It is nothing new that people, in general, avoid talking about death, as if simply speaking could anticipate it. This stance seems inexplicable to us, since the to dielike this to be born, it is just a process that we will all go through one day. After all, with the notable advances in Medicine, people just took longer to perish.
Currently, more than applying invasive treatments without benefits, what should be sought is to alleviate the patient’s emotional and physical pain in their final moments, guaranteeing them a death without suffering and with a minimum of dignity. In this context, the report by the British consultancy Economist Intelligence Unit reveals that Brazil obtained a grade of 42.5% in the “Quality of Death Index”, occupying 42nd position in the ranking of 80 countries, being one of the least prepared States in terms of palliative care for terminally ill patients. For Maria Goretti Sales Maciel, a doctor at Hospital do Servidor Público Estadual (São Paulo), one of the pioneers in palliative care in Brazil, and who participated as a consultant during the preparation of the report, Brazil does not allow broad access to therapies and medicines, painkillers especially, concluding that, in our country, “whoever has pain, dies in a lot of pain”.
When we can talk freely about death, we have the chance to say goodbye, which is what really matters.
Kathryn Mannix, British doctor and author of the book With the End in Mind: Dying, Death, and Wisdom in an Age of Denial (“With the End in Mind: Dying, Death and Wisdom in the Age of Denial”, in free translation), became a pioneer in palliative care, dedicating her career to treating patients with incurable diseases, in the last stages of their life. In an interview given to BBC Ideas, she explains that it is common to observe that people use similar terms for certain words and expressions that designate the event of death: “We stopped using the word ‘die’ and started using similar ones. Instead of “dead”, we say “deceased”. Instead of saying someone is dying, we say they are ‘very sick’.”
She asserts that the use of these substitute words means that families are unable to understand that the moment of death is approaching. And that “this is a big problem because, when the family is at the bedside of someone about to die, they don’t know what to say to each other or to the patient themselves, who also don’t know what to say or what to expect”. For her, the moment of death does not have to be like this. After all, “normal death really is a peaceful process—something we can recognize, something we can prepare for, and something we can deal with.”
Fortunately, it looks like things are changing. In 2011, an initiative arrived in Rio de Janeiro that emerged from the ideas of Swiss anthropologist Bernard Crettaz: the Death Cafe, a meeting that brings together people to discuss aspects related to the end of life. Originally, this event was developed by British Buddhist Jon Underwood, who was inspired by Crettaz to develop a similar model.
The idea of Death Cafe it is precisely not having a defined roadmap, having the following basic premises: lack of profit; not having a therapeutic or support group proposal; have no employees, only volunteers; have a scheduled start and finish time. In one of these meetings, a couple narrated their painful experience of losing their daughter, then 21 years old, in a traffic accident in Teresópolis, in the mountainous region of Rio de Janeiro, an event that occurred in 2016. They reported that they had to relearn how to live afterwards of the tragedy, as they had never thought about death, much less that of a child. Most likely because they never thought that their daughter could die before them. The truth is that this “natural order”, according to which parents die before their children, is pure human creation. There is a natural need for human beings to organize their lives, to “slice up time”. However, the reality is that the “natural order of things” only exists in our heads, considering the randomness of life and events.
Although people in general prefer to think only about life, the truth is that reflecting on death does not mean contradicting life. Much less does it reveal some kind of contempt for life. On the contrary, talking about death in a natural and serene way, demystifying it, is living. Talking about death makes us aware of our time and live a life that leads to a lighter ending, without regrets. We have to keep in mind that life is unpredictable and death is part of it. When we can talk freely about death, we have the chance to say goodbye, which is what really matters.
Reis Friede, master and doctor in Law and federal judge, was president of the Federal Regional Court of the 2nd Region (2019/21), and is a professor at the Federal University of the State of Rio de Janeiro (UNIRIO).
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