May 8, 2020

As Britain limps through a sixth week of lockdown, are we all still pretending we can live forever? As the debate about how to defeat coronavirus rages on, I’ve found myself thinking about how my grandmother faced her own death.

She was intimately acquainted with mortality. She’d been a doctor and a farmer, and had by old age outlived her brother, two husbands and three of her four children as well as most of her friends. Even so, confronting her own decline into Alzheimer’s took tremendous courage. While she still had capacity, my mum and I helped her go through the details of a document that listed her medical preferences, for when she no longer had the capacity to advocate for herself.

It was not easy reading: a grim catalogue of scenarios such as seizures and strokes, defibrillation, ventilation, and the circumstances in which she would like medical treatment or palliative care. Despite her tough pragmatism, and her faith in life after death, I remember how tense and miserable she was the day we got the document notarised.

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Some time later, after dementia claimed her once razor-sharp mind, she fell out of bed in the nursing home and broke her finger. Under safeguarding guidelines, the staff were obliged to call an ambulance, and the paramedics were in turn obliged to take her to hospital. These rules could not be sidestepped, despite everyone involved knowing that for someone in their 90s, with advanced dementia and a minor injury, transfer to hospital was likely to cause extreme distress and could even be a death sentence.

Happily, the document detailing her preferences absolved staff and paramedics alike of their reluctant obligation to follow these rules even against their own clinical judgement. They splinted the finger in situ, it mended just fine, and she was spared a confusing and frightening experience.

We have been considerably less clear-sighted than my grandmother about facing the implications of coronavirus. On the surface, much of the response to the government’s measures has treated the situation as a continuation of the Brexit wars. But beneath this displacement activity lurks a consensus that cuts across culture war lines for all but the youngest and most staunchly libertarian: swivel-eyed horror at the realisation that we haven’t, after all, vanquished death.

Of course we know in theory that death comes for us all eventually. But for the most part, our culture treats death as abnormal, even outrageous — not the inevitable fact it still is. While volunteering as a bereavement counsellor, I learned that some GPs will prescribe antidepressants barely days after a loss, as though normal grief at the death of a loved one is a medical condition. And one of the most contentious areas of debate among doctors is how to manage relatives’ pleas for life-prolonging interventions for a patient, even in cases where there is no hope and such measures will only cause pain and distress to a dying person.

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Or consider the way fatal accidents are often described in tabloid headlines as ‘tragic’. If we read that in the Aristotelian sense, it would imply such fatalities came about due to a flaw in the character of the deceased, and that the pity and fear evoked by their demise should be treated as a moral experience for readers.

Of course, applying Aristotle to tabloid idiom is overkill, and in contemporary usage ‘tragic’ commonly just means ‘very sad’. But the term retains a trace of the classical understanding of a tragedy as more than simply random misfortune. We can see this in the way that random misfortunes described as ‘tragic’ in tabloid newspapers often seem to prompt a search for a moral lesson. ‘Tragic accident’ stories frequently trigger a campaign for new safety regulations, designed to prevent any such misfortune from recurring. Over time, this dynamic has made a substantial contribution to the regulatory environment of daily life, from sensible measures such as compulsory seatbelts to more contested ones such as councils ripping up cobbled streets.

But if we apply it to a pandemic whose mode of transmission is unclear, for which we have no vaccine and no very reliable treatment, and which kills people, it’s clear we’re going to run into trouble. What kind of rules can forestall misfortune on the scale of Covid-19?

This quandary in turn helps explain why the government’s initial response to the pandemic (which arguably it is still following, albeit more circumspectly) was so politically unpalatable. This initial response followed roughly the lines set out in the government’s pandemic flu planning documents. The assumption was that transmission would be impossible to contain, so the aim was to slow the spread, ensure healthcare systems are not overwhelmed, and over time to reach a state where enough people are immune that replication would fade away: ‘herd immunity’.

But from the outrage that erupted when Boris tried to explain this, you’d think it was a calculated plan to kill off the old and frail. Surely we could do more. ‘More’ turned out to be total lockdown — an approach that still commands widespread support with the British public. A recent Opinium survey suggested that even the barest hint that the government might be considering relaxing lockdown has caused public approval of Johnson’s handling of the crisis to dip. Most of us, it seems, want rules that will prevent any further tragic deaths.

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Except lockdown won’t prevent coronavirus deaths, just slow down their rate of occurrence. Unless a vaccine is discovered, any relaxation of lockdown will result in a new spike in infections, followed by further lockdowns, and so on until we reach — yes — herd immunity.

In earlier centuries, everyone experienced the death of loved ones, often of ailments that are preventable today. Funerary practices reflected this familiarity with death, and my grandmother’s wishes belonged in this tradition. When she died, at the age of 96, my mum laid out and washed her body — an ancient practice traditionally carried out by female relatives of the deceased, but barely followed today. Grandma believed that souls stay close to a body for three days after death, and asked for a wake at my mum’s home, with an open coffin. I stayed with my mum for those three days, and it was a surreal but strangely intimate time. Grandma did indeed feel very close to us.

Her death came shortly before my own wedding, and I remember sitting at my mum’s kitchen table, with Grandma in her coffin in the adjacent room, making table favours from tiny packets of wildflower seeds for the wedding breakfast. Joy and sorrow seemed woven together, in a strange in-between time when Grandma wasn’t quite gone, and my new phase of life hadn’t quite started. It was where I said my goodbyes to someone I’d loved very much, and for me the funeral seemed almost an afterthought.

Over my grandmother’s lifetime, hygiene and medicine advanced so dramatically that it must have seemed for a while as though life expectancy would go on rising forever. As recently as 2018, breathless articles were imagining humans living to 1000, while transhumanists continue their quest to defeat death by uploading human consciousness to a computer.

As death has receded, so too has our willingness to look it in the face. Today, barely 10% of families keep a corpse at home between the death and funeral. Funerals themselves have become arms-length affairs, with the deceased mostly whisked away shortly after death is confirmed and only reappearing for a swift ceremony before vanishing again on a conveyor belt to be cremated.

But now, like nothing since the two world wars, the pandemic has brought us into a mass confrontation with the mortality we imagined we’d conquered, or at least indefinitely postponed. And as death has returned to hover at the edge of our peripheral vision, our habitual mass aversion to it has shaped the field of acceptable political response to the virus.

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It’s no coincidence that less wealthy nations have in many cases weighed the risk of pandemic against the certainty of starvation for subsistence communities, and decided against imposing lockdowns. When death is already a familiar presence, the risk calculus of virus transmission looks very different.

But in nations where death seemed on the back foot, it’s all very well for scientists to repeat that the only way out is via herd immunity, but it’s not something we seem willing to countenance. Not yet, anyway. Accepting it means allowing risk and death back into the room. So almost without exception we remain crouched in lockdown, a frozen state that addresses our terror of death by banning nearly everything that makes life worth living.

If we’re to find a way out of this state, we’ll need to face not just the likelihood of successive waves of infections, but also the fact that some misfortunes are not tragic in the classical sense, just very sad. Sometimes there isn’t a moral lesson.

No rules can be devised that will banish death altogether. And no amount of prophylactic regulation will stop the coronavirus in its tracks, only slow it and try to ensure medical facilities are not overwhelmed. There’s no guarantee we’ll ever have a vaccine or cure. Until that changes, if we are to begin living again, we may need to re-learn some forgotten lessons about how to walk in the valley of the shadow of death.

Comment


  • May 12, 2020
    Thank you, this was an excellent article. This topic needs widely discussed if we are going to learn how to live, and die, with covid-19 Read more

  • May 11, 2020
    It’s a really important point that points up something very worrying in our society’s attitudes. And on a lighter note, made me think of the marvellous exchange in Educating Rita - “Man killed by falling tree is not a tragedy.” “It is for the poor sod under the tree!” Read more

  • May 11, 2020
    Quite right. Read more

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