At a palliative care conference years ago the audience was asked to choose between two options. Would you rather die instantly without warning or would you rather know about it and die more gradually? We were instructed to think through both options for a few minutes before a show of hands was counted for each option.
Dying instantly, for example from a cardiac arrest, would mean less suffering for the dying person. It’s possible it wouldn’t be so bad for the person going through it. No fear of what was about to happen to them would be generated as they would be taken by surprise.
Ignorance may well be blissful but would have drawbacks as well. Total loss of control, and inability to finish important business. You’d be robbed of the chance to say goodbye to those important to you. You wouldn’t be able to leave your intended legacy. Death is associated with loss and sudden death is associated with its own set of losses. Those left behind would also lose the opportunity to say goodbye to you, to obtain at least some sense of closure. Survivor’s guilt, “If I had known he was about to die I would never have left them alone at home.” There may be more suffering for your loved ones, so many things they will never be able to say to you again.
Dying in a slower fashion of a more chronic illness on the other hand would have different items included on the pros and cons list. Knowing you are dying could allow you to have some control of your situation, you know what you are having to deal with and could adjust your life accordingly. You might not work so much. You might choose to spend more time with your loved ones. You might choose to live the life that you want to live, rather than the one you have to live. You’d have the benefit of being able to close off relationships, to say goodbye on your terms. To make sure that your legacy is what you want it to be. To plan your funeral, what sort of service you want, what playlist you exit the world listening to.
There might be more suffering for the dying person. Distressing symptoms may worsen over time. A person loses more of their wholeness over time, and people are seen melting away piece by piece. Their loved ones may witness more suffering which causes them to be in suffering too. Physical appearance will change and there is the possibility of cognitive changes as well. The dying person may say things they never would’ve said when they were well. “The illness is speaking, not the real person.”
There are no easy answers to the question and there is much to ponder. Could you choose an option that would be in between both? Prepare stuff just in case you do die suddenly. I’m not planning to die for a long time, but sudden illness and death could happen to anyone. Maybe you could prepare letters pre-written to your loved ones to be sent in case you did die suddenly. That’s the sort of stuff that Advance Care Planning is all about. People who are going to die, prepare for their pending death. Who belongs to this group? Well anyone alive is also at risk of death. Have I missed anyone?