine, too.

      And I’ll tell you right now: you’re not going to get it perfect, not even close. So don’t even pretend to worry that you’re not getting it perfect, because you won’t.


  20. Speaking as someone who’s partner of thirty years is approaching the we end of her three year struggle with ovarian cancer two things seem to be important.
    First keep the pain under control, and second try to find a way to get to the happy places you knew before the prospect of death reared its ugly head. Prior to the cancer, we loved cycling, but latterly when she tried, my partner found that she could barely manage a couple of kilometres on the flat. We bought an e-bike and found that she could do twenty or thirty km quite happily, with the added amusing bonus (to her) that she was now faster up the hills than I am. This is just an example from our circumstances, but I think it is the sort of thinking behind Miller advocating baking cookies.

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