The Experience of Dying

Despite the power and status of the wealthiest among us, in death they will be no different from the poorest among us; Simply food for worms.

In Act IV, Scene III, Hamlet insults Claudius by telling him that he’s no different than a lowly beggar:

HAMLET
A man may fish with the worm that hath eat of a king, and cat of the fish that hath fed of that worm.

KING CLAUDIUS
What dost you mean by this?

HAMLET
Nothing but to show you how a king may go a progress through the guts of a beggar.

Hamlet’s quote could be considered the quintessence of “death being the great equalizer.”

However, American politician and educational reformer Horace Mann (1785 – 1859) would argue that education is the great equalizer.

In today’s society, the dying experience — the ability to “die with dignity” — as well as the quality of your education largely depends on your financial status, and your zip code.

The single strongest predictor of our health and how we spend our final days in this realm is our position on the class pyramid. Whether measured by income, education, or occupation, those at the top have the most power and resources and on average live longer and healthier lives. They have less stress, and are also less sleep-deprived (which leads to poor health). Those at the bottom are most disempowered and get sicker and die younger. Most of us fall somewhere in the middle.

Life’s Change Agent

Steve Jobs, founder of Apple, said the following at the commencement address he gave at Stanford in 2005 (shortly after he was diagnosed with pancreatic cancer):

No one wants to die. Even people who want to go to heaven don’t want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life. It is Life’s change agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it is quite true.

The final stages of death are the same for all of us as the body begins its natural process of slowing down all its functions. How long this process takes varies from person to person; it may take hours or days. However, the dying experience itself suffers from inequalities. While most, if not all, would prefer palliative care and the ability to die at home with loved ones close by, not everyone has the resources necessary for this option: The ability to cover the cost of caregivers, dedicated family members, insurance that covers stays in nursing homes when needed, and living in a neighborhood with a well-stocked local pharmacy that can supply the correct medications for severe pain.

For many people, having these resources would be considered luxuries. Not having them can make dying at home a lonely and painful experience.

More people are beginning to discuss their end-of-life preferences with their physicians and family members. Many will prefer to die at home, and the option of hospice and palliative care will most likely factor into these discussions.

When discussing your preferences take into account social and economic realities that may not allow for home-based hospice. Research your hospice options long before needed. Being willing and able to attend to the details of how you die is a part of being fully engaged with how you live your life.

Death may be the great equalizer insomuch as our physical bodies become nothing more than food for worms. But regardless of our lot in life, and whatever inequalities we’ve suffered, we all deserve to die with dignity and as peaceful as possible.