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A Matter of life and death....

'In this world nothing can be said to be certain, except death and taxes," wrote Benjamin Franklin to Jean-Baptiste Leroy in 1789.

A mere 224 years later, nothing has changed. The only difference is that while we will happily analyse every nuance of the property tax to infinity, we are happy to remain clueless about the subject of our inevitable passing, even though both are set to wipe us out, in one way or another. Indeed, as a nation, we probably talk about death less than we ever have at any other period in time.

Given that half the population is male and 17pc of women won't have children, it is fair to say that just over four out of 10 of us will experience childbirth first-hand.

Whether you want a water birth, a silent birth, or a brass band playing as you pop Junior out, advice and options on how to go about it will come at you until they are pouring out your ears. There is a vast range of people and products to help with every aspect of bringing new life into the world, from dealing with your cracked nipples to soothing your squalling infant at 3am.



It's the same for any other life event, no matter how minor. Buying a car? Going on holidays? Choosing a dress for a party? Looking to trim your tubby tummy? You don't have to search far, as any amount of people will help you through the process. You can arm yourself with all sorts of different types of information and proceed from there.

However, apart from being born ourselves, which none of us remember anyway, there is one process that we must all go through without exception. Dying is the one thing that gets us all in the end, but there has never been a process so shrouded in mystery and subterfuge as the journey out of this world.

I am always struck by how clueless we are when it comes to handling death. What I have noticed with my own friends and family is that when someone is diagnosed as being terminally ill, we never seem to know how to handle it.

Doctors come in and give medical diagnoses and advice, but there is no procedure for discussing the different and best ways of dying.

For example, I have witnessed several friends dying from a particular form of cancer that is almost always terminal, and they all took very different approaches to its treatment. One opted to do nothing, declaring that he wouldn't back a horse on the odds that he was given, and he stayed quite well until the very end. He wasn't suffering the ill-effects of the treatments given for cancer, and he got to travel, spend time with loved ones and kind of faded out gracefully.

Two others chose the surgery, chemotherapy and radiotherapy routes, with a view to prolonging their lives, but their families said that the sickness and lengthy hospital stays they endured as a result of the treatment weren't worth the few extra months they gained.

Each case is individual, and I wouldn't blame anyone for trying to prolong their lives, but maybe it would be better if we were better informed so that we didn't kind of muddle through what turns out to be a hugely important decision.

A bereavement counsellor I spoke to said that one of the areas that haunted the bereaved afterwards was the feeling that they embarked on a course of action that, in retrospect, wasn't the best option for the short time they had left together. The second regret was that they didn't speak honestly enough with their loved ones, which is another area that is confusing and distressing for all involved.

I think a lot of subterfuge goes on when it comes to dying, with family members and friends pretending that the loved one is going to recover, when they know they are not. My friend Rita, a nurse, once told me that dying patients often spoke openly to her at night when their families were gone home. They knew they were dying, but their upset families were acting as if they would recover, and they went along with it so as not to distress anyone further.

I often think that while dying is the one journey that you have to embark on alone, it must be extremely lonely to go along with the pretence that you are going to recover.

Maeve Binchy wrote a fabulous piece on it a few years ago, where she spoke of a friend dying from stomach cancer. His friends stopped inviting him out for dinner, although he would have loved to go along for the company and the laughs, and ended up feeling isolated as his pals chose the wrong, but well-intentioned, option.

It is why the famous interview that the late Nuala O'Faolain conducted with Marian Finucane in 2008 struck a chord in me. Having been diagnosed with incurable cancer, which began in her lungs and spread to her brain and liver, she turned down the option of chemotherapy.

"I was supposed to start 18 weeks of it, six goes of it," she said. "But whether it was the disease or the brain radiation I don't know or care, [it] reduced me to such feelings of impotence and wretchedness and sourness with life... and fear that I decided against it."

Nuala railed about the fact that she was dying, and I thought it was so healthy to see someone speak honestly and openly about her despair.



The interview caused a huge stir when it was aired, but why was that, I wonder? We are all going to die and lose loved ones, so we should be expressing ourselves more openly about it and maybe we'd have a better experience.

"I was just reading about some best-selling man who says, 'Live your dream to the end' and so on, and I don't despise anyone who does, but I don't see it that way," said Nuala. "Even if I gained time through the chemotherapy it isn't time I want. Because as soon as I knew I was going to die soon, the goodness went out of life."

Unlike birth, there are no cheerleaders willing you on through the process of death, and everyone around you is grieving and out of their minds with worry and upset.

Hospices are wonderful, but not everyone has the luxury of dying in one and sometimes short-staffed hospitals are so taken up with the process of keeping people alive that they don't have time to devote to those who are passing.

At a dying friend's bedside last year, we wondered if he could hear us, if he wanted a drink, if he was in pain or scared? It drove me mad that people sometimes spoke as if he wasn't there, because who knows if he was trapped in a fading body, but perfectly aware of what was going on?

Unlike people with their birth stories, both good and bad, nobody ever comes back to tell us of their experiences and lament that we didn't do enough to make their passing easier.

Human death from illness can be protracted, messy, distressing and heart-breaking. When my pets become ill, I go to the vet, hold them in my arms and they pass peacefully within seconds of the injection going in. They are not getting better and their suffering is mercifully ended.



This option doesn't apply to humans, so we need to talk about death more honestly and make it a better experience for everyone. Thankfully, there are some books and services that can help us.

"I think the late John O'Donohue's beautiful book, Anam Cara, gives a most powerful and compassionate guide on how to be with a soul that you have the honour and privilege to be with on their journey from this life," says best-selling author Patricia Scanlon.

"He writes of the importance of offering support, comfort, and encouragement to the beloved one. He reminds us that being with the soul that is passing over is an incredible privilege as they make their way to the eternal world and that one's own grief should not burden them. That can come later."

Patricia added, of the death of her beloved mother Bernadette in 2007: "Ten years after I first read Anam Cara, it was my turn to witness that powerful and private moment of someone I greatly loved taking the next step on her journey. Everything John had written came back to me, and what a difference his advice made to my experience of death."