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Dying Well
a guide to enabling
a good death
Second Edition
Julia Neuberger
Foreword by Dorothy Austin and Peter Jupp
Dying Well
A guide to enabling a good death
Second edition
Julia Neuberger
Former Chief Executive
King’s Fund
London
Radcliffe Publishing
OXFORD . SAN FRANCISCO
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2004 by Julia Neuberger

CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works

Version Date: 20160525
International Standard Book Number-13: 978-1-138-03043-5 (eBook - PDF)
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Contents
Forewords iv
Preface viii
Acknowledgements xiv
1 An introduction to the history of ideas about death 1

2 Grief – reactions normal and abnormal 17
3 The role of helpers 33
4 The best that we can do 65
5 Religious beliefs and customs 85
6 How can we make dying better for people? 123
7 The good death 133
General information and bibliography 147
Foreword
When Rabbi Julia preached to her South London Liberal congregation about
death, they responded, ‘Bravo! Now what will you do about it?’ Her answer
to their challenge was the campaign that built the North London Hospice.
The origin, extent and consequences of a taboo about death in the 20th
century awaits full assessment, yet Margaret Torrie’s Cruse and Dame Cicely
Saunders’ first hospice began to break it. Since then, the initiatives and team-
work of increasing numbers of individuals have started to transform British
attitudes to death. Rabbi Julia has not only made the subject of death and
dying her own but her leadership in the field of healthcare has helped to
ensure the wide salience of the subjects of death and dying.
In giving a warm welcome to the second edition of Dying Well, we should
recognise how far death has moved up the political agenda in the last five
years. The UK government has examined a range of death-related issues
including cemeteries, coroners, death registration and certification, retained
organs and the Shipman enquiry. This year it will consider advance direc-
tives. All these are, in part, responses to newly perceived needs: from within
the health services, from the funeral industries, from death- and bereavement-
related charities and from reform organisations.
When the sociologist Michael Young turned his spotlight on the role of
death in British culture, The Dead Citizens Charter was just part of his overall
task, whose scale was assessed by the anthropologist Mary Douglas thus,‘He
must know that it is difficult to transform a whole culture of embedded reti-
cence. It is hard enough to make a deliberate speech reform; to reform a
silence is a tall order.’
Even though we are far better prepared to care for dying and bereaved
people than in the 1960s, we need to be, because of the decline of the family
and of religion. For generations these two institutions were the drivers of
such care. Dying Well outlines the next stage, ‘What society has to do now is
Foreword v
to bring itself to talk more openly about the good death’ (p.61). Just over
600 000 people die in the UK each year. If this conversation is to be fruitful,
we need far more strategies of collaboration between these families and all
the interests providing care.
Dying Well not only encourages this teamwork but argues for death educa-
tion in our schools, a cause given more prominence this May by the Child
Bereavement Trust and others. Dying Well welcomes the wider recognition of
the spiritual needs of the dying. It also argues for a fuller contribution from
the major religions. Rabbi Julia has often noted that the Christian tradition is
stronger on care for the sick and dying than for the bereaved. Now she fears
that theological discussion of the meaning of death is disappearing from
almost all faiths. As Bede’s story of King Edwin reminds us, the interpretation
of human origin and destiny is a basic contribution of religion to daily life. It
should not be discarded.
Attitudes to death are too important for their promotion to be left either to
the government or the media. What is required is a wide conversation about
the nature, experience and meaning of death at both academic and popular
levels. Rabbi Julia’s purpose here is to make the dying process life-enhancing
for the dying, the bereaved and their carers.
Peter C Jupp
Co-editor of Mortality
Visiting Fellow, Department of Sociology
University of Bristol
May 2004
Foreword
Julia Neuberger’s book, Dying Well: A guide to enabling a good death (2e) is
destined to become a classic. It is a rare book that can speak to ordinary
members of the public who want to think more about how better to prepare
themselves for the death of a loved one, or for their own death. It can serve
also as an invaluable guide for healthcare professionals who care for the
dying.
What makes this book so remarkable? To begin with, all of us, no matter
what our age, gender, class, nationality, religious tradition or none, hope to
die well, in reasonable comfort, ripe in years, compos mentis, surrounded by
our loved ones, at peace with ourselves and the world, feeling we have lived
a good life and prepared to return to our ancestors. Dying Well (2e) is a well-
written book, more of a literary pleasure than a textbook and it affords us a
chance to consider our death as a life-enhancing event.
What we yearn for in a book like this is to be in the good company of a
deeply intelligent, learned, and compassionate teacher and writer, like Julia
Neuberger, who knows a great deal professionally and personally about
dying well. It is not incidental to the depth and richness of this book that
Julia writes as a mature scholar, a professional Rabbi, the chair of an NHS
Trust, and as a daughter – an only child who has had the privilege and
responsibility of seeing her mother and father to a good death.
Dying Well (2e) is a humane book, scholarly, intimate, conversant on the
issues of the day: the hospice movement, euthanasia, living wills, advance
directives and the like; and, at the same time, this is a book written by a
professional with a seasoned and generous eye; a woman well acquainted
with grief, who captures the details of professional healthcare, grieving and
dying, in ways that even the most seasoned of doctors, nurses and other
healthcare professionals will find revelatory and informative, and a moving
read.
Foreword vii
Julia Neuberger knows, for instance, how to approach ‘truth-telling’ and

counseling, how to enable a dying person and their family to be in charge of
the most important decisions that they will have to make. Julia states that for
many decades healthcare professionals and families have had difficulty
talking about dying, grieving, and death. As a consequence, many people feel
that they have lost the language with which to speak of death as a meaningful
part of life, but the author of Dying Well (2e) is not at a loss for words.
Throughout this book, Julia is well spoken, most especially on the subject of
religion, a sensitive and important matter intimately related to dying well.
Julia is one of the very best in the field, writing on the role of religion in
dying well, and Dying Well (2e) may well be the best book on the subject
available to nurses, doctors, and hospice workers; pastoral counselors, Rabbis,
priests, and imams; medical students, divinity students and chaplains, all of
whom should be required, as a matter of competency, to be religiously
informed and religiously literate regarding the role that religion plays (or fails
to play) in helping people to die well.
Dying Well (2e) is brilliant for giving us a lively account of the world’s reli-
gious traditions, according us an excellent grasp of those religious attitudes,
rites and rituals that are distinctive to each major tradition. Obviously, not to
have this cultural knowledge at hand would leave us woefully unprepared
and unskilled to care for people who are dying. Julia Neuberger’s voice is
rare in that there is nothing parochial in this book, nothing about its presenta-
tion of religion that would set the book apart from a general readership, and
that is a good thing.
Finally, one cannot fail to be moved by Julia’s thoughtful ruminations on
funerals, memorial services, and her unparalleled discussion of grief. Reading
Julia on the subject of grief, I couldn’t put the book down until I had come to
its end – she is a powerful writer.
This second edition of Dying Well will become an important and major
book in the field: its time has come and there is no other book like it, nothing
as good. In the courses I teach on death and dying and pastoral care, for
divinity students and medical students, Dying Well (2e) will become our basic
primer. Julia Neuberger has done us a good service and written a wonderful
book on dying well, for which we can only be grateful.
Dorothy Austin
Harvard University
Cambridge, Massachusetts
May 2004
Preface
Between the first and second editions of this book, my mother died, my
father having died between the first and second drafts of the original edition.
Once again, we were blessed with superb care for my mother in her last
days, weeks and months, at home, by a dedicated team. More than anything
else, more than all the theory, all the observations as a professional rabbi, or
chair of an NHS Trust, more than as a theoretician about dying, the experi-
ence of the loss of both my parents within a five year period, as an only
child where the full responsibility fell on me, has convinced me that we have
– at best – a wonderful way of caring for the dying in Britain, if you are
lucky enough to live in the right places. And, as I was finishing the work on
this second edition, the government announced (26 December 2003) an addi-
tional £12 million for training for health professionals in caring for the dying,
wherever that might happen, of whatever cause. It is nowhere near enough,
but it is a start – the recognition that we cannot all die in hospices, or be
cared for by palliative care teams. We do not all die of cancer, MND or
AIDS, and our needs, whatever the cause of death, are of paramount impor-
tance. Those of us who die of end stage renal failure, or congestive heart
disease, are now also, at last, being recognised as deserving high quality
care. What we as a family experienced will now, gradually, be rolled out
nationwide, if the training and education and encouragement of health
professionals is done in the most sympathetic and supportive way as a result
of this new initiative.
Meanwhile, I wrote publicly about the deaths of both my parents, partly
because neither died of cancer, and partly because I wanted to express my
gratitude to the teams, and the system, that ensured both had such good
deaths – in their terms, as well as mine, as well as in the terms of the profes-
sionals who cared for them. I quote both articles below. When my father died,
he had been ill for a long time, and our experience of the care he received
Preface ix
from all the professionals involved was extremely positive. Nevertheless, as

anyone who has lost a parent, or a spouse, or anyone close to them, will
know, it is amazingly painful. One can be left with few regrets and still miss
the person terribly, or one can wish one had done more, said more, been
there more. Whatever the case, I believe that my work on the two editions of
this book, though no other aspect of my life, has been improved by the
experience of losing my parents. I hope that it will be helpful both to ordinary
members of the public who want to think more about how to prepare them-
selves for the death of a loved one, or for their own death, and more particu-
larly for healthcare professionals who might find within it some ideas about
how death is perceived, and what is felt so strongly, that will help them to
care even better for those who are dying under their care. We owe a great
debt of gratitude to those who cared for my father and my father-in-law who
died 10 weeks after my father, and I append here the article I wrote for the
Health Service Journal to draw attention to how well we deal with it in this
country.
That is important, because I believe there is always room for improvement,
but that we have a very high baseline from which to improve our service, and
be leaders throughout the world in caring for our dying and those who are
left after them.
In the last few months, both my father and my father-in-law have died. It
has not been an easy time, but it has been much helped, the whole family
has been much helped, by the remarkable support of many staff working
within the NHS. I write this as an informed user of services, not from my
usual starting point as Chairman of Camden and Islington Community
Health Services NHS Trust, though some of the staff who looked after both
fathers, and the rest of the family, were from my Trust. I write this because
the NHS gets so much flak, and indeed within the NHS as Chairman of a
Trust I tend to see so many complaints, that I felt it important to tell the
story of what it feels like when things go absolutely right, even though the
events concerned, the deaths of much loved fathers, are ones one would wish
were not happening.
My father was cared for on and off for the last few years of his life by
staff in the cardiology ward of the Royal Free Hospital in Hampstead. He
always joked that he had been in every ward of the Free except the maternity
wards, but in fact most of his admissions were to the cardiology ward, and
they knew him well. When it became clear that there was little more anyone
could do for him, the care they gave him was exceptional. Several nurses
spent a great deal of time talking to him, asking him how he felt about
dying, asking him what his wishes were. When he decided to come home on
a Bank Holiday Sunday (why is the NHS so hopeless over Bank Holidays?),
when support at home could not be set up, a nurse and a houseman spent
hours in the freezing cold, as he sat in my car threatening to drive away,
persuading him to stay, until care could be organised. One nurse in parti-
x Preface
cular befriended him and got his confidence completely, so that he could tell
her things he felt he could not tell us.
When he did come home, for what turned out to be the last 28 hours of
his life, everyone involved was kind and helpful, from the ambulance men
who carried him upstairs and teased him, to the wonderful district nurse
who took charge of the situation and helped us organise the next few days,
to the Marie Curie nurses who came to be with him constantly, to the GP
who helped the district nurse make his bed, and was kindness itself to my
mother and me. It was a team effort between professionals and across organi-
sations of a quality I had not witnessed before at such close quarters. It was
also an object lesson, as a carer, of how much difference really professional
staff, who care passionately about what they do, can make.
My father was a very large man, and it took two or three people to turn
him. So we had a visit from the night community nurses, one of whom
spent quite some time comforting me. Despite her working in the Trust I
chair, I had never met her before. I shall certainly go out with them one
night, and watch that remarkable service from a more objective standpoint.
For the comfort they brought, late at night when the world is silent, and
early in the morning when fears run highest, was considerable.
When it became clear my father was sinking fast, and Alison, the district
nurse, and Carol, the Marie Curie nurse, helped me make it clear to my
mother – though she did not accept it at the time – the way they did it was
a lesson in how to provide care and support well, to my father, my mother,
and me. Carol even took my son home at the end of her shift – well beyond
the call of any duty.
I wish it were always like this. People might say it was as a result of
privilege, because I chair the Trust, that we were treated so well. But I am
so old I changed my name when I got married. My father and I did not
share a surname, and though some of the staff knew who I was, the
engaging young man who came to collect the equipment from Home Loans
certainly had not got a clue, and his smiling face, and considerable charm as
he expressed his sympathies, were helpful in themselves. When I told him
that the wheelchair had originally been delivered to my office and was now
going back with him, and would he explain it to Cath, he looked at me
quizzically and asked how I knew Cath. I explained I chaired the Trust, at
which he seemed completely unfazed, and just said – correctly – that I did
not look the same as I did in my photographs. That was not entirely
surprising after three days and nights in the same pair of jeans, and going
though a roller-coaster of emotions, plus exhaustion.
It was only a few weeks later that my father-in-law died at home, and
was also looked after by some of our district nurses. There the name was the
same as mine. But everyone by then knew that he was not my father. Once
again, the care was remarkable. He had private nurses as well, and the
integration between NHS and private worked extraordinarily well. The
district nurses provided great comfort to my father-in-law, but also remark-
Preface xi
able support to my mother-in-law, husband, brother-in-law and the rest of

the family. Once again, it was a faultless service. Once again, an elderly
man died in his own home, surrounded by loved ones, pain-free and peace-
fully – as he, and his family, had wanted.
I know it is not always like this. I hear all too often of parts of the
country, even parts of London, where such care is not made available, where
the palliative care service does not cover weekends, or really provide a proper
service integrated with the community nurses. But our experience was quite
wonderful. It leaves us all with a feeling of deep gratitude, of wonder at the
devotion of the people who provide that service day after day to very
distressed people, and also quite certain that we should provide this for
everybody, everywhere, throughout the country. The NHS has got this right.
We ought to shout about it much more loudly, show it to other countries
where people still die hospitalised, intubated deaths. But, first, we must make
sure it is possible for everyone here in the UK to receive such care – because
it feels absolutely right.
First Person, Health Service Journal, 3 October 1996.

(reprinted with permission)
Five years later, my mother died. She had also been ill for a very long time,
from before the time my father died, though we made light of her illness,
telling her that it was my father who was ill. How unkind that seems now.
She had a horrible auto-immune disease, manifesting itself in a variety of
ways, including sudden total loss of hearing, painful legs, renal failure, odd
skin lesions. Wegener’s Disease, or, as she described it, the attentions of Mr
Wegener, is a singularly unpleasant, unpredictable condition, with which
she suffered considerably but also showed immense courage in the face of
its worst onslaughts. Here follows the piece I wrote for The Observer at the
time:
My mother died in May 2001, after four years of an auto-immune disease

which left her with painful legs, poor kidney function, and general lassitude.
There was little the doctors could do, but she went regularly to see her
‘professor’ at University College Hospital, argued about how much steroid
she was prepared to take, and hoped for some miracle.
It never came, but injections of erythropoietin over those four years, by
Breda Sheehan, her beloved district nurse, and regular visits from GP
Jonathan Sheldon, made her illness more bearable, and alleviated the worst of
the symptoms.
But from January of that year, it was clear she was deteriorating, and
from mid-April we were into the last few weeks. At that point, the service
we received was ratcheted up a few notches. After a fall, she was taken to
the Royal Free Hospital. Despite their being on a ‘take’ for University
College, my mother was treated with the utmost courtesy, visited by the care
xii Preface
of the elderly team as well as the A&E Registrar, allowed to go home

provided she was careful, and visited the following day by the specialist
occupational therapists.
Two weeks later, with things obviously deteriorating, we moved to daily
district nurse visits from Breda, to support not only my mother, but the
devoted carers too.
Her GP came to talk to both my mother and me at my mother’s flat, so
that he could discuss with her what her worst fears were, allay them, plan
for what might be needed, and set it up before he went on holiday. My
mother was terrified of going into a home, of losing control. For someone
who had been a refugee from Nazi Germany, security was important.
Together, Jonathan Sheldon and I promised her she could stay at home. That
is what she did.
A week later my mother had a major collapse. Melodie Francis, her pallia-
tive care nurse, and Breda were both there, and thought she was dying. We
were called. By the time the afternoon came and went, my mother was
sitting up in bed reading the paper. Breda, Melodie, my husband and I were
all exhausted, and bemused. So it went for a few days, until we began the
final decline.
At that point, Breda and her colleagues were visiting up to five times a
day: my mother needed help with virtually everything, and one carer was
not enough. Melodie was coming in two or three times a day, because my
mother turned out to be allergic to morphine; she itched frantically, we
scratched in sympathy. Pain control, particularly with the cramps she was
then experiencing, was quite difficult. But controlled it was, and if it meant
calling Breda out again, it was never too much trouble. If we needed help at
night, it was there.
Towards the last, when we had been on an emotional roller-coaster, the
team members turned their attention to all of us as well as their prime
patient. Mrs Ryan, May, Juliet, Cavell, and Hayley, her ‘team’ of carers,
were supported, as were her family. Breda joked with my children, who were
facing university exams, teased my husband, comforted me, and helped to
keep the atmosphere light and supportive. At the end, we had private night
nurses for my mother, so that she could have pain relief whenever it was
needed, and so that we could get some sleep. Once again, those nurses fitted
brilliantly into the system.
My mother died as she wished, in her own home, compos mentis,
surrounded by people she loved, and by her own things. She slipped away,
in an NHS-provided hospital bed with an air mattress, with the best possible
care anyone could have.
But that was not all. Within three days, the equipment, the drugs, the
stuff needed for my mother’s care had been removed by people whose condo-
lences were genuine. Breda continued to come to see us, to make sure we
were all right, and Melodie rang to check that I was coping.
I do not believe that the private sector on its own could ever deliver a
Preface xiii
service like this, with the component parts working smoothly and apparently
effortlessly together. I know that there is huge effort in making those partner-
ships work, but we experienced the result of that hard work in a magnificent
service where organisational boundaries never showed. We saw the NHS at
its best – across community services and the acute sector, across primary
care and palliative care. And they worked happily with the private sector.
At best, this country has services for people who are dying and their
families which are incomparable. We should praise them more. Reading
newspapers and watching television, one might think the NHS never gets it
right. But what we have just experienced makes it clear that it can be
superb. I am grateful for the way my mother’s dying was supported, for it
makes the pain of loss easier to bear.
More to the point, the real appreciation was hers. She thought she was
wonderfully looked after, with remarkably little pain and distress. Before she
died, she too blessed the NHS, and thanked her carers, her nurses, NHS and
private, her GP, her consultants, and everyone else who had made dying like
that possible. It was truly remarkable.
These articles give some flavour of what we experienced as a family, with the
help of professionals who were both amazingly kind – in my view beyond
the call of duty – and superbly professional and knowledgeable. Their skills,
knowledge, and human warmth, were a real help and comfort to my family
and my parents’ friends – I do not believe either of my parents would have
had such good deaths had it not been for those people. Equally, five years
apart and two different teams, with different GPs and primary care teams
involved, suggests that this is more of a pattern than isolated instances – and
that from that pattern, and what those experiences teach us, we can learn
much more about dying well. So, to those who made the going easier for
both my parents, and to those who made their dying easier for all of us, this
book is dedicated – to them, their skills, and their devotion.
How we can die well, and help our families, friends, patients and neighbours
die well too.
Julia Neuberger
May 2004
Acknowledgements
This second edition is in memory of my parents, Walter and Liesel Schwab,

and is dedicated to all those who made my parents’ deaths easier, happier
and better, supporting my family and me in May 1996 and again in May
2001, especially Ann Hamlet, David Evans, Tom Evans, Breda Sheehan,
Jonathan Sheldon, Melody Francis, Nuala Ryan (snr) and Juliet Mwaniki.
1
An introduction to the history of
ideas about death
Wherever we are in the world, whatever our age, our gender, our class, we
all have feelings about death. Those feelings are often poorly expressed,
even poorly acknowledged. For many peoples throughout the world, how
they bury or cremate their dead, and how they mourn them, labels the
group from which they come, the tribe. Often it says little about belief but
far more about culture. Often it says little about individual desires but more
about community expectations. How we view our deaths, how we treat our
dying, how we console the bereaved, how we care for the carers, is
universal subject matter. But how it is addressed varies considerably from
individual to individual, from group to group, from country to country,
from healthcare system to healthcare system, from you to me to her to him.
There are no universal answers to the question: ‘How will I, or you, or him,
or her, meet the end?’
The idea of the good death is an ancient one. The Biblical expression of
being gathered to one’s fathers has a certain restfulness to it, and, indeed,
an idea of what is normal. We are supposed to die in generational order,
parents before children, grandparents before parents. We are supposed to be
gathered to our fathers and mothers. The most satisfactory outcome to be
desired is that we will die peacefully, possibly aware that we are near our
end, having achieved most of what we wished to achieve. Our hope is that
there will be no pain, either physical or emotional (a hope rarely completely
achieved), and that we will either know nothing about it (dying at home in
our sleep) or that we will know very little, just enough to say our farewells
to those we love.
We would like to be like Abraham, in the Hebrew Bible:
2 Dying well: a guide to enabling a good death
And these are the days of the years of Abraham’s life which he lived, an
hundred threescore and fifteen years. Then Abraham gave up the ghost, and
died in a good old age, an old man and full of years, and was gathered to
his people. And his sons Isaac and Ishmael buried him in the cave of
Machpelah, in the field of Ephron the son of Zohar the Hittite . . . (Genesis
25:7–9) in the cave which Abraham had bought from Ephron as a burial
place for his first wife, Sarah, and which became the family tomb.
Or, if we cannot be like that, and perhaps some of us might have our doubts
about reaching the age of 175, worried about who will care for us, we would
certainly like to be like Moses, who, though he did not go into the promised
land, saw it from the top of Mount Nebo, and was:
an hundred and twenty years old when he died: his eye was not dim, nor
was his natural force (sexual powers) abated. (Deuteronomy 34:7)
We would all like that. Or even to be like King David, who said to Solomon
his son:
I go the way of all the earth (1 Kings 2:2)
and then gave him instructions:
Be thou strong therefore and shew thyself a man; and keep the charge of the
Lord thy God, to walk in his ways, to keep his statutes, and his command-
ments, and his judgments, and his testimonies, as it is written in the law of
Moses, that thou mayest prosper in all that thou doest, and whithersoever
thou turnest thyself. (1 Kings 2:2–3)
These are only a few examples of the peaceful deaths we encounter reading
though ancient Hebrew literature, though possibly – in the Greek classics at
least – we read more about the violent deaths in battle, or in some kind of
disgrace. As a result of the texts that are our legacy, we know about how
suicide was abhorrent to many ancient peoples – yet there was a wholly
acceptable form of martyrdom: killing the women and children before turning
the swords on themselves, rather than falling into the hands of particular
enemies. We know that city captors often treated their captives to cruel and
prolonged deaths by torture. And, of course, we read about women dying in
childbirth as well, a commonplace event. So the expressions about death we
cherish are those of a peaceful death, being gathered to our ancestors, or
‘sleeping’ with them. The image of an endless rest is an appealing one. The
idea that our rest might be broken in an afterlife, with torment as punishment
for acts we have performed in this life, is a later idea, and a deeply disturbing
one.
Yet the idea of an underworld, peopled by demons and guards, is itself an
An introduction to the history of ideas about death 3
ancient one. The ancient Greeks and Romans believed in their underworld,
with Charon the boatman taking the dead across the Styx to Hades, where a
shadowy existence continued. Ancient Greek funeral customs included
putting a coin in the mouth of the deceased person as they were being
prepared for burial, in order that they had the money to pay Charon for the
fare across the river. And bodies had to be buried quickly – not, as many
have argued, because of the heat of the summers in the ancient world, but to
prevent the spirit wandering about aimlessly – presumably because it was
thought that just such an aimless spirit could do damage if it decided to do
so. It was Christianity that developed the idea of Heaven and Hell, as well as
Purgatory, possibly out of older ideas about the underworld, and with other
influences at work such as Mithraism, a religion that was enormously
popular in the Roman world. Judaism was later in its construction of an idea
of a place for an afterlife. Whilst the place to which the dead go in the
Hebrew Bible is Sheol, the pit, a belief grew up in rabbinic Judaism, very
likely under Christian influence, or in competition with the successful prosely-
tising of Christianity, in Heaven, in a place to which we go (often named
pardes, i.e. Paradise). The idea of punishment and reward grew, and it
stretched out through Christianity and Islam as well, especially the reward or
punishment of the soul, as distinct from the body, immediately after the
death. The idea of the resurrection of the dead at the end of days began to
grow too, a concept not found in the Hebrew Bible except in the extraor-
dinary prophecies of the prophet Ezekiel, in his vision about the valley of dry
bones:
And he said to me, Son of Man, can these bones live? And I answered, O
Lord God, thou knowest . . . And when I beheld, lo, the sinews and the flesh
came up upon them, and the skin covered them above; but there was no
breath in them . . . And ye shall know that I am the Lord, when I have
opened your graves, O my people, and brought you up out of your graves.
(Ezekiel 37:3,8,13)
The fascination with death, and with the possible future life of the dead, is an
ancient one. One has only to look at Egyptian tomb paintings, and to learn a
little about the ancient Egyptian obsession with death, and the world of the
dead, to the extent that the dead person took everything necessary with them
to the next world, servants, meals, clothes, and so on, to realise that the next
world was as ‘real’ to them as this. Concepts of Heaven in many traditions are
very similar to the ideal life as lived on earth, too, and Egyptians are not alone
in packing up everything someone might need for them to take with them on
their journey to the afterlife. We see it dramatically in Chinese customs, as well
as in what we read in Homer of the death of Patroclus and the human sacrifice
that took place at the time. Equally, there is some pretty unpleasant evidence
of what the Vikings did in the ninth and tenth centuries, when burying one of
their hero warriors. A slave-girl, of no status, would be forced to have sex with
a selection of the chieftains, and would then be ritually murdered and buried
with the deceased hero. And there is much more – all of these customs
suggesting that something had to be done to give safe passage to wherever the
dead person was going, something to give help – it could be pots and pans, a
concubine, servants, money or such like. The Aztecs forced their prisoners to
be buried alive – or killed them first – in their funeral rituals for their dead
heroes, and in Bronze Age Nitriansky Hradok, in modern Slovakia, there were
10 apparently praying, kneeling individuals buried alive – willingly, according
to some authorities, though Timothy Taylor (2002) suggests that willingness is
a curious term to use of those who might have felt duty, altruism or fear for
their own afterlives or, even, the present lives of their children and families.
We do not know. Suffice it to say that the ancient world seems to have many
examples of human sacrifice as part of death rituals for those who have died
naturally or in battle, and that the idea of taking people with you in death to
the next world was commonplace.
Along with all that, there were the prayers and rituals needed for the dead
person to get to where they needed to be. Indeed, the depiction of the sun
god, Ra, making his journey by boat across the sky and then going under the
earth to the world below – some equivalent to the world of the dead – and
being reborn every day shows a little of the thinking behind Egyptian
concepts of the world beyond this life. It is, of course, a universal human
concern, as is fear of death, fear of pain, and a way of looking at one’s end
without being able simply to accept it and ignore it. For human beings,
however matter-of-fact, there is too much emotion associated with our end,
even where life is cheap, and where grief seems to modern western people
either too short-lived or overly ritualised.
There is also the feeling that ‘we shall meet again’, a feeling shared by
people who are dying and people who are bereaved, something that has its
ancient origins in the idea of an afterlife where all will gather, or in the ideas
about a final resurrection at the end of days when everyone will be resur-
rected at their best, and meet again. But the sense that people who have been
separated in death will meet again is very strong in many cultures and reli-
gions, including Britain where formal religion has been in considerable
decline for many decades.
More recent thinking about death
In modern times, in the west, ideas about the good death originate very
largely from the 18th century. The good death was pain free, or pain dulled
by laudanum. It consisted in saying one’s goodbyes surrounded by one’s
family. The later, overly sentimental, Victorian pictures of deathbed scenes
actually originate from the 18th century concept of the good death, where
farewells were said, where prayers were said, where the family came to say
goodbye, and where death itself was not a terrifying presence.
The anticipation of a good 18th century person was of a moment to say

goodbye at death. ‘Ars moriendi’, the art of dying, is, amongst other things,
the title of a medieval treatise that contains images of horrible and persuasive
demons who prey upon a person’s last moments, and which necessitate a
firm hold on Christian belief in order to counter them. But the idea of an art
in dying, the art of dying well, is probably as old as humanity itself, and the
problem that has hit us in the 20th and 21st centuries is that, from the end of
the Victorian era on, we have used euphemisms for death, regarded those
who discuss death as morbid, and somehow forgotten that the experience of
dying is as important as almost any other experience for human beings, and
deserves proper consideration, though not obsession.
It is worth thinking about our use of langauge for a moment. All too often,
we do not even say that someone has died. We say instead that they have
‘passed on’ or ‘passed away’. They are ‘the dear departed’, or the ‘one who
has gone to his/her eternal home’. Euphemisms came into common usage in
the Victorian age, but that was a time when death was, if anything, overly
marked. The Victorians took the funeral and grief to hitherto unknown
degrees of observance; some would argue that many Victorians themselves
became obsessional, including Queen Victoria in her profound grief for Prince
Albert. Whatever the truth of that, it is at the end of the Victorian age that the
plethora of euphemisms really hit the English scene. Non-conformists seem to
have been the first to use them, but it became commonplace soon after, so
that when George V died in 1936, his death was announced on BBC radio as
the fact that he ‘had passed peacefully away’. The word death was not used.
People ‘passed away’, ‘fell asleep’, ‘departed this life’. In military action, they
‘copped it’, or ‘their number was up’. And colloquialisms abound – people
‘pop their clogs’, ‘hop the twig’, and ‘turn their toes up’. There are many
more such expressions.
But, if these are the expressions that are used, if saying the word ‘death’
becomes less common, even less acceptable, the idea that one might contem-
plate one’s death, as early religious thinkers would have urged us to do,
would have seemed morbid. Indeed, the consideration of death and dying at
all was considered morbid during the middle of this century – which did not
stop people studying and talking about the subject. But it was not a subject
for polite society. When Ian Crichton wrote his book, The Art of Dying, which
was published in 1976, he started with the fact that everyone had told him it
was a morbid subject when they had asked what he was writing about and
he had told them. When Sarah Boston and Rachel Trezise were working on
their TV series and book for Channel Four, Merely Mortal, a decade later, they
were met with the same reaction. Indeed, approaching terminally ill patients
for discussions with them for the film was an exercise in tact itself, given the
sensitivities.
How then, with these attitudes so prevalent in our time, can one talk
properly about the good death? How can this be done, particularly in the
light of the fact that either we are considered morbid to want to talk about it
at all, or we are drawn away from it in embarrassment because of the aware-

ness of how many people have been killed violently, in war, genocide, or by
famine and suffering, who had no chance to think about a good death in
reasonable old age? And did that reluctance to discuss death hit us in the
wake of the First World War, when so many young men were killed in the
trenches, when barely a family in Britain was untouched by loss? Was death
the great unmentionable, the stuff of nightmares and panic attacks but not of
debate and discussion and comfort? For, though from the 16th century on,
people had kept a ‘memento mori’ – a picture of a skull and a Bible, just a
skull or some other reminder by their side – to remember that we must die,
from the end of the First World War onwards that custom became deeply
unfashionable. We did not want to remember that we must die. Too many
had just died, before their time, and those that had returned had their nerves
shot to pieces, and were blinded or aimless and deeply depressed. Hence the
lack of discussion, and hence the reaction of the 1970s and 1980s to an
unmentionable subject – now once again fashionable, but still too rarely made
unemotional, factual and practical.
Yet, during all this period, some have continued to think about it, and write
about it. In some ways, discussion of some aspects of death and dying has
become fashionable, particularly some of the details surrounding physical
relief of pain and the attendant emotional, and psychological, relief that goes
along with it, allowing a different kind of contemplation. The old adage, that
we should live every day as if it were our last, or that we should repent one
day before we die – on the basis that it should be a permanent state, for most
of us cannot know exactly when we will die (Mishnah: Ethics of the Fathers
II:15) – has somehow stuck with us. You cannot ignore it. Though various
studies have shown people shying away from it (quoted by John Hinton in
his superb book Dying), the majority of people have wanted to think about it
and talk about it, as TV programmes on euthanasia, and on the ever-popular
hospice movement, make abundantly clear.
Indeed, the hospice movement, which has so caught the imagination of the
British public that it has become one of the most popular human charities,
expresses the desire people have for a ‘dignified death’, an expression one
hears all too often, and which, even with the best will in the world and the
best offices of the hospice movement and other palliative care services, is
unlikely to happen. Death is not a dignified business, in most cases, though
that does not militate against us dying well, even enjoying, odd though that
may read, ‘a good death’.
In some extraordinary way, the 19th century, particularly the latter half of
it, destroyed that concept of the good death. The Victorians were wonderful
at funerals and at mourning. All the rules about purple and black, about large
funerals, about great new cemeteries that were monuments to magnificent
architecture and stonemasonry, are Victorian. Exhibitions on the subject of the
Victorian way of death show all too clearly how they rejoiced in a funeral
train to go to Randall’s Park at Leatherhead in Surrey, or how the great
monuments of the south London cemeteries came to be constructed. A decent

funeral came to be every working person’s desire and dream. Until the 1940s
and even later in some parts of the British Isles, people were putting away a
shilling a week for their funerals, giving it to the insurance man when he
came round. My mother, when she first came to Britain from Nazi Germany
as a refugee, had never encountered the shilling for the funeral before. But
amongst working girls at Marks and Spencer in the 1930s, it was still
commonplace. Decency in death was as important, possibly even more impor-
tant, than decency in life.
But it became overly sentimentalised, in two distinct ways. First, there was
the sentimentality surrounding the death of children. Sunday school prize
novel after Sunday school prize novel told the tale of an angelic child, often,
but not always, female, who was going to Heaven. We saw her in a golden
glow, with fair hair shining. The child was saying goodbye to her not too
grief stricken family, who knew she was on her way to a better place. The
best known picture of a doctor attending a dying child, Sir Luke Fildes’ The
Doctor, where a child lies dying with the doctor beside her in a fisherman’s
cottage on the English coast, uses that particular theme, that particular lie,
one might almost add. There are thousands upon thousands of stories like
that to be found in second-hand bookshops, but the style of thinking about a
child’s death is by no means original in those volumes. For the classic of all
times in that regard is perhaps Charlotte Brontë’s Jane Eyre, where, towards
the beginning of the schooldays at the appalling Lowood school, a real school
which Charlotte Brontë both attended as a child and where she later taught,
Helen Burns dies of consumption. Helen was almost certainly Charlotte’s
own sister Maria, and the conversation which Helen and the young Jane have
is one which both reduces the reader to tears and irritates beyond measure.
For Helen herself is sure she is going to a better place. There will be no more
earthly pain. Jane is not to grieve for her too much. As I have got older I have
felt more and more angry about that idea that Jane should not grieve for her
too much. ‘Why not?’, I hear myself asking. The need to grieve is a very
human one. To somehow find solace in the idea that the dear departed has
gone to a better place is one thing, but not to be allowed to grieve because of
it seems extraordinary, when the grief is largely to do with missing the
person, and having terrible feelings of disappointment at what they failed to
achieve in their life because it was cut short. And, in this case, the fictionalised
person whose life was cut short was the author’s sister, a child who died
unnecessarily because conditions at the school were so appalling.
But Jane Eyre takes the sentimentalising of childhood deaths to its apogee,
possibly as a literary device to pour scorn on the school and its governors
who allowed such conditions which led to the girls’ illnesses and deaths to
persist. There are thousands of examples, however, and the Victorian imagi-
nation on the subject of childhood death, at a time when the death of children
was common, is one that still colours some of our thinking, even though we
now find the death of children in the west virtually unbearable.
But the other important factor in Victorian thinking about death, at least
within the English speaking world, was the death of Queen Victoria’s
husband, Prince Albert, and her lifetime of mourning for him. She took
mourning to a fine art herself. She insisted on court mourning, on great
memorials, including the vast Albert Memorial in Hyde Park. And she barely
came out of her mourning to celebrate any event at all after his death. That,
in itself, had a powerful impact on the public, and set an example of how we
should approach death, with formality, and outward visible signs of
mourning, and with memorials and black-edged cards, and black-edged
newspapers, and so on. So black became the colour favoured by widows in
Victorian England (it had always been the colour of mourning in the Mediter-
ranean countries) and the commonplace stationery of grief became black
cards and black-edged envelopes, to be bought cheaply at any stationers.
Black for mourning. Pink and gold for the colours of expectation of heaven,
particularly for children. That was done in books, at least in part as a result of
the thinking that, for many of the children who died in appalling conditions
of poverty and disease, the fact was that their lives had been ‘nasty, brutish,
and short’. Heaven for innocent children had to be better than that. Though
whether this was simply a way of coping with commonplace child death is
unclear – it may well be that conditions looked so appalling for so many of
those children that anything would seem a release from the objectionable. Yet
the sentimentalisation of childhood death must have slowed quite consider-
ably the effect of the anger of those social reformers who looked at conditions
and saw how dramatically and how speedily they could be improved.
Indeed, with the rise of the ‘respectable’ working classes, the assumption was
that decent conditions could be found in poor homes if they tried hard
enough – and the working classes themselves went along with these major
mourning rituals, with the wearing of black, and with the invention of that
new sign of mourning, the black armband.
But the Victorian fascination with death, and almost celebration of it,
changed with the coming of the new century. With telegraph and the tele-
phone, it became possible to hear news of death in war all too quickly. The
savagery of the First World War and the needless loss of life, the sense that
thousands of young men had died quite unnecessarily in the trenches, was
one element in a changing attitude towards death. Death in war, death before
one’s proper time, death of the prize of England’s youth, the agony of the
war poets, all this added up to a different attitude. Much of that has been
recorded in the writing of the time and later – no-one can fail to be moved by
Pat Barker’s evocation of the smell of death in her Booker prize winning The
Ghost Road, or by the pain recorded in Vera Britain’s Testament of Youth, as the
flower of England’s youth met its end. Death was painful. It had to be faced,
by almost every family with young men serving in the army. But it was no
longer sentimental. A much darker tone hit descriptions of death. Blood, mud
and gore were featured. Wilfrid Owen captured a mood of despair. The
trenches were about fear, and stenches, and rats. Young men who survived
returned with nightmares, often politely described as ‘shellshock’. It was not

the shells that had shocked them. They had seen their friends and comrades
die. They kept reliving their experiences. Psychological interventions were in
their infancy. Yet these young men could no more ‘pull themselves together’
than fly. The spectre of death in its worst guises kept returning to haunt
them. Victorian sentimentality would no longer do. So descriptions of death
darken, and then they gradually disappear. After the First World War poets,
death as a theme becomes less common. Instead, with Freudian thought
capturing the world, people began to talk about sex (long before the 1960s).
Yet, as ordinary talk of death disappeared in the main from literature, a
movement for birth control for the working classes, and for euthanasia for the
unfit, was beginning. Eugenics was growing in popularity, and had its darker
side. For instance, long before the Nazi programme of extermination of the
Jews, the early Nazi policy makers came up with the idea of exterminating all
those who were living in state institutions who were mentally ill or handi-
capped, on cost grounds. The most extraordinary piece of deceit took place.
Whilst parents were being told of their children’s new clothes, and that they
were eating well, their children were being systematically murdered, with the
connivance of churchmen, very often – though it was church objections that
finally halted the process – and all this was with the active participation of
psychiatrists, who had been unable to help the young men returning from the
First World War trenches.1 It took a long time for the German psychiatric
profession to retrieve its professional standing after that. But it also helps to
explain, even before the mass exterminations of Jews, gypsies and others,
why the view of death changed from one of sentimentalisation to one of
horror – brutal war, brutal extermination, the beginnings of a scientific theory
about the survival of the fittest being used to justify murdering the less fit.
And then there was the Holocaust, and the systematic murder of millions of
civilians, quite apart from the other casualties of the Second World War.
People who had lived through the death camps could not talk about them.
Others were filled with horror of death. All this deliberately engineered death
was happening just at the time that it was increasingly possible to keep
people alive. The old-time deaths from tuberculosis were slowing down with
the discovery of antibiotics. Polio was gradually disappearing with inocula-
tion and vaccinations for other childhood diseases were making their mark.
Life expectancy was shooting up. Normal death at a young age was
becoming less common. Abnormal death at a young age was much to be
feared. And people did not talk.
Only in some of the new West Indian communities of the 1950s and 1960s
in Britain, the Windrush generation and its successors, was there discussion
of death, and a more open way of marking dying and bereavement. In West
Indian communities, deathbed scenes were commonplace – and often still are
– and the churches supported both the dying people and their families, with a
huge funeral in many cases, and rituals that recognised the importance of
grief as well as a sense of joy in the expectation of a very real Heaven.
A modern reflection
But, apart from very specific communities with a different view, in main-
stream Britain, by the time I was growing up in the 1950s and 1960s, my
generation was not familiar with dead bodies. I did not see a dead body
until I was in my twenties. As genocides became more common –
Cambodia, Rwanda, Uganda, to name but a few – most of my contempor-
aries were the same. They had never seen a dead body, except on television,
in appalling images of large numbers of corpses. But they were not real to
them in most cases. More than never having seen a dead body, they
probably had not been to a funeral. For many of them, the first funeral they
went to was that of a parent or grandparent. Ordinary death, ordinary
people dying ordinary deaths at home surrounded by their loved ones, was
disappearing. People we knew died in hospital. It was somehow more
hygienic. You did not have to think about it; or see it; or be there. It would
all be tidied away. Just as babies began to be born in hospital as the norm,
so people began to die in hospital. It was the norm and we all accepted it.
We did not talk about death. We did not draw down the curtains when the
cortège went past for the funeral, unless we lived in Scotland or Ireland. We
simply ignored it, despite increasing news of people starving, or being killed
in appalling regional wars, and growing genocidal killings.
Meanwhile, those who died in hospital had a less than easy time of it as
well. Hospitals were places for curing people, not for looking after them
when they were dying. All the training of young doctors and nurses was
geared towards getting people better, not to alleviating their pain and
discomfort when they could no longer improve. Patients who were dying
were all too often shoved into a side ward, given a massive dose of
morphine every four hours, and left to get on with it. Little was done to
alleviate their distress. All too little was understood about their pain,
physical and mental, and though cruelty was not intended, it took place
every day.
For, to be packed away and left to die alone, in pain, is a terrible experi-
ence for anyone. In a culture where no-one was even talking about death
any more, it was cruel. The dying people were often not even told that that
is what they were doing. They were given false reassurances in blustery,
jolly voices: ‘Oh, you’ll soon be out of here . . .’ (In a box . . .!) ‘We’ll get you
up and about in a jiffy . . .!’ (Not bloody likely.) But the prevailing attitude
was not to talk. So the dying person would lie there, high as a kite on
morphine for a couple of hours, and in pain, disorientated, without anyone
to tell him or her honestly what was happening, with a few people coming
in from time to time to talk about the weather – but nothing that mattered.
To some extent, this remains the case, but such practice is diminishing. Yet,
even now, all too often, where a person cannot die in a hospice or at home,
staff in hospitals or in nursing homes, unintentionally, treat dying patients in
a cavalier way. In many cases, they have not been trained to do otherwise.
The ethos of many teaching hospitals is, in any case, to go for acute interven-
tion rather than skilled care of people who in some sense have ‘no hope’ in
the terms of cure-motivated health professionals. Indeed, it is further compli-
cated by the fact that people with very little chance of recovery or even of
remission and survival for any length of time worth talking about, are
subjected to heroic interventions, which may be more for the benefit of the
carers than of the patients. If carers themselves, healthcare professionals, have
been brought up like the rest of us, then unless they have been trained
specially, they will be unfamiliar with death. Even now in hospitals, they may
regard it as their duty to try to avert death rather than welcome it, making
the patient comfortable in the process.
This has reached a far more serious stage in the United States than in
Europe. For, in the USA, there is almost an attitude that death is to be averted
in all possible circumstances, that there is no natural lifespan. Life expectancy
after the age of 84 is higher than in the rest of the western world. People lie in
intensive care for months, with battle being waged against death. And so
people die horrible, prolonged, intubated deaths, well recorded by Sherwin
Nuland in his year-long 1994 US best-seller, How We Die. But what he
describes, and what we can see in the wards of American hospitals, cannot be
the kindest way to go.
It is as a result of this kind of thinking, this desire to preserve life, that a
new movement grew up in the 1980s and 1990s for people to sign a living
will, an advance directive, in the United States. Indeed, as a result of legisla-
tion passed in 1991 (The Patient Self-Determination Act), every institution in
receipt of state or federal funds, which means more or less everywhere in
the American healthcare system, has to ask a patient each time they are
admitted whether or not they have signed an advance directive or
appointed a healthcare proxy. Although many institutions have not taken
this altogether seriously, to the extent that they have allowed the cleaning
staff to ask the question, on the grounds that everyone else is too busy, the
intention behind the legislation is altogether clear. Patients should be able to
decide for themselves when they want no more treatment. And they should
be able to decide, in advance of being in a state where they cannot make
their wishes known to their carers, as to what it is they want done, or not
done. Of course, this is in part a reaction against the worst excesses of the
American healthcare system, with people being kept in intensive care for
months, full of tubes, unable to tell night from day. But it is also a form of
rationing – it is an attempt to cut down the absolutely huge sums of money
spent on patients in the last few weeks of life. Indeed, there are those who
argue that half of all health expenditure is spent in the last six months of
life. The thinking surely goes like this: If people can make advance direc-
tives, they will decide to have less expensive, less interventionist treatment
if they are mentally unfit, and will therefore spend less on care, which will
in turn cost the state or the federal government less. But there is disturbing
evidence from the New England Journal of Medicine that one in four advance
directives has been disregarded.3 Nevertheless, the thinking is about treating

those who are very ill, and probably dying, more humanely, or at least
more in accord with their own wishes.
Questions of conscience
For this is really the problem. From the late 20th century onwards, we have
had choices about how we die if we live in the western world – with its extra-
ordinary healthcare that can often keep us alive, if not living. We can make
choices about how hard to try to stay alive, about whether to go for pain
control and comfort, or heroic, but unlikely, interventions. Yet, even the
unlikely interventions sometimes work. Many of us have things we still want
to do, still want to achieve, or see happen. There is a possibility that we
might be able to get some of those things done, if we submit ourselves to
some of the interventions that are sometimes suggested, unpleasant though
they might be. Do we have to have the treatment every time? Can we say to
ourselves we have had enough? These are questions of conscience for each of
us as individuals now, but they are also questions of conscience for every
healthcare professional. Should the doctor or the nurse decide who should
live, and for how long, or not? Whose decision should it be, now we can take
it, whether to go for life-support? The doctor’s? The nurse’s? The patient’s?
The patient’s family?
And how do we come to these decisions? Alone? With help? With that
modern answer to all communications issues, a video? Watching a video
alone? Is it my decision, or yours? Is it my body? Whose body is it anyway?
And, once the decision is taken, should we then be able to say that we want
complete pain relief, and to be put out of our misery if we suffer pain? And,
if that is the case, does that justify us asking a doctor to kill us? For eutha-
nasia is not legal in the United Kingdom, though it has been decriminalised in
Holland. But discussions about its introduction are increasingly common,
with Joel Joffe leading a campaign for its introduction in the House of Lords,
and a committee being set up to examine it again in 2004. Meanwhile, the UK
government is proposing legislation to allow advance directives in the UK
(proposed for 2004), which will, at least, make it plain that choice of treatment
is the dying person’s choice, rather than the healthcare professionals’. And
that has become ever more necessary as more and more cases are tested in
the UK courts over whether someone has a right to die (the totally paralysed
Miss B convinced judges she should be allowed to die, with a cessation of life
preserving treatment, in 2002) or even whether they have a right to live, as
cases are being tested at present (2004) over severely disabled Child N, whom
healthcare professionals have, arguably, decided not to resuscitate when she
has severe breathing problems. Or David Glass, the child whose disabilities
led to doctors ceasing feeding and giving him a diamorphine drip at aged 11,
on the basis that his severe disabilities made resuscitation absurd. His rela-
tives unplugged the drip (The Observer, 4 January 2004) and resuscitated him
themselves, and a ruling on what the law should be in these cases is expected
from the European Court in early 2004. All these are cases which illustrate the
difficulty. The question is whose control matters, and who gets to make the
decision. In modern Britain, we increasingly seem to think that it is our
choice, the dying person’s and their family, the disabled person’s and their
family, and not for heath professionals. All this can be predicated, arguably,
on a basic human right to control our own fate.
But how do we make those decisions sensibly, when circumstances have
changed so much? For, alongside the development of techniques for keeping
people alive, with the great advances in clinical medicine, goes the develop-
ment of the modern hospice movement. Founded in Britain by Dame Cicely
Saunders, OM, it has had a profound effect worldwide. For the modern
hospice movement preaches pain control at the very beginning, and then
caring for the whole person, not just the physical symptoms. It preaches care,
and love, and faith. For those without faith, its philosophy can be hard to
take. For those who prefer to think of themselves as autonomous individuals
with the right to take their own lives, or ask others to take it for them, the
hospice is curiously fatalistic. They prefer more decisive action, less prayer
and faith. But for many people who do not share the intensity of Christian
faith which Dame Cicely Saunders has, as do many of those working in the
hospice movement, there is nevertheless much to be gained out of the skilled
control of pain developed by the hospice movement, with the proper use of
morphine and other drugs, in no greater quantities, indeed often smaller, than
conventional hospitals. Yet the philosophy is of relief of pain, and allowing
the person to go smoothly and painlessly into death.
The hospice movement has had a powerful impact. But it is by no means
enough. Still fewer than 10% of people die in hospices. More now die at home,
around 50%, and many of them with home care teams helping and supporting
them and their carers. Even then, care is still infinitely better for those dying
from cancer, AIDS or motor neurone disease than for those dying of conges-
tive heart failure, for instance, or end stage renal failure. The hospice
movement has done much to change our attitudes to dying, but its main focus
has been on cancer, whilst many, older people particularly, die of other condi-
tions and combinations of causes which the palliative care specialists have
often ignored. So, far more still needs to be done to challenge the hi-tech view
of death, the way that heroic interventions are carried out often for the benefit
of the healthcare professionals, and the way caring for dying people in a
regular hospital is often so disappointing. The task facing all healthcare profes-
sionals when dealing with dying people is to try to come to terms with the fact
that many people do not want all the heroic efforts in the world, everything
possible, in fact, to be done for them. They do, however, want to be made
comfortable, and that, with the skills now available and the huge knowledge
base about pain control which has been developed as a result of the hospice
movement, is entirely possible. And they want dignity to the last. Meanwhile,
some of us have the great good fortune, not necessarily regarded as such by
our family and friends, to go to bed one night and simply not wake up, but
we rarely talk about it as our hope. As one of my children put it when she was
very young, to go to bed and wake up dead. For most of us, that is the ideal
death. If there were to be just the smallest bit of warning, such as a hint a
couple of weeks or months before, then we could be sure we had put our
affairs in order, that we had done the best to sort out any mess we had left,
and could die at peace. And dying at peace with oneself is something dying
people often talk about as their most cherished aim.
How we die
But most of us do not die like that. We go to the doctor because we have an
ache, a pain, a swelling in the breast or in the groin, or we are unable to pass
water. We cannot eat or drink. We simply feel off colour. Or an ambulance is
called because we have had a stroke, or a coronary attack, or a sub-arachnoid
haemorrhage. One or other of these things is what gets most of us into the
situation where we think we might have a terminal illness. Not all these
conditions are by any means terminal. Our GP might laugh at us and say we
are just imagining it. The breast lump turns out to be benign. The inability to
pass water is just the usual prostate trouble without any malignancy. But we
have had the fear. We have begun to worry. And nothing is quite the same
afterwards, because the beginnings of worry stay in the backs of our mind.
We have had our first intimations of mortality.
Then, for most of us, comes the real illness that lays us low, and turns out
to be terminal. Often, we do not know that to be the case at the outset, and
there are questions to be asked about the way we are treated when we have a
life-threatening, but not necessarily terminal, illness. For the standard practice
amongst healthcare professionals is to be less than wholly frank with the
prognosis, on the basis that, if we knew how unlikely a cure, or a remission,
was, we would be less likely to take the treatment. The situation is changing.
In the United States, there may be little tact involved, but healthcare profes-
sionals tend to be more honest. In Britain, the younger doctors particularly
are more inclined to give the full picture.
But it is not as simple as that. For giving the whole picture means different
things to different people, at different times. If I were in my mid-forties, with
two dependent children, and was told I had a life-threatening disease, I
would be more likely, given my situation and my personality, to want to go
for all the heroic interventions that might give me a bit more time. In my
fifties, I begin to feel differently; less worried about my children now they are
grown up, but with lots of things I still want to do in my life. I imagine, but,
of course, cannot be sure, that if I were in my mid-seventies I would be more
fatalistic (at precisely the time when the malignancy is likely to grow more
slowly anyway) and decide against the very unpleasant forms of treatment in
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paid to the teaching of Systematic Americanism. It is a branch now much
neglected. The professor should take pains to instruct his “fellow
Academicks” in the manners and customs of their own country, so that
they should no longer be reckoned strangers on their native soil. They
should be taught to avoid entangling analogies drawn from the experience
of other lands, and to look directly at the subject-matter. When they see
something going wrong, they should not jump at the conclusion that it is a
repetition of the classic tragedy of the Decline and Fall of the Roman
Empire,—for it may be something quite different. When there is a popular
movement on the prairies, they should not begin to talk of the French
Revolution and of the excesses of the proletariat. Before they talk in
European fashion of the “classes and the masses,” they should make
certain that we have such things, and if we have, that there is a sure way
of telling which is which. The Old-World generalizations about the upper
and lower and middle classes should be well shaken before using.
Those who elect the course in Americanism should be taught to
overcome the nervous fright to which bookish people are subject at the
appearance of any man in public life who shows signs of unusual virility. It
is a weakness of those who are more familiar with the careers of Cæsar
and Napoleon than with the temper of their fellow-citizens. In the early
seventies there were academic minds thoroughly convinced that they
were watching the Republic in its death struggle with Cæsarism.
Curiously enough, they fixed upon plain Ulysses Grant to act the part of
Cæsar. It would have been hard to find one less fitted for the rôle. When
we look back and contrast what really happened with what the well-read
spectators thought was happening, we are reminded of the remark of the
British matron to her husband as they left the theatre where they had
been seeing the play of “Antony and Cleopatra,” “How unlike the home life
of our dear Queen!”
The great thing, as President Roosevelt has often reminded us, is to
“think nationally.” This is no small achievement. A nation is a psycho-
geographical fact which it requires a very great effort of the imagination to
conceive. The same word represents a land and the people who inhabit it.
The physical features of the landscape have their spiritual counterparts. It
may be that the landscape impresses itself on the imagination of the race,
or, as may be maintained with equal plausibility, the imagination of a gifted
race may interpret the landscape and impress itself upon it forever. In
either case there is a recognizable harmony between the two elements. In
reading the great literature of Israel we never forget that the nation was
desert-born. “He found him in a desert place, he led him about, he
instructed him.” In psalm and prophecy we are conscious of barren
mountain ranges, of rocks in a weary land, of narrow valleys which laugh
for very joy over the incongruity between themselves and the surrounding
desolations. There is the passion of the desert, born of solitude and the
stars. In the prophet of righteousness there is the same urgent note that
Bayard Taylor catches in his “Bedouin Song:”—
From the Desert I come to thee

On a stallion shod with fire;
And the winds are left behind
In the speed of my desire.
The impatient human cry is followed by the refrain natural to those whose
lives are surrounded by the eternal calm of the desert,—
Till the sun grows cold,

And the stars are old,
And the leaves of the Judgment Book unfold.
When we think of the Greeks we think at the same time of
the sprinkled isles

Lily on lily that o’erlace the sea,
And laugh their pride when the light wave lisps “Greece.”
England and her Englishmen are forever inseparable. “This happy breed
of men” belong to “this little world, this precious stone set in a silver sea,
this blessed plot, this England.” That Great Britain is an island is more
than a fact of physical geography. It is the outward and visible sign of an
insularity of sentiment which gives its peculiar quality to British patriotism.
There is something snug and homelike about it, as of a family that enjoys
“the tumultuous privacy of storm.”
We become conscious of Spain and her Spaniards as we read
Longfellow’s lines:—
A something sombre and severe

O’er the enchanted landscape reigned,
As if King Philip listened near
And Torquemada, the austere,
His ghostly sway maintained.
When we come to the United States of America there is a peculiar

difficulty in thinking and feeling nationally, because the imagination does
not at once find the physical facts to serve as symbols. It is not easy to
conceive the land as a whole. When we sing “My Country, ’tis of thee,” the
country that is visualized is very small. The author of the hymn was a New
England clergyman, and naturally enough described New England and
called it America. It is a land of rocks and rills and woods, and the hills are
templed, in Puritan fashion, by white meeting-houses; for the early New
Englander, like erring Israel of old, loved to worship on “the high places.”
Over it all is one great tradition: it is the “land of the Pilgrims’ pride.”
The farmer in North Dakota loves his country, too; but the idea that it is a
land of rocks and rills and templed hills seems to him rather farfetched.
His heart does not thrill with rapture when he thinks of these things. He
can plow all day in the Red River valley without striking a stone, and he is
glad to have it so.
The Texan cultivates an exuberant Americanism, but he does not think of
his country as the “land of the Pilgrims’ pride.” Texas is not proud of the
Pilgrims, and perhaps the Pilgrims would not have appreciated Texas.
When the American has come to feel, not provincially, but nationally, the
words “my country” bring to his mind not merely some familiar scenes of
his childhood, but a series of vast pictures. They are broad and simple in
outline. “My country” is no tight little island shut out from “the envy of less
happier lands.” It is continental in its sweep. It lies open and free to all. It
is large and easy of access. There is a vision of busy cities serving as its
gateways. Behind them is a pleasant home-like land with “a sweet
interchange of hill and valley.” Beyond the mountains another scene
opens. We see the sources of the strength of America and feel the
promise of its future. To see the Mississippi valley is to believe in
“manifest destiny,” and to take a cheerful view of it. To the ancient world
the valley of the Nile was the symbol of fertility. It is a narrow ribbon of
green in the midst of the desert. Here Plenty and Famine were in plain
sight of one another. There was always the suggestion of Pharaoh’s ugly
dream of the lean kine devouring the fat and well-favored. But in the
valley of the Mississippi the fear of the lean kine is dispelled. One may
travel at railroad speed day after day, and still the fields of wheat and corn
smile upon him. Here the ample land gives happy confidence to men’s
prayer for daily bread. And beyond the fertile prairies “my country”
stretches in high plains and lofty mountain ranges. Here are new
treasures waiting bold spirits who claim them. The land has a challenge
and an invitation.
What a weary dearth

Of the homes of men! What a wild delight
Of space, of room! What a sense of seas
Where seas are not! What salt-like breeze!
What dust and taste of quick alkali!
And beyond the mountains lies the American Avilion, where never—
wind blows loudly; but it lies

Deep-meadow’d, happy, fair with orchard lawns
And bowery hollows: crown’d with summer seas.
And this great land is one; though it is “a nation of nations” it has achieved
a national consciousness. There is an atmosphere about it all which we
recognize. To breathe it is an exhilaration. One loves to think of it as the
land of “the large and charitable air.”
* * * * * *
The conception of the continental proportions of America did not at once
dawn upon its new inhabitants. They thought and spoke as transplanted
Englishmen. Each of the thirteen States was a tight little republic insisting
on its own rights. Each plucky Diogenes sat in its own tub, saying to its
neighbors, “Get out of my sunshine!”
It was only as they turned westward that Americans discovered America,
—a discovery which in some instances has been long delayed. “The
West” is not merely a geographical expression, it is a state of mind which
is most distinctive of the national consciousness. It is a feeling, an
irresistible impulse. It is the sense of undeveloped resources and limitless
opportunities. It is associated with the verb “to go.” To the American the
West is the natural place to go to, as the East is the place to come from. It
is synonymous with freedom from restraint. It is always “out West.”
Just where the geographical West begins it is not necessary to indicate.
On the coast of Maine you may be shown a summer cottage and told that
it belongs to a rich Westerner from Massachusetts. Massachusetts is not
thought of as exactly the Far West, but it is far enough.
The psychological West begins at the point where the centre of interest
suddenly shifts from the day before yesterday to the day after to-morrow.
Great expectations are treated with the respect that elsewhere had been
reserved for accomplished facts. There is a stir in the air as if Humanity
were a new family just setting up housekeeping. What a fine house it is,
and how much room there is on the ground floor! What a great show it will
make when all the furniture is in! There is no time now for the finishing
touches, but all will come in due order. There is need for unskilled labor
and plenty of it. Let every able-bodied man lend a hand.
One does not know his America until he has been touched by the
Western fever. He must be possessed by a desire to take up a claim and
build himself a shack and invest in a corner lot in a Future Great City. He
must be capable of a disinterested joy in watching the improvements
which other people are making. Let the man of the East cling to the old
ways and seek out the old landmarks. The symbol of the West is the
plank sidewalk leading out from a brand-new prairie town and pointing to
a thriving suburb which as yet exists only in the mind of its projector.
There is something prophetic in that sidewalk on which the foot of man
has never trod.
One who has once had this fever never completely recovers. Though he
may change his environment he is always subject to intermittent attacks.
I remember on my first evening in Oxford sitting blissfully on the top of a
leisurely tram car that trundled along High Street. The dons in academic
garb were on their way to dinner in the college halls, and they looked just
as my imagination had pictured them. I was introduced to one of them.
When he learned that I was an American, there was a sudden thaw in his
manner.
“Have you ever been in Dodge City, Kansas?” he inquired eagerly.
I modestly replied that I had only passed through on the railway, but I was
familiar with other Kansas towns, and, reasoning from analogy, I could tell
what manner of place it was. This was enough. I had experienced the
West. I was one of the initiated. I could enter into that state of mind
represented by the term Dodge City. It appeared that in the golden age,
when he and Dodge City were both young, he had sought his fortune for
some months in Kansas. He had experienced the joys of civic newness, a
newness such as had not been in England since the Heptarchy. He
discoursed of the mighty men of those days when every man did what
was right in his own eyes, and good-humoredly allowed his neighbor to do
likewise. As we parted, he said, with mournful acquiescence in his
present estate, “Oxford does very well, you know, but it isn’t Dodge City.”
If poetry is emotion remembered in tranquillity, what could be more
poetical than Dodge City remembered in the tranquillity of Oxford
quadrangles?
In this case the poetical view was a sound one. The traveler across the
newly developed States of the West has the traveler’s license to contrast
unfavorably that which he sees with that which he left behind him in his
home country. He may say a dozen uncomplimentary things, and each
one of them may be true. He may exhaust all his stock adjectives, as
“crude” and “raw” and the like. But when he remarks, as did a certain
critic, that because the country lacks “distinction” it is uninteresting, he
betrays his own limitations.
It is just that lack of distinction that makes America interesting. Here, no
longer distracted by what is exceptional, one may take the welfare of the
masses of men seriously.
Here the doings of men correspond to the broad doings of the day and the night,
Here is what moves in magnificent masses, careless of particulars.
When Shelley was an undergraduate he was attracted to a lecture on

mineralogy. It seemed to him a subject full of poetical suggestiveness. His
expectations were disappointed, and he unceremoniously bolted and
returned to his room. “What do you think the man talked about? Stones!—
stones!—stones! I tell you stones are not interesting—in themselves.”
Shelley was right. Stones are not interesting in themselves; neither are
railroads, nor stockyards, nor new unpainted buildings, nor endless
cornfields. But for that matter, neither are crumbling columns, nor old
manuscripts, nor the remains of feudal castles interesting—in themselves.
Things become interesting only when seen in relation to the people
whose thoughts they have stimulated and whose imaginations they have
stirred.
America is a fresh field for human endeavor. Here are men busily making
roads, bridging rivers, building new cities. They have been given the task
of subduing a continent. But in such conflicts with Nature the conquered
influences the conquerors. What impress does the continent make upon
the minds of the hardy men who are mastering it? What visions of the
future do they see which transform their drudgery into an heroic
adventure?
In the case of the older nations such questions about the beginnings and
the ideals of the beginners cannot be answered. The formative period,
with all its significant aspirations, is buried in oblivion. “Who thinks any
more as they thought?” we ask in regard to the pioneer of Britain. Poetry
has license to picture him as a knight in armor and to tell how in romantic
fashion he pitched
His tents beside the forest. And he drave

The heathen, and he slew the beast, and felled
The forest, and let in the sun.
It was all a long time ago, and the men who did these things are not
clearly revealed. Not being able to get at their ideals, we attribute to them
those which we think appropriate.
The historians are troubled by their lack of authentic material. They are
like the magicians, astrologers, sorcerers, and Chaldeans of the court of
Nebuchadnezzar. Nebuchadnezzar had a dream that he knew was very
important, but before he could get it interpreted by his wise men he forgot
what it was. They were good at interpretations, and could have made one
to fit if only the king had brought the dream with him so that they could try
it on. But that was the very thing he could not do.
The founders of London and Paris had doubtless their dreams of the
future; but alas! they have long since been forgotten. But Chicago has not
had time to forget. Everything is still vivid. Men walk the streets of the
great city who remember it when it was no bigger than the Londinium of
the time of the Cæsars. They have with their own eyes watched every
step in the civic development and they have been a part of all that they
have seen. The Londoner has seen only a passing phase of his London;
the greater part of its history is received on hearsay evidence. The
Chicagoan sees his Chicago steadily and sees it whole. No wonder that
there is a self-consciousness about the new metropolis that is not to be
found in the old. Its greatness has been thrust upon it suddenly, and there
is a full realization of its value.
The genuine American who is the maker of the new fortunes of the world,
and who is in love with his work, has not been adequately portrayed in
literature. It requires an ample imagination to do justice to his character.
There must be a mingling of realism and romance. The realism must not
be the minute, painstaking portraiture of a Miss Austen, but the hearty,
out-of-door reality of a Fielding. The American Fielding has not yet
appeared, but what a good time he will have when he comes! What a host
of characters after his own heart he will find! The American Scott, too, is
called for to give us a story of American life which will read as well on the
edge of a clearing in the forest as “The Lady of the Lake” did in the
trenches of Torres Vedras, when the soldiers forgot the enemy’s shells as
they gave a glorious shout over the poet’s lines, which their captain was
reading to them. I like that story, in spite of the fact that a recent critic
declares that to like it shows an uncultivated taste. “This is not,” he says,
“a test of poetry. An audience less likely to be critical, a situation less
likely to induce criticism, can hardly be imagined.” Nevertheless, Scott
would much rather have written lines that rang true to soldiers in the hour
of battle, than to have been given a high mark by the most competent
corrector of daily themes.
The imagination of Hawthorne, brooding over the past, repeopled the
House of the Seven Gables with the successive generations. But there is
another kind of romance, in which the imagination is projected into the
future. Looking at the new house not yet enclosed against the storm, it
dreams dreams and sees visions. There is a story there, also, and the
best of it is that it is to be continued.
* * * * * *
A shrewd old New England farmer recounted to me the warlike exploits of
his family. He himself had been in Gettysburg, and each generation since
the time of the French and Indian wars had had its soldier. His son had
been shot at Santiago. “The bullet went clean through his body,” he said,
indicating a course which seemed to me necessarily fatal. I expressed
sympathy. “Oh, it didn’t hurt him much,” he said, “it seemed to go through
a vacant spot.”
That there are vacant spots in the character of the typical man of the
Western world no one would be more ready to admit than he. His
shortcomings are obvious. Yet most of those which have been harshly
commented upon by the world are of the kind that might be commended
to the consideration of the kindly Pardoner. Some of his weaknesses
touch upon nobleness. Those who best know his environment and the
work he has done are most ready to grant him a reasonable degree of
indulgence.
The most serious charges against him are that he is a boastful materialist
enamored of crude bulk, and that he has trampled upon the old sanctities
and is a worshiper of the almighty dollar. There is some color for these
charges in his manners, but those who make them have certainly not
understood his spirit. “The Western Goth,” Lowell called him. The Goths
had a bad reputation once as wanton destroyers of ancient art. But after
they had had their fling and had settled down, the Teutonic barbarians
showed that they could make a thing or two themselves. Gothic has long
since ceased to be a term of reproach. Even in the destruction of the
ancient, archæologists now admit that the Goths did not do as much harm
as was at first feared. The real destroyers of ancient Rome have been the
Romans.
From the fact that western America is a place where people are actively
engaged in making money, and that they find their work so interesting that
they like to talk about it, the superficial observer jumps at the conclusion
that this is the seat of the cult of wealth-worship. But there is a vast
difference between making a thing and worshiping it. It is reported that
one of the varied industries of Great Britain is the manufacture of molten
images. It is undoubtedly a sin, but the British manufacturer comforts
himself with the reflection that he only breaks half the commandment; he
makes the idol, but he does not bow down before it.
Worship is not talkative or boastful. It is reserved and self-abasing. The
worshiper accepts the superiority of the object of his devotion as a fact
not to be questioned. For such serious-minded worship of wealth go to
the English moral tales so popular a generation or two ago, before the
wave of democracy came in. Then the affluent Squire and his lady were
lifted into the place of superior beings. They dispensed bounty after the
manner of Providence to their poorer neighbors, and there was no
thought of questioning their ways. They were rich, as had been their
fathers and mothers before them, and all other virtues were attributed to
them by fond superstition.
The men of the Western mining camps, where millionaires are made in a
day, have no conception of such a reverential attitude toward the
possessor of wealth. When you see them in the eager pursuit of dollars,
you are watching not their religion, but their sport. They care for money as
the fox-hunter cares for the fox. They admire the man who wins the prize,
in proportion to the skill and pluck which he has exhibited. But there are
no illusions of a personal superiority imparted by the possession of
property. That is impossible in a community where everybody is
acquainted with the short and simple annals of the rich.
The man who is conspicuously successful in the national sport is
undoubtedly an object of interest, but it is interest of the superficial sort.
He is not the man whom the people delight to honor, and he usually has
the good sense to know it. In a Western newspaper my attention was
attracted by the headlines: “Noah a Millionaire.” It seems that some one
had calculated that, even after making allowance for the low price of labor
and materials in his day, the Ark must have cost over half a million dollars,
and that Noah must have had at least a million in order prudently to
undertake the work. It put the patriarch in a fresh light, and I read the
article diligently, as did most of my fellow passengers on the train. But that
was the end of it; our opinions about diluvian and antediluvian matters
remained unchanged. I suppose that the publicity given to the doings of
our conspicuously rich contemporaries has no greater significance.
The millionaire who cares for the admiration of his fellow-citizens must do
more than accumulate. When he has made his fortune the next question
is, “What will he do with it?” He must do something or sink into the rank of
nobodies. Even the most selfish and parsimonious feels that something is
required of him. A great part of the stream of new wealth may be wasted,
so far as the higher interests of society are concerned, but a certain part
of it is pretty certain to be directed toward those same higher interests.
The process is like that which goes on with an hydraulic ram. Where there
is a good stream of water, one can afford to lose most of it. The waste
water, before it escapes down the hill, pumps a slender but sufficient
stream into the second story.
Indeed, it is the interest of our millionaires in art, science, and religion
which has created a puzzling ethical problem. They are not content to be
mere money-getters. They aspire to be benefactors on a large scale. But
what if the wealth so freely offered has not been honestly come by? What
if the best institutions should hesitate to receive it? The poor rich man
cannot contemplate such a refusal with equanimity. It would interfere with
the fulfillment of his most cherished plans. To have unlimited opportunities
to make money, and to be hindered in giving it away, seems to him like
building a trunk line of railroad and then being denied terminal facilities.
Of course he could change his plans and keep it all himself, but to a man
who had been accustomed to “doing things” that would be a humiliating
anti-climax.
* * * * * *
The fact that the American is greatly absorbed in his work with material
things is no sufficient basis of the charge of materialism that is lightly
brought against him. The crucial question is, “What do the things stand for
in his mind? Are they finalities, or are they means to an end?” The most
appalling picture of a purely materialistic civilization is that given in the
book of the Revelation. It is an inventory of the wealth of the Babylon
which was Imperial Rome. The inventory is an indictment. “The
merchandise of gold, and silver, and precious stones, and of pearls, and
fine linen, and purple, and silk, and scarlet, and all thyine wood, and all
manner vessels of ivory, and all manner vessels of most precious wood,
and of brass, and iron, and marble, and cinnamon, and odours, and
ointments, and frankincense, and wine, and oil, and fine flour, and wheat,
and beasts, and sheep, and horses, and chariots, and slaves, and souls
of men.”
The heart grows sick when the list of commodities ends with the “souls of
men.” What were they worth, measured against all that goes before?
A very different impression comes as we read Joaquin Miller’s exultant
cry over the West:—
O heart of the world’s heart, West! my West!

Look up! Look out! There are fields of kine,
There are clover fields that are red as wine,
·····························
There are emerald seas of corn and cane,
···························
There are isles of oak and a harvest plain
Where brown men bend to the bending grain,
There are temples of God and towns new born.
·····························
And the hearts of oak and the hands of horn
Have fashioned them all, and a world beside.
This frank delight in the riches of the earth is not materialistic. The souls
of men are not in the market. They form the supreme standard of value.
Materialism is not a disease to which nations are subject in their lusty
youth. It comes with senile decay.
Sometimes when we are wearied with the intense activity of modern life
we quote the saying, “Things are in the saddle.” Perhaps our sympathy is
misplaced. If the poor Things could speak, they would tell us that, so far
from being in the saddle, they are under the lash of furious young idealists
who give them no rest. It is the nature of a Thing to “stay put,” but these
headstrong youths despise this conservative bias. They are no respecters
of Things, being wholly absorbed in Purposes.
To see Things in undisputed possession, go into “the best room” of a
respectable old farmhouse. Here the Thing has the place of honor, and
the Person is a base intruder, having no rights of his own. The priestess
hovers occasionally around her sacred Things, waving her feather duster
as a mystic wand, and then leaves them in respectful gloom. Nothing
short of a death in the family would induce her to disturb them. Go into a
busy workshop, and you may see how the Thing may be taught to know
its place. It is always at the mercy of the innovating Intelligence. When a
new Idea comes, the old Thing which had heretofore had a useful function
is thrown aside. It is still as good as it ever was, but it is not good enough.
It must go to the scrap pile.
* * * * * *
The man of the West is likely to offend against the standards of propriety
in speech. When he begins to explain the character of his country, he is
accused of inaccuracy. His prospectus is not always confirmed by the
Table of Contents. He has acquired the habit of “talking large.” This
prejudices many people against him. They accuse him of willful
exaggeration, and if he be the promoter of some commercial enterprise,
they impute to him a mercenary motive.
But he is in reality quite sincere. If he talks large, it is only because he
feels large. His is a language natural to those who are engaged in
creative work, and who foresee great things. It is like “the large utterance
of the early gods.” He does not feel called upon to limit his statements to
the facts that are already apparent; he expects the facts to grow up to his
statements. He is not shooting at a fixed target, but at a flying mark; if he
is to hit it, he must aim a little ahead.
Another reason for this large utterance is that in a new country the
ordinary man identifies himself with his community in a way impossible to
any but very great magnates in an old civilization. He feels very much as
did the kings and earls he has read about. How proudly on the
Shakespearean stage a great noble will speak of himself as Norfolk or
Northumberland! It is as if his personality had been multiplied by so many
square miles. He is no longer a mere individual,—he is a whole county.
An American may have much the same sense of territorial
aggrandizement by identifying himself with a promising community in its
first stage of growth. He is not a unit lost in a multitude. His town has a
fine name and a glorious future. Some day these glories may be divided
among thousands, now they are his own. He is proud of the town, and the
pride is more satisfying because he is it.
I once camped for a whole month in the city of Naples on the shores of
the Pacific. I knew it was a city, for a huge sign announced the fact to
every one who passed by the beautiful, secluded spot. Unlike some of the
boom towns of that period, Naples had an inhabitant, whom I had
occasion frequently to meet. When I addressed him, it was hard for me to
use his surname, as I would with a common man. For to me he was
Naples. It would have seemed appropriate for him to speak in blank
verse.
* * * * * *
There are those who look upon the Western delight in the idea of bigness
as an evidence of vulgarity of sentiment and of the lack of idealism. They
have a scorn of those who habitually think of quantity rather than of
quality. But the man of fastidious taste should not be allowed to have it all
his own way. One poet may be inspired by “the murmur of a hidden brook
in the leafy month of June.” But another may prefer to stand on the shore
of the ocean and feel its immensity. He is tremendously impressed by its
size. It is a big thing. But the ocean is as poetical as the brook, though in
its own huge way.
There are some things wherein quality is the first consideration. They are
the luxuries of life. But when we come to the prime necessities, the first
question is in regard to the adequacy of the supply. When a sentimental
young lady was seated at dinner next to a great poet, she waited,
awestruck, for him to give utterance to a fine thought. The only gem he
vouchsafed was, “How do you like your mutton? I like mine in hunks.” The
poet was a man of sound sense. There is one law for poetry and another
for mutton. Poetry is precious, and a little goes a long way; we can get on
without any but the best. But mutton should be served more generously.
It is the glory of the West that it treats what elsewhere are the luxuries of
the few as the necessities of the many. It dispenses even “the higher
education” not in dainty morsels, but in hunks.
Old Mrs. Means, in “The Hoosier Schoolmaster,” formulated the wisdom
of the pioneer. “You see, this ’ere bottom land was all Congress land in
them there days and sold for a dollar and a quarter, and I says to my old
man, ‘Jack,’ says I, ‘do you git a plenty while you’re gittin’. Git a plenty
while you’re gittin’,’ says I, ‘for ’twont be no cheaper than ’tis now;’ and it
haint, and I knowed ’twouldn’t.”
Translate Mrs. Means’s shrewd maxim into the terms of idealism, and you
have the characteristic contribution of the West. The old prudential
maxims, which were true enough in a finished civilization, may well be
disregarded by those who face a great new opportunity. They can well
afford to preëmpt more territory than they can at present cultivate. When
one’s aims are selfish, the desire to get a plenty is mere greed, but in the
altruist it rises into “the enthusiasm for humanity.” It is the ambition to
supply the wants of men no longer in niggardly fashion, but in full
measure.
In two directions the expectation of moral amplitude in things American is
fulfilled,—in Education and in Charity. Here we feel that the people have
been aroused to the need of making plentiful provision, not only for
immediate necessities, but for future growth. Along these lines we think
and plan nationally.
But there are some questions which give pause to the most boastful
patriot. Where is the distinctive American Art which interprets in a broad,
fresh way the genius of the land, and where is the public that would
recognize it and delight in it if it should appear? Where is the great
American Church able splendidly to organize the forces of spiritual
freedom as Rome organized the principles of ecclesiastical authority?
How is the vision of her prophets fulfilled?
And thou, America,

For the scheme’s culmination, its thought and its reality,
For these (not for thyself) thou hast arrived.
Thou, too, surroundest all,
Embracing, carrying, welcoming all, thou too by pathways broad and new,
To the ideal tendest.
The measured faiths of other lands, the grandeurs of the past
Are not for thee, but grandeurs of thine own,
Deific faiths and amplitudes, absorbing, comprehending all.
Where are these “deific faiths and amplitudes” that are worthy of the land
embodied?
America presents new problems for statesmanship; where are the large-
hearted, clear-eyed men who give themselves to the task? Here and
there we see them. In the crisis of the nation’s life nature came to the
rescue.
For him her Old-World moulds aside she threw,

And, choosing sweet clay from the breast
Of the unexhausted West,
With stuff untainted shaped a hero new,
Wise, steadfast in the strength of God, and true.
That is the kind of manhood America needs. Is the supply equal to the
demand? The growth of wealth in the Republic has been marvelous. Has
there been evolved a wisdom equal to the task of justly distributing what
enterprise has created? We hear of American “Captains of Industry.” How
far have they realized Carlyle’s idea when he gave the title to those
whose success lies not in personal gain but in ability to be real leaders of
men? How far has America produced great captains, able to bring into
commerce and manufacture the soldierly virtues of courage, loyalty, and
willing obedience?
When he considers these things the just critic must say to the Republic,
“Thou art weighed in the balances and found wanting.” But let him not
hastily assume that he is reading the mystic handwriting on the wall, the
Mene, mene, tekel, upharsin, that foretells the fall of nations. Let him
rather talk as to a young athlete who has not come up to the mark, “You
have done much, but you have not yet done your best! You are yet
wanting in some essential elements. You must try again.”
The American idealist recognizes the present failures, but it does not
quench his high spirits. They come to him as challenges. He takes his
falls as Adam and Eve took theirs. After the first shock was over there
was a healthy reaction.
Some natural tears they dropped, but wiped them soon;
The world was all before them where to choose
Their place of rest, and Providence their guide.
The most hopeful sign of the times is the number of young Americans
who have become conscious of the grave evils that beset their country,
but who neither whine nor scold nor prophesy ill. The pioneer spirit is
strong within them. They attack the abuses of democracy with a cheery
iconoclasm. They are impelled to their work not merely by a sense of
duty; they find their fun in it. It is with a sense of exhilaration that we
watch these pioneers. Their world is all before them. We are anxious to
see what they will make of it.
A COMMUNITY OF HUMORISTS
H UMOR is not usually looked upon as a civic virtue. It is for the most
part confined to a modest sphere of usefulness, and is accepted as
an alleviation to the lot of the private man. He learns to find pleasure in
his small misadventures and to smile amiably at his discomfitures. The
most ancient pleasantries have almost always an element of domesticity.
They form the silver lining to the clouds that sometimes gather over the
most peaceful homes. What comfort an ancient Hebrew must have taken
in the text from Ecclesiasticus: “As climbing up a sandy way is to the feet
of the aged, so is a wife full of words to a quiet man.” The quiet man
would murmur to himself, “How true!” He would seize the simile as a dog
snatches a bone, and would carry it off to enjoy it by himself.
But it would never occur to him to treat the large affairs of the community
in this fashion. Here everything seems too dignified to allow of pleasant
conceits. The quiet man could not treat the prolixity of his social superiors
as he could the too long drawn out wisdom of his wife. He must take it, as
he would take the invariable laws of nature, with unsmiling acquiescence.
Lord Bacon in his list of works that ought to be undertaken declared the
need of one to be entitled “Sober Satire; or the Insides of Things.” Such
sober satire might express the moods of a philosophical statesman, who
could contrast the inside of great affairs with the outside. It implies a
certain familiarity with the institutions of society which the common man
does not possess.
Now and then, however, there is a reversal of the usual relation. The
community is of such a nature that each member can see through it and
all around it. The ordinary citizen becomes a philosopher indulging
habitually in sober satire. He knows that things are not as they seem, and
is pleased at the discovery. In such a case humor envelops everything
and becomes the last word of sociological wisdom.
So it was in a community which I fondly remember. It was not much to
look at, this brand-new Nevada mining town. The main street swaggered
up the gulch in a devil-may-care fashion, as if saying to the teamsters,
“You may take me or leave me.” To the north it pointed to an alkali flat,
and to the south to a dusty old mountain, which was immensely richer
than it seemed. On the mountain side were hoisting works and hundreds
of prospect holes which menaced the lives of the unwary. In the gulch
were smelters which belched forth divers kinds of fumes. To the stranger
they seemed to threaten wholesale asphyxiation, but to the citizen they
gave the place the character of a health resort. An analysis of the air
showed that it contained more chemicals than were to be found in the
most famous mineral springs. Certain it was that there were enough to kill
off all germs of contagious diseases. The community felt the need of no
further hygienic precautions, and put its trust in its daily fumigations. No
green thing was in sight, not so much as a grass blade, for the fumes
were not only germicides, but also herbicides. On the main street were
saloons and gambling houses, in close proximity to two or three struggling
churches. There were two daily newspapers, each of which kept us
informed of the other’s manifold iniquities. A narrow-gauge railroad had its
terminus at the foot of the gulch. Once a day a mixed train would depart
for the world that lay beyond the alkali flat. Some of the passengers would
be “going below,” which meant nothing worse than a trip to California;
others were promoters going East on missions of mercy to benighted
capitalists. The promoter was our nearest approach to a professional
philanthropist. As for the rest, the chief impression was of dust. It would
roll in great billows down the gulch; it seemed as if the mountains had
been pulverized. Then the wind would change and the dust billows would
roll back. No matter how long it blew, there was always more where it
came from.
I cannot explain to an unsympathetic reader why it was that we found life
in our dusty little metropolis so charming, and why it was that we felt such
pity for those who had never experienced the delights of our environment.
Nor can I justify to such a reader the impulse which led a woman whose
husband had died far away in New England to bring his body back to be
laid to rest in the bare little cemetery amid the sage brush.
“It’s not such a homelike country as the other,” I ventured.
“No,” she answered, “it isn’t, but he liked it.”
And so did we all; and the liking was not the less real because it was an
acquired taste. There was nothing in it akin to serious public spirit. It was
a whimsical liking, like that of Touchstone for Audrey,—“An ill-favoured
thing, sir, but mine own; a poor humour of mine, sir, to take that that no
man else will.”
When several thousand people, set down in the midst of a howling
wilderness, tacitly agree to consider it as the garden of the Lord, they can
do much. It pleases the ephemeral community to make believe that it is
permanent. The camp organizes itself into a city, with all the offices and
dignities appertaining thereto. Civilization is extemporized like a game of
dumb crambo. It amuses the citizens to see their beloved city going about
in institutions several sizes too large for it. Nothing is taken literally.
Humor is accepted not as a private possession, but as a public trust, and
cultivated in a spirit of generous coöperation.
In the town were men whose education and experience had been in the
great world. There were mine superintendents who a little while ago might
have been in Germany or Cornwall; there were assayers and engineers
fresh from the great technical schools, and “experts” full of geological lore.
The mines were as rich in litigation as in silver, and there were lawyers
great and small.
But all were dominated by one typical character who was accepted as the
oracle of the land,—“The Honest Miner.” To him saloons were dedicated
with alluring titles, such as “The Honest Miner’s Delight” and “The Honest
Miner’s Rest.” At the end of the gulch was “The Honest Miner’s Last
Chance,”—one which he seldom missed. The newspapers and political
orators appealed to his untutored judgments as the last word of political
wisdom. He occupied the position which elsewhere is held by the “Sturdy
Yeoman” or the “Solid Business Man.”
The Honest Miner of the Far West is one of those typical Americans who
are builders of commonwealths. His impress is upon the western half of
our continent. He is a nomad, the last of a long line of adventurers to
whom the delight of the new world is in its newness. Sometimes his work
is permanent, but he never is quite sure. His habitual mood is one of
sober satire.
I know nothing more pleasant than to sit with an old-timer who has spent
years in prospecting for silver and gold, and listen to his reminiscences.
Here is a philosopher indeed, one with an historic perspective. He has the
experience of the Wandering Jew, without his world-weariness. He has
seen the rise and fall of cities and the successive dynasties of mining
kings. His life has been a mingling of society and solitude. With his pack
upon his back he has wandered into desert places where no man had
been since the making of the world,—at least, no man with an eye to the
main chance. A few weeks later the lonely cañon has become populated
with eager fortune-seekers. The camp becomes a city which to the eyes
of the Honest Miner is one of the wonders of the world. A year later he
revisits the scene, and it is as Tadmor in the Wilderness. He pauses to
refresh his mind with ancient history, and then passes on to join in a new
“excitement.” He measures time by these excitements as the Greeks
measured it by Olympiads.
He loves to tell of the ups and downs of his own fortune. There is no
bitterness in his memory of his failures. They relieve the record from the
monotony that belongs to assured success. His successes are not less
gratifying because, like all things earthly, they have had a speedy ending.
A dozen times he has “struck it rich.” He has thrown away his pick and
shovel and gone below to bask in the smiles of fortune. He has indulged
in vague dreams of going to Europe, of looking up his family tree, and of
cultivating grammar and other fine arts. Fortune continued to smile, but
after a while her smile became sardonic, and with a wink she said,
“Time’s up!” Then the Honest Miner would take up his pick and shovel
and return to his work, neither a sadder nor a wiser man,—in fact, exactly
the same kind of man he was before. That Experience is a teacher is a
pedantic theory which he rejects with scorn. Experience is not a
schoolmaster, Experience is a chum who likes to play practical jokes upon
him. Just now he has given him a tumble and got the laugh on him. But
just wait awhile! And he chuckles to himself as he thinks how he will
outwit Experience.
All the traditions of the mining country confirm him in his point of view:
Listen to what Experience says, and then do just the opposite. It is the
unexpected that happens. The richest diggings bear the most lugubrious
names. The Montanian delights to tell of the riches taken out of Last
Chance Gulch. The Arizonian for years boasted of the gayety of
Tombstone and the amazing prosperity of the Total Wreck Mine.
* * * * * *
Certain physiologists are now telling us that the poetic praise of wine is
based upon a mistake. Alcohol, they say, is not a stimulant, but a
depressant. It does not stimulate the imagination so much as it depresses
the critical faculty so that dullness may easily pass for wit. An idea will
occur to a sober man as being rather bright, but before he has time to

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1 An introduction to the history of ideas about death 1

Julia Neuberger knows, for instance, how to approach ‘truth-telling’ and

from all the professionals involved was extremely positive. Nevertheless, as

able support to my mother-in-law, husband, brother-in-law and the rest of

First Person, Health Service Journal, 3 October 1996.

My mother died in May 2001, after four years of an auto-immune disease

of the elderly team as well as the A&E Registrar, allowed to go home

This second edition is in memory of my parents, Walter and Liesel Schwab,

I go the way of all the earth (1 Kings 2:2)

and then gave him instructions:

More recent thinking about death

The anticipation of a good 18th century person was of a moment to say

at all, or we are drawn away from it in embarrassment because of the aware-

monuments of the south London cemeteries came to be constructed. A decent

returned with nightmares, often politely described as ‘shellshock’. It was not

directives has been disregarded.3 Nevertheless, the thinking is about treating

From the Desert I come to thee

Till the sun grows cold,

When we think of the Greeks we think at the same time of

the sprinkled isles

A something sombre and severe

When we come to the United States of America there is a peculiar

What a weary dearth

wind blows loudly; but it lies

When Shelley was an undergraduate he was attracted to a lecture on

His tents beside the forest. And he drave

O heart of the world’s heart, West! my West!

And thou, America,

For him her Old-World moulds aside she threw,

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