Death: Thinking about living it

Here are three golden rules to dying: talk, talk and talk. Discussing death with your loved ones, and especially with yourself, is the unconventional wisdom from Gian Domenico Borasio, professor and chair in Palliative Medicine at the University of Lausanne and chief of the Palliative Care Service at the Lausanne University Hospital. His book, Dying, has recently been translated into French after topping book sales in Germany, where nearly 150,000 people took an interest in the seemingly paradoxical advice of considering their own death while still alive. Understandably, it is something one might want to put off with multiple avoidance techniques. Gian Domenico Borasio writes how life’s end remains largely unexplored territory despite the gains in knowledge about how life begins, but. If you look up the “death” section in a physiology manual, you will find information only about the death of individual cells, parts of tissue or maybe organs.

The author has built his book on questions that are simple only in appearance. “Why do we die?”, he asks, going through the typical stages in pulmonary death or brain death. Or: where do we die? In a nursing home? At the hospital? In our own home? And more importantly: what do we need when we die? He describes the “lubricant” that is the communication between doctor and patient, “essential to any successful guidance” at the end of one’s life. Gian Domenico Borasio takes a spirited tone as he points out how, unfortunately, doctors quite often prove that it is easier to communicate badly than to overcome fears and difficulties about bringing up the subject. He is an active supporter of teaching medicine differently. The specialist advocates an approach that is less strictly focused on technological development in favour of one that focuses on the more sensitive aspects, such as the emotions stirred by guiding patients in the last stage of their life. He studies communication in the broad sense, within the family or between specialists. In no way does he spare his own profession, always elegant but direct, and seasoned with a dash of humour – yet another lubricant. “Have you worked in a team? Show me your scars,” he says, referring to the sometimes turbulent collaboration between professionals at the bedside of a dying patient.

While we are postponing, life speeds by.

For Gian Domenico Borasio, death – especially the death of others – is the essential subject of study in his life. The expert describes a number of other needs of the patient and their loved ones when dealing with such finiteness. In a style that reflects his uncommon intelligence and strength of conviction, he lays poignant and sometimes provocative arguments on the table, especially in the chapters on “pitfalls”. The first is believing that patients should be treated at all costs right up until the very last breath. But the facts are stubborn, he says. The benefits and undesirable effects from artificially feeding and hydrating patients at the end of their life has been documented in scientific studies. The book is ideally structured by alternating between analyses and testimonies from patients and their loved ones. Then he supports his demonstrations by telling real-life stories, often with great sensitivity.

Question one’s practices, the fine line between the conviction to treat people and the risk of uselessly prolonging life. These are the issues that define the area of specialisation in which Gian Domenico Borasio has gained his international renown. But he laments that many people simply don’t know what palliative medicine entails. Quoting a survey by the Federal Office of Public Health, he writes that barely one-third of German-speaking Swiss can offer a definition. The French-speaking Swiss are the best informed (78%). Gian Domenico Borasio has undoubtedly dealt with this high score in practice as the first chair in palliative medicine in French-speaking Switzerland since 2011 who also promotes it with various federal bodies.

So what’s his philosophy? He believes that, ideally, palliative medicine could lastingly bring modern medicine closer to the patient, as it covers multiple disciplines and is more focused on dialogue with a certain awareness of its limitations. It will not be easy, though. There is considerable resistance within the medical community.

And Gian Domenico Borasio has already overcome a number of these hurdles. The first is the reader. His appeal coaxes even the hardest-headed audience into thinking about their own death. His book, Dying, could just as well be entitled “Living”. By taking a pragmatic approach to the various steps preceding death, he invites readers into a form of deep introspection about the meaning of their own life – introspection that is neither imposed nor even suggested, but that flows naturally. His words teach us not only how to die, but also how to live, here and now, echoing the writings of Seneca as he fittingly warns, “While we are postponing, life speeds by.”