Death and Burial Articles


1. A Process, Not Stages
2. DIY Funerals
3. Epitaphs
4. Wills and Legacies
5. Ethical Wills
6. Top Funeral Songs
7. Too Much Land For Cemeteries
8. The Body Farm
9. Online Assets
10. How Doctors Die
11. Autopsies
12. Fear of Death
13. Contemplating Death
14. The Evolution of Funerals
15. What happens To Your Body
16. Last Words
17. Back From The Dead
18. Spontaneous Human Combustion
19. A Soldier's Last Words
20. Why Are You Not Dead Yet?
21. Why Are You Not Dead Yet? Part 2
22. Death and Romans
23. Suicide
24. Barrow Burial
25. UK Life Expectancy
26. What Happens To Your Body After You Die
27. Choosing Your Own Death
28. DIY Funerals
29. Funeral Poses
30. Comedians and Suicide
31. Waist Size and Life Expectancy
32. India's Talking Autopsies
33. Most Common Year of Death
34. Caring For The Dying
35. Blocking The Path To Suicide
36. How You Want To Be Buried
37. The Right To Die
38. C21 Hearses
39. Assisted Dying
40. Floral Tributes
41. Direct Cremations
42. Cliches and LT Obituaries
43. The End of Death: The Start
44. Digital Immortality
45. Jeremy Clarkson's Idea of a Funeral




A Process, Not Stages

  • One autumn day in 1964, Elisabeth Kubler-Ross, a Swiss-born psychiatrist, was working in her garden and fretting about a lecture she had to give. Earlier that week, a mentor of hers, who taught psychiatry at the University of Colorado School of Medicine, had asked her to speak to a large group of medical students on a topic of her choice. Kubler-Ross was nervous about public speaking, and couldn't think of a subject that would hold the students' attention. But, as she raked fallen leaves, her thoughts turned to death: Many of her plants, she reflected, would probably die in the coming frost. Her own father had died in the fall, three years earlier, at home in Switzerland, peaceful and aware of what was taking place. Kubler-Ross had found her topic. She would talk about how American doctors - who, in her experience, were skittish around seriously ill patients - should approach death and dying.

    Kubler-Ross prepared a two-part lecture. The first part looked at how various cultures approach death. For the second, she brought a dying patient to class to talk with the students. Asking around at the hospital, she found Linda, a sixteen-year-old girl with incurable leukemia. Linda's mother had just taken out an ad in a local newspaper asking readers to send Linda get-well and sweet-sixteen cards. Linda was disgusted by the pretense that her health would improve. She agreed to visit the class, where she spoke openly about how she felt. The students, Kubler-Ross observed, were rapt but nervous. They avoided dealing with the source of their discomfort - the shock of seeing an articulate, lovely young woman on the verge of death - by asking an abundance of clinical questions about her symptoms.

    Soon afterward, as her biographer, Derek Gill, relates, Kubler-Ross took a job as an assistant professor of psychiatry at the University of Chicago. Four students from the Chicago Theological Seminary learned that she was interested in terminal illness and asked if she might help them study dying people's needs. Kubler-Ross agreed to try. At Chicago's Billings Hospital, she began a series of seminars, interviewing patients about what it felt like to die. The interviews took place in front of a one-way mirror, with students observing on the other side. This way, Kubler-Ross gave the patients some privacy while accommodating the growing number of students who wanted to watch.

    Many of Kubler-Ross's peers at the hospital felt that the seminars were exploitative and cruel, ghoulishly forcing patients to contemplate their own deaths. At the time, doctors believed that people didn't want or need to know how ill they were. They couched the truth in euphemisms, or told the bad news only to the family. Kubler-Ross saw this indirection as a form of cowardice that ran counter to the basic humanity a doctor owed his patients. Too many doctors bridled at even admitting that a patient was terminal. Death, she felt, had been exiled from medicine.

    Kubler-Ross began to work on a book outlining what she learned in her work with the dying. It came out in 1969, and, shortly afterward, Life published an article about one of her seminars. (A gasp of shock jumped through the watchers, the Life reporter wrote. Eva's bearing and beauty flew against the truth that the young woman was terribly ill.) Kubler-Ross received stacks of mail from readers thanking her for starting a conversation about death. Angered by the article and its focus on death, the hospital administrators did not renew her contract. But it didn't matter. Her book, On Death and Dying, became a best-seller. Soon, Kubler-Ross was lecturing at hospitals and universities across the country.

    Her argument was that patients often knew that they were dying, and preferred to have others acknowledge their situation: The patient is in the process of losing everything and everybody he loves. If he is allowed to express his sorrow he will find a final acceptance much easier. And she posited that the dying underwent five stages: denial, anger, bargaining, depression, and acceptance.

    The stage theory, as it came to be known, quickly created a paradigm for how Americans die. It eventually created a paradigm, too, for how Americans grieve: Kubler-Ross suggested that families went through the same stages as the patients. Decades later, she produced a follow-up to On Death and Dying called On Grief and Grieving (2005), explaining in detail how the stages apply to mourning. Today, Kubler-Ross's theory is taken as the definitive account of how we grieve. It pervades pop culture - the opening episodes of this season's Grey's Anatomy were structured around the five stages - and it shapes our interactions with the bereaved. After my mother died, on Christmas of 2008, near-strangers urged me to learn about the stages I would be moving through.

    Perhaps the stage theory of grief caught on so quickly because it made loss sound controllable. The trouble is that it turns out largely to be a fiction, based more on anecdotal observation than empirical evidence. Though Kubler-Ross captured the range of emotions that mourners experience, new research suggests that grief and mourning don't follow a checklist; they're complicated and untidy processes, less like a progression of stages and more like an ongoing process - sometimes one that never fully ends. Perhaps the most enduring psychiatric idea about grief, for instance, is the idea that people need to let go in order to move on; yet studies have shown that some mourners hold on to a relationship with the deceased with no notable ill effects. (In China, mourners regularly speak to dead ancestors, and one study has shown that the bereaved there suffer less long-term distress than bereaved Americans do.) At the end of her life, Kubler-Ross herself recognized how far astray our understanding of grief had gone. In On Grief and Grieving, she insisted that the stages were never meant to help tuck messy emotions into neat packages. If her injunction went unheeded, perhaps it is because the messiness of grief is what makes us uncomfortable.

    Anyone who has experienced grief can testify that it is more complex than mere despondency. No one ever told me that grief felt so like fear, C. S. Lewis wrote in A Grief Observed, his slim account of the months after the death of his wife, from cancer. Scientists have found that grief, like fear, is a stress reaction, attended by deep physiological changes. Levels of stress hormones like cortisol increase. Sleep patterns are disrupted. The immune system is weakened. Mourners may experience loss of appetite, palpitations, even hallucinations. They sometimes imagine that the deceased has appeared to them, in the form of a bird, say, or a cat. It is not unusual for a mourner to talk out loud - to cry out - to a lost one, in an elevator, or while walking the dog.

    The first systematic survey of grief was conducted by Erich Lindemann, a psychiatrist at Harvard, who studied a hundred and one bereaved patients at the Harvard Medical School, including relatives of soldiers and survivors of the infamous Cocoanut Grove fire of 1942. (Nearly five hundred people died in that incident, trapped in a Boston night club by a revolving front door and side exits welded shut to prevent customers from ducking out without settling their bills.) Lindemann's sample contained a high percentage of people who had lost someone in a traumatic way, but his main conclusions have been borne out by other researchers. So-called normal grief is marked by recurring floods of somatic distress lasting twenty minutes to an hour, comprising symptoms of breathlessness, weakness, and tension or mental pain, in Lindemann's words. There is restlessness, inability to sit still, moving about in an aimless fashion, continually searching for something to do. Often, bereaved people feel hostile toward friends or doctors and isolate themselves. Typically, they are preoccupied by images of the dead.

    Lindemann's work was exceptional in its detailed analysis of the experience of the grieving. Yet his conception of grief was, if anything, more rigid than Kubler-Ross's: he believed that most people needed only four to six weeks, and eight to ten sessions with a psychiatrist, to get over a loss. Psychiatrists today, following Lindemann's lead, distinguish between normal grief and complicated or prolonged grief. But Holly Prigerson, an associate professor of psychiatry at Harvard, and Paul Maciejewski, a lecturer in psychiatry at Brigham and Women's Hospital, in Boston, have found that even normal grief often endures for at least two years rather than weeks, peaking within six months and then dissipating. Additional studies suggest that grief comes in waves, welling up and dominating your emotional life, then subsiding, only to recur. As George A. Bonanno, a clinical psychologist at Columbia University, writes in The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After Loss (Basic; $25.95), When we look more closely at the emotional experiences of bereaved people over time, the level of fluctuation is nothing short of spectacular. This oscillation, he theorizes, offers relief from the stress grief creates. Sorrow . . . turns out to be not a state but a process, C. S. Lewis wrote in 1961. It needs not a map but a history.

    To say that grief recurs is not to say that it necessarily cripples. Bonanno argues that we imagine grief to be more debilitating than it usually is. Despite the slew of self-help books that speak of the overwhelming nature of loss, we are designed to grieve, and a good number of us are what he calls resilient mourners. For such people, he thinks, our touchy-feely therapeutic culture has overestimated the need for grief work. Bonanno tells the story of Julia Martinez, a college student whose father died in a bicycling accident. In the days after his death, she withdrew from her mother and had trouble sleeping. But soon she emerged. She went back to school, where, even if sometimes she felt sad and confused, she didn't really want to talk to her friends about the death. Within a few months, she was thriving. Her mother, though, insisted that she was repressing her grief and needed to see a counsellor, which Julia did, hating every minute of it.

    Bonanno wants to make sure that we don't punish this resilient group inadvertently. Sometimes the bereaved feel as much relief as sorrow, he points out, especially when a long illness was involved, and a death opens up new possibilities for the survivor. Perhaps, he suggests, some mourners do not need to grieve as keenly as others, even for those they most love.

    Yet Bonanno's claims about resilience can have an overly insistent tone, and he himself turns out to be a rather imperfect model of it. He thrived after his own father died, but, as he relates in his book's autobiographical passages, he became preoccupied, many years later, with performing an Eastern mourning ritual for him. The apostle of resilience is still in the grip of loss: it's hard to avoid a sense of discordance. All of which forces the question that's at the heart of all thinking about grief: Why do people need to grieve in the first place? To the humanist, the answer to that question is likely to be something like: Because we miss the one we love, and because a death brings up metaphysical questions about existence for which we have few self-evident answers. But hardheaded clinicians want to know exactly what grieving accomplishes. In Mourning and Melancholia (1917), Freud suggested that mourners had to reclaim energy that they had invested in the deceased loved one. Relationships take up energy; letting go of them, psychiatrists theorize, entails mental work. When you lose someone you were close to, you have to reassess your picture of the world and your place in it. The more your identity was wrapped up with the deceased, the more difficult the loss. If you are close to your father but have only a glancing relationship with your mother, your mother's death may not be terribly disruptive; by the same token, a fraught relationship can lead to an acute grief reaction.

    In the nineteen-seventies, Colin Murray Parkes, a British psychiatrist and a pioneer in bereavement research, argued that the dominant element of grief was a restless searching. The heightened physical arousal, anger, and sadness of grief resemble the anxiety that children suffer when they're separated from their mothers. Parkes, drawing on work by John Bowlby, an early theorist of how human beings form attachments, noted that in both cases - acute grief and children's separation anxiety - we feel alarm because we no longer have a support system we relied on. Parkes speculated that we continue to search illogically (and in great distress) for a loved one after a death. After failing again and again to find the lost person, we slowly create a new assumptive world, in the therapist's jargon, the old one having been invalidated by death. Searching, or yearning, crops up in nearly all the contemporary investigations of grief. A 2007 study by Paul Maciejewski found that the feeling that predominated in the bereaved subjects was not depression or disbelief or anger but yearning. Nor does belief in heavenly reunion protect you from grief. As Bonanno says, We want to know what has become of our loved ones.

    When my mother died, Christmas a year ago, I wondered what I was supposed to do in the days afterward - and many friends, especially those who had not yet suffered an analogous loss, seemed equally confused. Some sent flowers but did not call for weeks. Others sent well-meaning e-mails a week or so later, saying they hoped I was well or asking me to let them know if there is anything I can do to help. One friend launched into fifteen minutes of small talk before asking how I was, as if we had to warm up before diving into the churning waters of grief. Without rituals to follow (or to invite my friends to follow), I felt abandoned, adrift. One night I watched an episode of 24 which established the strong character of the female President with the following exchange about the death of her son:

    AIDE: You haven't let your loss interfere with your job. Your husband's a strong man, but he doesn't have your resilience. PRESIDENT (sternly): It's not a matter of resilience. There's not a day that goes by . . . when I don't think about my son. But I'm about to take this nation to war. Grief is a luxury I can't afford right now.

    This model represents an American fantasy of muscling through pain by throwing ourselves into work; it is akin to the dream that if only we show ourselves to be creatures of will (staying in shape, eating organic) we will stave off illness forever. The avoidance of death, Kubler-Ross was right to note, is at the heart of this ethic. We have a knack for gliding over grief even in literary works where it might seem to be central, such as Hamlet and The Catcher in the Rye. Their protagonists may be in mourning, but we tend to focus instead on their existential ennui, as if the two things were unrelated. Bonanno says that when he was mourning his father he had to remind himself that just about any topic pertaining to a dead person . . . still made people in the West uncomfortable.

    Uncomfortable and sometimes - the Johns Hopkins psychologist Kay Redfield Jamison, an expert on bipolar disorder, suggests - impatient. In her new memoir, Nothing Was the Same (Knopf; $25), about the death of her husband, Jamison describes an exchange, three months after his death, with a colleague who asked her to peer-review an article. Finding it difficult to switch from contemplative sadness to hardheaded rationalism, Jamison snapped, My husband just died. To which her colleague responded, It's been three months. There's a temporal divide between the mourner and everyone else. If you're in mourning - especially after a relationship that spanned decades - three months may seem like nothing. Three months, to go by Prigerson's and Maciejewski's research, might well find you approaching the height of sorrow. If you're not the bereaved, though, grief that lasts longer than a few weeks may look like self-indulgence.

    Even Bonanno, trying to offer a neutral clinical description of grief, betrays how deeply he has bought into the muscle-through-it idea when he describes a patient who let sad feelings bubble up only when she could afford to. Many mourners experience grief as a kind of isolation - one that is exacerbated by the fact that one's peers, neighbors, and co-workers may not really want to know how you are. We've adopted a sort of ask, don't tell policy. The question How are you? is an expression of concern, but mourners quickly figure out that it shouldn't be mistaken for an actual inquiry. Meanwhile, the American Psychiatric Association is considering adding complicated grief to the fifth edition of its DSM(the Diagnostic and Statistical Manual of Mental Disorders). Certainly, some mourners need more than the loving support of friends and family. But making a disease of grief may be another sign of a huge, and potentially pernicious, shift that took place in the West over the past century - what we might call the privatization of grief.

    Until the twentieth century, private grief and public mourning were allied in most cultures. In many places, it used to be that if your husband died the village came to your door, bearing fresh-baked rolls or soup. As Darian Leader, a British psychoanalyst, argues in The New Black: Mourning, Melancholia, and Depression (Graywolf; $16), mourning requires other people. To lose someone was once to be swept into a flurry of rituals. In many nations - among them China and Greece - death was met with wailing and lamentation among family and neighbors. Some kind of viewing followed the cleaning of the body - what was known as a wake in Ireland, an encoffining in China. Many cultures have special mourning clothes: in ancient Rome, mourners wore dark togas, and the practice of wearing dark (or sometimes white) clothes was common in Continental Europe in the Middle Ages and the Renaissance. During the Victorian era in England and the United States, family members followed an elaborate mourning ritual, restricting their social lives and adhering to a dress code. They started in full mourning (for women, this was stiff black crepe) and gradually moved to half mourning (when gray and lavender were permitted). Among Hindus, friends visit the house of the bereaved for twelve days and chant hymns to urge the soul on to the next world. In the Jewish shivah, a mourner sat on a low chair and chose whether to acknowledge visitors; those mourning their parents may recite the Kaddish for eleven months, supported by a minyan of fellow-worshippers. Even at the turn of the twentieth century, the death of a man still solemnly altered the space and time of a social group that could be extended to include the entire community, notes Philippe Aries, the author of the magisterial The Hour of Our Death (1977), a history of Western attitudes toward dying.

    Then mourning rituals in the West began to disappear, for reasons that are not entirely evident. The British anthropologist Geoffrey Gorer, the author of Death, Grief, and Mourning (1965), conjectures that the First World War was one cause in Britain: communities were so overwhelmed by the sheer numbers of dead that they dropped the practice of mourning for the individual. Certainly, there does seem to be an intuitive economy of grief: during war, plague, and disaster, elaborate mourning is often simplified or dispensed with, as we now see in Haiti. But many more Americans died during the Civil War than during the First World War; it seems, then, that broader changes in the culture hastened the shift.

    Even before the war, according to Emily Post, mourning clothes were already becoming optional for any but the closest of kin. More people, including women, began working outside the home; in the absence of caretakers, death increasingly took place in the protective, and isolating, swaddling of the hospital. With the rise of psychoanalysis came a shift in attention from the communal to the individual experience. Only two years after Emile Durkheim wrote about mourning as an essential social process, Freud's Mourning and Melancholia defined it as something fundamentally private and individual. In a stroke, the work of mourning had become internalized. As Aries says, within a few generations grief had undergone a fundamental change: death and mourning had been largely removed from the public realm. In 1973, Ernest Becker argued, in The Denial of Death, that avoidance of death is built into the human mind; instead of confronting our own mortality, we create symbolic hero-systems, conceptualizing an immortal self that, through imagination, allows us to transcend our physical transience. (In the early morning on the lake sitting in the stern of the boat with his father rowing, he felt quite sure that he would never die, the young Nick Adams thinks in the last line of Ernest Hemingway's Indian Camp.) Gorer himself had diagnosed an over-all silencing of the mourner: Today it would seem to be believed, quite sincerely, that sensible, rational men and women can keep their mourning under complete control by strength of will and character, so that it need be given no public expression, and indulged, if at all, in private, as furtively as . . . masturbation. Aries added that this silence was not due to the frivolity of survivors, but to a merciless coercion applied by society.

    In the wake of the AIDS crisis and then 9/11, the conversation about death in the United States has grown more open. Yet we still think of mourning as something to be done privately. There might not be a right way to grieve, but some of the work Bonanno describes raises the question of whether certain norms are healthier than others. In Western countries with fewer mourning rituals, the bereaved report a higher level of somatic ailments in the year following a death.

    Today, Leader points out, our only public mourning takes the form of grief at the death of celebrities and statesmen. Some commentators in Britain sneered at the crocodile tears of the masses over the death of Diana. On the contrary, Leader says, this grief is the same as the old public grief in which groups got together to experience in unity their individual losses. As a saying from China's lower Yangtze Valley (where professional mourning was once common) put it, We use the occasions of other people's funerals to release personal sorrows. When we watch the televised funerals of Michael Jackson or Ted Kennedy, Leader suggests, we are engaging in a practice that goes back to soldiers in the Iliad mourning with Achilles for the fallen Patroclus. Our version is more mediated. Still, in the Internet age, some mourners have returned grief to a social space, creating online grieving communities, establishing virtual cemeteries, commemorative pages, and chat rooms where loss can be described and shared.

    In On Death and Dying, Elisabeth Kubler-Ross, too, emphasized community by insisting on the importance of talking to the dying. Against the shibboleth that we die alone, Kubler-Ross thought that we should die with company. On Death and Dying shaped our grieving styles by helping establish the hospice movement and by an updated notion of the good death, in which the dying person is not only medically treated but emotionally supported.

    Yet the end of Kubler-Ross's own life was a lonely one. Like many pioneers, she was driven by messianic convictions that sometimes distanced her from her friends and family. Named Woman of the Decade by Ladies' Home Journal in the nineteen-seventies, she separated from her husband and left him with the children, bought a house in Escondido, California, called it Shanti Nilaya (Final Home of Peace), and, in 1977, established it as a growth and healing center for the dying. She became a devoted exponent of reincarnation, arguing that death was a transition to a better stage, akin to breaking out of a cocoon. (As a volunteer in Europe after the war, she had been moved by the sight of butterflies carved into the walls of the children's barracks at Majdanek, a concentration camp.)

    Then, in 1995, Kubler-Ross suffered a stroke that left her paralyzed on one side. By 1997, living a severely circumscribed life in Arizona, she had grown depressed. For 15 hours a day, I sit in this same chair, totally dependent on someone else coming in here to make me a cup of tea, she told a reporter from the San Francisco Chronicle. She became known as the death-and-dying lady who can't seem to manage her own death. Her isolation was chronicled in the documentary Facing Death (2003). It showed a solitary Kubler-Ross in her cluttered home. I always leave the television on, she says. That way something is always moving. An English muffin hardens next to her on a plate. She says that she got in the habit of saving food in case she is hungry later in the day. Her son Kenneth lives nearby and stops in from time to time. Yet she seems as hauntingly alone as the patients she interviewed some thirty years earlier.

    It has become a truism of the hospice movement that people resist death if they have something left they need to say. After the documentary, Kubler-Ross emerged from her anomie to revisit what she had written about grief. Realizing that the stage theory had grown into a restrictive prescription for grief, she collaborated with David Kessler, a hospice expert, to write On Grief and Grieving. Near the end of a chapter about her own grief - which arrived late in life, following the death of her ex-husband - she noted, I now know that the purpose of my life is more than these stages. I have been married, had kids, then grandkids, written books, and traveled. I have loved and lost, and I am so much more than five stages. And so are you.

    On Grief and Grieving was a personal triumph of sorts for the ailing Kubler-Ross. Yet her crusade to open up a conversation about death and grief was ultimately distorted by her own evasions: the woman who wanted us to confront death unflinchingly came to insist that it was really an opportunity for personal growth among the survivors, as if it were a Learning Annex class. As she put it in an essay for an anthology, Death: The Final Stage of Growth (1997), Confrontation with death and dying can enrich one's life and help one to become a more human and humane person. This approach - suffused with an American we can do it better spirit - made grief the province of self-help rather than of the community. In the end, Kubler-Ross could perhaps have done more to help her own family grieve after her death. Like many Americans, she planned her funeral, and insisted it be a celebration rather than an occasion for mourning. Dozens of E.T. balloons were released into the air, symbolizing unconditional love. Perhaps we were to picture her bicycling through the sky toward home.

DIY Funerals

    When Jerrigrace Lyons goes out on a case, she carries a basic set of tools: makeup kit, cardboard caskets and a handbook with practical instructions for icing and transporting bodies.

    Lyons is a "death midwife," a specialist in the little-known field of helping people manage the passing of a loved one -- outside the traditional funeral industry. As the nation reels through its worst economic crisis in decades, her business is booming.

    In the past, Lyons' clients have been drawn by the alternative nature of her service. Now many simply cannot afford traditional funerals and burials, often more than $10,000.

    "People want something that is in line with what their loved ones would have wanted," Lyons said by telephone from Hawaii, where she was teaching a sold-out workshop. "But they also want something that they can afford."

    An ordained minister from Sebastopol, Calif., Lyons started a nonprofit organization called Final Passages. She teaches workshops about such topics as how to care for a body while it's in the family home and about burials outside traditional cemeteries.

    Lyons also guides families through the legalities and paperwork of at-home funerals -- death certificates and body transport permits -- while providing emotional support and counseling. Her services can run from $500 to $1,500.

    "As a death midwife, I'm helping to usher a person out of this world and into the next," said Lyons. "It is really the same threshold as birth. I think of it as the comings and goings of our spirit. We come in and we go out. But it is the same doorway."

    She's not the only death midwife to report increased interest in the service.

    "In good times and bad, funerals have consistently been an incredible expense," said Joshua Slocum, executive director of Funeral Consumers Alliance. "This economic situation is forcing us to reassess the value of the dollar -- and not just the value of money, but the value of what we buy."

    When Howard Kopecky, 66, of northwestern Wisconsin was diagnosed with terminal cancer this year, he decided that he did not want his family to spend a lot of money on his funeral.

    "We thought, 'Why should we put all that money into the ground, when we could leave it to our children and grandchildren?' " said Howard's wife, Phyllis, who had just lost her job at a nursing home when he was diagnosed.

    The couple did not know exactly how to proceed, until Howard noticed a newspaper ad for death midwife Lucy Basler. "I think it made us feel like, OK, other people are doing this," Phyllis said.

    Basler, who had been trained at one of Lyons' workshops, assisted the couple with the details of staging a home funeral.

    When Howard died, Phyllis and their children held a memorial then buried him in a pine box on their property, in a spot they had legally designated as a cemetery. For a headstone, they used a large rock from a neighboring field.

    The cost: under $1,000.

    The economic crunch has pushed others toward money-saving options. Cremation was chosen last year in about 35% of deaths nationally, up from about 28% in 2002, the Cremation Assn. of North American reported.

    And "green" burials -- which often skip embalming (about $600) and grave liners ($400 to $1200) -- are increasingly popular because they are thought to be better for the environment as well as potentially less expensive.

    "The financial constraints that people are facing, and the realization that there are more ecological burial options, are the two forces that are really reshaping the death system," said D. Brookes Cowan, a grief educator and professor at the University of Vermont.

    Even those opting for traditional services are looking for ways to save. Slocum has recently advised families on cost-cutting measures such as making the casket, bringing flowers, and having a family viewing without embalming and then a closed casket during the official funeral.

    "It is a social taboo, when talking about death, to talk about money," Slocum said. "But for a society of people who consider themselves to be savvy consumers, we have been remarkably unsavvy when it comes to one of the most important things that we will have to deal with."

    Many people simply don't know the laws, say Slocum and other funeral consumer advocates. Just seven states require that an undertaker be involved in a funeral. In almost all states, it is legal to keep an un-embalmed body at home for at least 24 hours.

    When Joanne Grefsrud's husband, Vern, died this year from Addison's disease, she kept his body in their Wisconsin home for 3 1/2 days on a massage table packed with dry ice.

    Grefsrud and her family washed, dressed and anointed Vern's body and held a memorial service at the house for his friends.

    "When the neighbors started coming, it was quite a surprise to everyone that we hadn't sent him to a mortuary," Grefsrud said. "But it gave me great comfort because I could cozy up in a blanket in a chair right beside him and talk to him. It just gave me more peace."

    But the family ran into problems finding a crematorium to do the work.

    "The medical examiner said that we would have to go out of the county," Grefsrud said. "He said no one was going to cooperate with us."

    So the family drove his body 100 miles -- in a pine casket in the back of a pickup -- to a facility that agreed to cremate it for about $800.

    Basler acknowledged "a home funeral isn't for everybody: It involves a lot of hands-on, and there are some folks who feel uncomfortable with that."

    Last month, just before Thanksgiving, Elizabeth Sky Nogotona, 61, invited Lyons to her house in Santa Rosa to discuss with her children and elderly father the possibility of an at-home funeral. Nogotona knew that she would not be able to afford a standard funeral for her father or her mother, who is in a nursing home. But she was willing to do whatever they thought was right.

    After a discussion, the family decided on at-home funerals followed by cremation.

    "It's less expensive," said her father, Michael J. Borge, "and more personal."

Epitaphs

    Epitaphs Of last words, none is more final than an epitaph: a definitive moment of self-congratulation, a conclusive opportunity to commend oneself to the Almighty, or simply a chance to settle old scores in stone.

    Epitaphs have fallen out of fashion over the past half-century - which is a pity, for the English epitaph is often a thing of beauty and sly wit. The late Robin Cook is the only modern personality I can think of with a memorable epitaph: I may not have succeeded in halting the war, but I did secure the right of Parliament to decide on war. In its self-justification, precision with words, and slightly rebarbative tone of superiority, it perfectly reflects the man.

    As J.P.G.Taylor writes in his fascinating collection of English epitaphs, the epitaph frequently informs in a way that modern inscriptions rarely do. Epitaphs are not supposed to be true. The epitaph is a single pithy statement, either by or about the lately departed. There are few words more carefully crafted and carved out of the language: the epitaph writer has a very small page, and only a few words to play with.

    That's all, Folks! reads the inscription on the headstone of Mel Blanc, the voice of Bugs Bunny. Spike Milligan's grave memorably insists: I told you I was ill. Distinct from the one-liners are the exhortatory epitaphs: Here lies the body of Jonathan Swift... where savage indignation can tear his heart no more. Go, traveller, and if you can, imitate one who with his utmost strength protected liberty. W.B.Yeats considered Swift's the greatest epitaph in history.

    My favourite epitaphs are those that tell a story. In most instances the events behind the headstone can never be fully known, but the few words leave the taste of a mystery part-obscured.

    Take, for example, the gravestone of Donald Robertson at Hillswick in the Shetland Islands, who died on June 4, 1847. A peaceable, quiet man, and to all appearances a sincere Christian... his death was caused by the stupidity of Laurence Tulloch, who sold him nitre instead of Epsom salts, by which he was killed in the space of five hours after taking a dose of it. Why do I feel that there is more to this story than Tulloch's chemical confusion? Perhaps it is the phrase to all appearances. If I were investigating Robertson's death, I would start by interviewing whoever paid for his gravestone, which fingers Tulloch but is unable to resist a small moral jab at the deceased.

    An epitaph can offer an entire play in a few words, like that of Ellen Shannon in Nova Scotia, Who was fatally burned March 21, 1879, by the explosion of a lamp filled with RE Danforth's Non-Explosive Burning Fluid. I can find no other reference to Danforth's fluid. Shannon's gravestone appears to be the only place it was ever written down: in attempting to damn Danforth's Non-Explosive Burning Fluid from beyond the grave, Ellen Shannon gave this fatally misleading product eternal life.

    All epitaphs are, in a way, warnings, but some read like health and safety announcements. Elizabeth Picket of Stoke Newington, her headstone proclaims, died in 1781 at the age of 23, in consequence of her clothes taking fire. The stone warns: Reader if you ever should witness such an affecting scene; recollect that the only method to extinguish the flame is to stifle it by an immediate covering.

    The grave of the three Atwood sisters offers similarly grave counsel. The sisters were poisoned by eating funguous vegetables mistaken for champignons in 1808: Let it be a solemn warning that in our most grateful enjoyments even in our necessary food may lurk deadly poison. There is something rather touching about the sisters heading Heavenward with a severe mushroom warning attached.

    While most epitaphs speak of piety and uxorious love, a few echo with resentment, recrimination and adultery. Charles Ward's grave of 1770 carried an addendum: This stone was not erected by SUSAN his wife. She erected a stone to JOHN SLATER her second husband, forgetting the affection of CHARLES WARD her first Husband. So there.

    The widow of John Barnes, in a Vancouver cemetery, did put up a stone for her late husband, which reads like a situation vacant notice: Sacred to the memory of my husband, John Barnes, who died January 3, 1803. His comely young widow, aged 23, has many qualifications of a good wife, and yearns to be comforted. But the greatest untold story in an epitaph is that on a casket in Madeley, Shropshire, which simply reads: Mary Tooth, died November 15th 1843, Aged 65 years The Beloved Companion, Faithful friend and zealous Successor of the late Mrs Fletcher of blessed memory. Did Mary Tooth succeed her friend in the affections of Mr Fletcher?

    Exactly how zealous was she? And what unspoken warfare existed between these two bosom friends? Mary Tooth's grave is silent, but her epitaph speaks volumes.

Wills and Legacies

    Ann Turner, of Betchworth, drawing up her last will and testament in 1783, left everything to her sons, and nothing to chance. Her will runs to about ten pages, identifying every single one of the 1,545 items she owned: her walking cane, her marrow spoon, her copy of Tillotson's Sermons, her lace ruffles, her dung cart, three hens, 13 chickens and much, much more.

    George Fillipot, a mealman from Wansworthe, was more succinct as he prepared to leave behind his worldly goods in 1603: Because the time is dangerous and the life of man is in the hand of God if my son and wife die I will my brother shall be my Executor.

    These are just two of 28,000 wills, drawn up in Surrey between 1470 and 1856, and published online yesterday for the first time by the Origins Network, a family history website. The wills are astonishingly varied, a chapter of social history like no other spanning four centuries, but what Ann Turner, George Fillipot, and almost all the will-writers share is the urgency of their bequests. Wills and bequests matter deeply to ordinary people, now and in the past, in a way that historians and governments too often forget.

    A will is an epitaph in possessions. It can be a vehicle for malice, revenge, charity or love. Ambitious will-writers hope to change the world after leaving it. More often, the testator expresses the hope his chattels should not fall into the wrong hands after death. James Gouldsmith, weaver of Waldingham, was emphatic in 1604: Son-in-law Daniell Stone touching whom I have sworn he should never have any dealings with any things that are mine.

    Some wills are grandiose - such as Francis Drake's wish to be buried at sea, like a Viking, with his favourite ships sunk alongside him - but most are touchingly humble. John Pigeon, dying in 1618, leaves his wife Alice the bed I lie in. Captain Charles Dodgson, Lewis Carroll's grandfather, inserted into his will a touching premonitory passage addressed to his wife, just days before he was killed in action in 1804: A heart more warmly attached to her than that which dictates these lines she can never find.

    Some testators bequeath lasting mysteries. Why, for example, did William Shakespeare leave Anne Hathaway his second best bed, and not the best one? Others left strict and eccentric instructions. The Canadian millionaire lawyer Charles Vance Millar left the bulk of his estate in 1926 to whichever Toronto woman managed to give birth to the largest number of children in the ten years after his death. After a procreative race known as the Great Stork Derby (and a failed legal challenge by Millar's other heirs) four women received $125,000 each, having produced nine children apiece.

    The testator who leaves his money to the Church of Scientology or Oxfam is not acting so differently to the man from Mirfield in Yorkshire who left a friend his entire music collection on condition that he agrees to play Bat out of Hell (the whole CD) at least three times, and listens to it. The will in these cases is about propagating values and beliefs posthumously, whether for charity, religion or Meat Loaf.

    Though some bequests are more demanding than others, what all have in common is the desire to ensure that cherished possessions continue to be treasured, that the people or things we love or admire are rewarded, that our money continues to do what we want it to do whether that means leaving a favourite dung cart to a favoured son or, in the case of the late countess Karlotta Libenstein, bequeathing an estate worth £180 million to an eight-year-old Alsatian named Gunther IV, along with a butler.

    The most elaborate wills seldom work out quite as expected. George Bernard Shaw left £1 million and the royalties from his plays to the cause of rationalising English spelling. Shaw (rightly) argued that English spelling is illogical, and there are insufficient letters for the variety of sounds in the language. Once the will had been disputed, and the lawyers had taken their cut, the bequest was whittled down to almost nothing. Fifty-eight years after his death, Shaw's campaign is a £500 prize on spelling reform. And there are still only 26 letters in the alphabet (or alfabet). The urge to preserve and pass on to the next generation transcends class and wealth. In the Surrey wills, the poorest are as determined to see their few possessions disbursed rightly as those owning great estates. Nor is charity the preserve of the rich: people with almost nothing give generously to those with even less.

    Inheritance is often portrayed as the wealthy clinging to their riches down the generations, but the desire to bequeath is practically universal (although some unlikely people have died intestate, including Abraham Lincoln, Karl Marx and Pablo Picasso).

    The bounce in popularity enjoyed by the Tories after pledging to raise the threshold for inheritance tax (and the Government's subsequent attempt to play catch-up) reflected resentment at a posthumous levy widely seen as unfair. The middle class is prepared to pay taxes while alive, but considerably less content to have to pay tax a second time after death.

    The right to leave what we want, to whom or what we want, is deeply cherished in British culture, but also a strange and intriguing index of our lives; net worth at death is not the only or best way to measure real worth, but it is one we cling to. When The Times made a move to stop reporting wills in the 1990s, there was an outcry.

    Our love of legacy may lie not in the last will, but the testament that it contains or implies. A will leaves behind something for our inheritors, perhaps something for the taxman, a few objects, and a little postscript to our lives.

Ethical Wills

    When I was studying to become a rabbi, I became fascinated by Jewish ethical wills. I came across a series of documents written by rabbis in the medieval period and later to their children and descendants. There were similar documents among the Muslim and Christian communities at that time.

    These were not wills as we now know them - about property and dividing things up. These ethical wills made for fine, if sometimes eccentric, reading. They instructed their children on when to read particular religious books, and when to think about getting married. They told them to look after their mothers and sisters. They warned them to beware of dishonest traders and always to give the benefit of the doubt to people who came begging. And they tried to sketch out what a good life might be. They represent a lovely custom, as parents try to sum up in them all that they have learnt in life, expressing what they most want for and from their children. The letters were a precious legacy, because the parents believed that the wisdom they had acquired was just as much a part of what they wanted to leave their children as any material possessions.

    Could we turn that kind of thinking into something more modern and applicable to people facing death today?

    I mentioned to a friend, a hospice nurse, that I'd been reading an ethical will by a 17th-century rabbi. She said that the idea reminded her of something that terminally ill young women, usually dying of breast cancer, sometimes put together for their children. They create boxes filled with objects of sentimental value that they want to pass on to their children, whom they will never see grow up. Beside the objects they place letters in which they describe the things that have meant so much to them - beauty, art, helping others, books - and of course say how much their children mean to them. In the letters they also often suggest how their children might want to live, given that their mothers will not be there to guide them through life.

    It's almost unbearably painful to hear young women talk about doing this, said my friend. But the value of preparing such a box, of leaving it for the children for when they are older, is enormous. It helps the mother to cope with the loss of her children's future and it helps the children learn a little more about the mother they never really knew or can barely remember. Although it is heart-rending for both mother and child to realise what they did not know of each other, it brings some comfort. Although it can only offer a taste of the mother's personality, values, passions and love, it is nevertheless of immense value.

    After my own mother's death I was very moved to find a note thanking my husband and me for being so good to her during her last long illness. The fact that, in extreme pain and sadness, she had bothered to write the note meant a great deal to me. It was an ethical will of a sort but also just a simple yet heartfelt thank-you letter, and very dear to us because of that. And maybe her little note is as good an example - so kind, so generous, brief and memorable - as any of the longer and somewhat bossy ethical wills in the rabbinic literature.

    Some of the ethical wills of the mediaeval rabbis make me laugh and others make me cry. I love, for instance, the lengthy ethical will of Nathaniel Trabotti, an Italian rabbi who died in 1658, as recorded by his disciple, Samuel Belgradi. It begins: "I am now 86 years of age, no more can I go and come in your midst as I have done from my early youth . . . I have wronged none, but have tried my best to maintain union among you all small and great, so as to prevent scandals in your midst. Be gracious to me, my friends, and let your prayers be made on behalf of my soul, and I on my part will never cease to pray for you."

    Trabotti's represents one kind of ethical will, calling on the whole community. But there's another kind in which fathers try to get their sons to do things in a certain order, such as read particular books that fit their increasing maturity. A famous letter by Judah Ibn Tibbon (1120-c1190) to his son Samuel is an example of this. In it, he berates his child, reminding him how much he has done for him; and he ends with the instruction that his child should consult this will regularly. "My son, list to my precepts, neglect none of my injunctions. Set my admonition before your eyes; thus shall you prosper and prolong your days in pleasantness!"

    The tradition of the ethical will dates back to the Bible, when Jacob gathered his children round his bedside and told them how to live after he was gone; and when Moses instructed his people before his death. David prepared Solomon before he died by warning him whom to be wary of when he became king, and by asking him to complete the task he had begun.

    In my experience people usually love the challenge of writing an ethical will, which includes their practical, moral and political hopes for the future. It is a good way to sort out what matters to us personally as we write it - which in turn helps us face our own mortality peacefully.

    Whether we put pen to paper or not, I think we all should consider what our own ethical will might look like. These ethical or moral wills are by no means easy to write. If we are to do it seriously, we will have to look inside ourselves to see what essential truths we have learnt in a lifetime. We will have to face up to our failures and decide what really counted.

    An ethical will offers a chance to reflect, to think about what we want to say as a last message to our most beloved people, and then to craft something special - with a little humour and perhaps a measure of self-awareness so that it is neither too smug nor too fierce to be a bearable read. For these wills should give pleasure and joy, as well as instruction. They should be letters of kindness as well as of acquired wisdom. And they should make the recipient feel that they were written just for them.

    Not only is there value to us in the actual experience of writing it, but it may also be valuable to those who read it when the time comes. Whatever emotions they stir up, it is clear that ethical wills have an impact. Therefore, it must be right for us to recreate this tradition for our time - not just for Jews but for everyone.

    In a curious set of internet blogs called 'faithbooking', Donna Riner Weber asks: "What will happen when you are no longer here on Planet Earth? Maybe you've taken care of a will so that your material possessions will be distributed according to your wishes but what about the spiritual part? Those experiences that happened to you - will they die when you pass on?"

    Churches and individuals are latching on to the general concept behind 'scrapbooking your faith' or 'faithbooking'. In some respects it is similar to composing an ethical will, in that it is about leaving a "spiritual legacy - for the love of your family" (to quote Riner Weber), and is often created by grandparents for grandchildren. But, to my mind, it is as much about telling the story of our own lives in new ways as it is about leaving children guidance on how to live their own lives.

    After all, a legacy is all too often thought of as something tangible, something material that we have worked hard to achieve. We leave it in a will to our family or friends, to our community, church or town. We may leave it as something that testifies that we were here - "this is the bench he gave to the city", or "she donated this picture to the gallery."

    In spite of the various forms that a legacy can take - such as an ethical will, generous bequest, or lovingly crafted bits and pieces - some of us will be remembered for none of these. We will leave unwritten legacies through our acts of kindness, through those small private gestures as well as public acts which can change the ways in which the people around us live, think and act. This sort of legacy may not be celebrated and may indeed pass unremarked, but it will nonetheless allow us to approach our graves in the certain knowledge, in our hearts, that we made a difference while we were here on Earth.

Top Funeral Songs

    The cheery tune from The Life Of Brian film beat competition from The Jam's Going Underground and The Animals' We Gotta Get Out Of This Place.

    The survey, commissioned by the Children's Society, also found that nine out of ten people found talking about funeral arrangements more difficult than talking about sex.

    A spokesman for the society said it appeared people were turning away from serious funeral tunes such as Robbie Williams' Angels in an effort to make the experience a more uplifting one.

    A fifth of those surveyed said they would like Always Look On The Bright Side Of Life to be played at their funeral while 16% went for Cabaret, sung by Liza Minnelli.

    Other popular choices included Sid Vicious's cover of My Way, They're Coming to Take Me Away, Ha-Haaa by Napoleon and Enjoy Yourself, It's Later Than You Think by the Specials.

    Lorraine Groves from the Children's Society said: Funerals have changed a lot in the past few years - more people are planning ahead to make their funerals personal and reflective of themselves.

    We know many people prefer a simple affair and would rather their mourners give donations in memory rather than lots of flowers, along with a little light hearted twist during the proceedings like an alternative song.

    The research also found that around 40% of people do not have a will, and the Children's Society is offering free advice to anyone wanting to set one up.

    A total of 764 people were questioned for the survey.

    The top 10 alternative funeral songs:

    1. Always Look On The Bright Side Of Life - Monty Python

    2. Cabaret - Liza Minnelli

    3. Wish Me Luck As You Wave Me Goodbye - Gracie Fields

    4. My Way - Sid Vicious

    5. They're Coming To Take Me Away, Ha-Haaa - Napoleon

    6. Fame! I Want To Live Forever - The cast of Fame

    7. We've Gotta Get Out Of This Place - The Animals

    8. Going Underground - The Jam

    9. Spirit In The Sky - Dr and The Medics

    10. Enjoy Yourself, It's Later Than You Think - The Specials

Too Much Land For The Dead

    The land grab by the deceased across our cities must end. They should be laid to rest in back gardens and woods

    Being remembered with a shrine is the ultimate vanity The modern grave is a creation of the mawkish Victorians

    On long train journeys, my old boss liked to point out cemeteries. Everyone lying in there, he'd say, eyes glinting, believed they were indispensable. This mantra, filched no doubt from some American management manual, was designed to prick the egos of the living. Uppity underlings like me. But he had a point too about the arrogant solipsism of the dead.

    Who do they think they are, these corpses, taking up green fields with their mausoleums and headstones, their garden centre cherubs? Stretched out across hillsides in municipal graveyards as soulless as industrial estates, as regular as the aisles of Lidl, in their skeleton parking spaces, what gives the dead the right to stake out their neat rectangles of planet in perpetuity?

    But now this land grab by the deceased has reached crisis point. On our squashed island, room is running out: 150,000 people still want to be buried every year and they can't.

    The living and dead must battle for space, as they do in Honor Oak, in Southwark, my London borough. Here the council is considering whether a much used recreation ground should become an overspill cemetery. Goalposts or graves? How is that even being weighed up? I doubt the nans and gramps likely to be interred therein would want their grandkids to have no place to play. Besides if you concede your football pitch to the dead they will still, in just a few years, come back for the allotments. Time to make a ruling once and for all, that no one has a right to a grave.

    It is the ultimate vanity, the notion that you must be remembered by a shrine, a stretch of turf and imported granite. Such ugly places anyway, always on the outskirts of towns, as if you'd want to lie alongside a noisy A-road for all eternity. Too sterile and manicured - dead flowers quickly removed, no garish toys and football memorabilia allowed. And if neglected they seem an affront to the dead.

    The only appealing cemeteries are those like Nunhead, in South London, a sprawling gothic wilderness where - because its upkeep is unaffordable - ivy covers the masonry, wild flowers grow, children play among the broken angels: nature has claimed it back. The marked grave is a relatively modern fad anyway, created by that mawkish and sentimental force, the Victorian middle class. But it gels with our own modern sense that our every memory and idea must be externalised, whether in the tattoos on our bodies or the roadside bunches of flowers and teddies tied to railings, so poignantly tatty after just a few days. Like weddings, 30 per cent of funerals are now customised, the baby-boomers' last great effortful expression of our supreme individuality and taste.

    The Universe must not forget us: we insist upon it. And on our highest mountains and wildest cliffs, climbers now find cairns built to breast cancer victims or plaques to those who loved this place, claiming as theirs what belongs to all. Everyone must hear my pain. When did memories, bolstered by photos and letters - especially now we can share them on the internet - stop being sufficient? It seems space is running out fastest of all in our inner lives.

    One in seven people, according to a survey for the campaigning group Dying Matters this week, would choose to live for ever, but that being problematic, graves are our last stab at immortality. Sightseeing in Pere Lachaise cemetery in Paris, trudging miles between the tombs of Oscar Wilde, Jim Morrison and Edith Piaf, my younger son complained: Why didn't they just put all the famous people in one place? Actually all those buried in this ethereal prime real estate were once VIPs. Just history judged them more variously.

    The unremembered, unvisited entombed in the sarcophagi of their own self-importance don't seem very spiritual. Precious little ashes-to-ashes about an embalmed corpse mouldering laboriously in a brass-handled mahogany coffin. Little chance you will return to the earth, that t'worms will come and eat you up, given that all suggestions that burial plots should be tamped down after a few decades to admit fresh bodies is greeted with squeamish horror. As if we have not come to terms at all with the mechanics of death and decay. Another reason not to be buried, you'd think: that some council worker might eventually make a pile of your bones, like the time a fox dug up our garden of gerbil remembrance.

    Thankfully 70 per cent of British people are now being cremated, which is more economical and appropriately humble too. But not if your ashes are shot into space on a firework or processed into a memorial diamond or moulded into a piece of artificial reef or plonked in the centre circle at Wembley, like your DNA is so damn precious. Better to be blown in the wind, scattered on the sea, turned back into baser elements. Every time I go over Waterloo Bridge on the top of a bus, at that lovely sweep of the Thames, with views of both St Paul's and Westminster, I think I'd like to be quietly dispersed from a window just here, to become dust particles of the city that made me.

    Surely God didn't give us this planet to cover it in grey gravel and plastic carnations. If there is not enough land to build houses for the living, the dead can wait in line. (Or the rules loosened to allow burials on traffic islands and central reservations or - why not, if to the required depth? - back gardens.) The Church, fretting about the desire of parishioners to be buried beside their families, should steer them towards the crematorium or green burial sites. And while Muslims and Jews, according to their religous laws, cannot be cremated or buried in shared plots, there are apparently no theological reasons why they cannot be interred in fields or woodland.

    There are no headstones in these green cemeteries, although each person's place is logged by GPS - technology never forgets - and non-biodegradable coffins aren't allowed. So clad in a shroud or wicker coffin, we are left to decay. Meanwhile, sheep can graze, apple orchards feed on our minerals and visiting children stroll over our bones. When the body dies, the ego should too.

The Body Farm

    THE decaying corpses laid out in metal cages on a Texas ranch look as if they have come from a horror film. Some are waxy, yellow and mummified. Outside the cages, bleached bones are picked clean by vultures.

    The ghoulish display, protected by electric fences, is a deliberate study of the decomposition of bodies donated to science. By watching them decay, forensic scientists believe they can find out more about the hundreds of migrants who die each year in search of the American dream.

    The bodies of between 300 and 500 people who perish in the desert on their way into America are found each year. Just over half are identified, leaving the families of the remainder in Mexico and Central America with no idea of what happened to them.

    Many are buried in unmarked graves. Others are simply left, their bones scattered by coyotes or their bodies washed down the Rio Grande.

    Lori Baker, a 40-year-old forensic anthropologist, has dedicated her life to trying to identify the dead.

    In a former hardware store that serves as a forensic laboratory for Texas State University (TSU), Baker keeps shelves of boxes containing evidence from cold cases. She opens one to reveal a skull and four bones that have been gnawed by an animal, and a sealed plastic bag containing a watch.

    "This is characteristic of the kind of migrant remains from which we try to identify people," she said. "Border crossers usually remove any form of identification in case they're caught."

    Sometimes the scientists find photographs of family members or telephone numbers in shoes. With no fingerprints or hair to work from, Baker grinds some of the bone to try and extract DNA.

    It is laborious detective work and an enormous task. Baker believes the true number of people dying each year while attempting to cross the 2,000-mile border into Arizona, New Mexico and Texas is at least double the 300-500 cited by the US Bureau of Customs and Border Protection. "If a rancher finds a body, that doesn't count," she said.

    In Texas the job of identifying bodies rests with local justices of the peace. "An autopsy costs from $1,500 to $2,000, so rather than go over budget they often just bury them."

    She estimates that two thirds of the deaths are from exposure, with day time temperatures in the desert reaching 49C, then dropping to bitter cold at night. Some crossers follow guides known as 'coyotes' who take fees of as much as $ 1,500, then abandon them.

    The death toll has risen since the 1990s as border enforcement efforts have been stepped up, forcing the immigrants to cross through more inhospitable terrain.

    When it was possible to cross in a few hours it was mostly men who came seasonally for work. Now entire families try to cross, including the elderly and children, who are more vulnerable.

    Baker first became aware of the issue when, as a student researcher in Arizona, she bemoaned the lack of bones to study. A local sheriff said: "I can get you as many as you need." Another officer had a skull on his desk that he used as a pencil holder.

    When Baker graduated she worked in molecular anthropology and ancient DNA. In 2002 she was part of a team working in Peru to investigate atrocities committed by the military regime.

    One night the researchers talked about issues in their own countries. An expert from Guatemala, who had been working on a mass grave of children, told Baker: "You're from the United States, you don't have these problems. I realised we did," she said. "We have all these individuals dying on the border and not being identified and all these families never knowing what happened."

    Using her own money, she set up a project called Reuniting Families. She began excavating graves and launched a database to identify bodies, helped by her husband, a computer scientist. After encouraging families to input information, she found the numbers were even higher than she had realised. "It's astounding," she said. "I worked with the Mexican government and they were receiving 5,500 requests each year from families who had lost someone."

    Her first match was a single mother by the name of Rosa Cano. Baker was pregnant at the time and was horrified to realise the dead woman was her own age and had two children. "I cried by myself in the lab thinking they're never going to have their mum back," she said. "But the woman's mother was pleased to know and said, 'Now I have somewhere to go and pray'. And it was better for these little girls to know their mum hadn't just abandoned them, but had died trying to get a better life for them."

    Baker has identified 79 bodies since 2003. Another case that moved her was of a Mexican man who had grown up in the US and married an American. "It turned out he'd been living here illegally and he got deported," she said. "One night he called his wife and said: I'm going to cross. She never heard from him again."

    Baker is helped by Kate Spradley, an assistant professor at TSU who specialises in recreating facial features. "We're trying to put together as many avenues as possible," said Spradley. This is where the body farm comes in. "By watching decomposition as it happens we get a better understanding of the process . . . and work out how long people have been dead," Spradley explained.

    The project is modelled on a body farm started by Tennessee University in the 1970s, which inspired the Patricia Cornwell novel, Body Farm. The Texas body farm has 13 corpses in various states of decomposition. The university takes volunteers and has 75 pledges from future donors. The stench is overpowering, although the Texas climate is so dry that the bodies undergo rapid mummification. Though picking up some of the bones, Spradley shakes her head. "There's a huge vulture population here that can skeletonise a body in six hours - that really throws the research," she said.

Beneficiaries being blocked from online assets

    Britain's top law firms are advising clients to leave their usernames and passwords in their wills to make it easier for executors to tie up their e-mail, internet banking and social networking affairs when they die.

    Online industries are new and unregulated and there is a significant discrepancy between the policies of different websites, meaning that without passwords relatives may never be able to access web-based assets or protect the social networking profiles of their loved ones from unwanted attention. Chris Walton, who specialises in will trust and estate disputes at Irwin Mitchell, warned that people should include instructions on how to deal with their digital footprint. Some of his clients are beginning to do so already.

    He said: "We're seeing an increase from a few years ago in getting clients who are coming to us with what they want to happen with their online presence after death. Clients come in with a list of passwords and logins, Facebook and Twitter, and the like.

    "We would definitely recommend that people deal with their online life in the way that they would deal with their offline life. We would recommend that in the same way as you keep details of your assets, bank account savings, investments and the like it would be sensible to keep details of your online life and assets."

    According to a study released today by Goldsmiths College and webhosting company Rackspace, 11 per cent of British adults have, or are considering, leaving usernames and passwords in their will. Across the world it is estimated that 1.78 million Facebook users are expected to die this year, nearly 200,000 of them over the age of 55.

    Harry Small, partner at Baker & MacKenzie, a law firm, said that clients should be offered a formal opportunity to add their digital legacy to their will. "There may be a spot in the market here as the social networking generation ages. Why not accept that people might want to think that social networking assets are ones that you need to consider just as you need to consider your house, your furniture, your pets and so on."

    Social networks and e-mail providers refuse to disclose usernames and passwords to next of kin, and grant differing levels of access according to their terms and conditions. Facebook and MySpace offer the option for close family to shut down or otherwise "memorialise" profiles, meaning the account is frozen but preserved indefinitely. Yahoo! refuses all access. Google requires an order from a US court of law before handing over a deceased person's e-mails.

    Lawyers called for the regulation of online policy, saying that some clients had struggled to shut down the accounts of their next of kin and that the different systems were confusing, with processes taking different lengths of time and requiring a variety of documentation.

    Richard Roberts, chairman of the Law Society's Wills and Equity Committee, said that it should also be up to sites to find a common policy. "They're elephants in the room that we're not addressing and we need to start thinking about it," he said. "The website providers need to have a code of conduct that says if we are approached by a family member, as long as we're satisfied that this person is dead and this person is speaking with authority we'll take the page down."

    Facebook introduced 'memorialisation' in 2009 after public clamour over lack of control over the accounts of the deceased. Richard Harper, principal researcher at Microsoft Research, said that social networks in particular had been slow to create a firm policy on death and that closing an account was often "more difficult than closing a bank account".

    "We've only been talking about social media since 2005," said Steven Kuncewicz, intellectual property and media solicitor at HBJ Gateley Wareing in Manchester. "It's got a lot of growing up to do. It's got to deal with death."

    In the US informal services such as Legacy Locker and ifidie.com will store instructions or home-made videos sent to designated e-mail addresses upon a user's death, and send posthumous e-mail to designated friends and family. Such services are activated if a user fails to reply to regular e-mails.

    Mr Roberts said it is wise to make your wishes known. "It all goes back to the phrase 'die tidily,' " he said.

How Doctors Die

    Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient's five-year-survival odds - from 5 percent to 15 percent - albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn't spend much on him.

    It's not a frequent topic of discussion, but doctors die, too. And they don't die like the rest of us. What's unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

    Of course, doctors don't want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They've talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen - that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that's what happens if CPR is done right).

    Almost all medical professionals have seen what we call 'futile care' being performed on people. That's when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, "Promise me if you find me like this that you'll kill me." They mean it. Some medical personnel wear medallions stamped NO CODE to tell physicians not to perform CPR on them. I have even seen it as a tattoo.

    To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they'll vent. "How can anyone do that to their family members?" they'll ask. I suspect it's one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it's one reason I stopped participating in hospital care for the last 10 years of my practice.

    How has it come to this - that doctors administer so much care that they wouldn't want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.

    To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They're overwhelmed. When doctors ask if they want "everything" done, they answer yes. Then the nightmare begins. Sometimes, a family really means "do everything," but often they just mean "do everything that's reasonable." The problem is that they may not know what's reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do "everything" will do it, whether it is reasonable or not.

    The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I've had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who'd had no heart troubles (for those who want specifics, he had a 'tension pneumothorax'), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.

    But of course it's not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.

    Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman's terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.

    Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn't restore her circulation, and the surgical wounds wouldn't heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.

    It's easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they're asked, with little feedback, to avoid getting in trouble.

    Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack's worst nightmare. When I arrived at the hospital and took over Jack's care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.

    Even with all his wishes documented, Jack hadn't died as he'd hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack's wishes had been spelled out explicitly, and he'd left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It's no wonder many doctors err on the side of overtreatment.

    But doctors still don't over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had "died peacefully at home, surrounded by his family." Such stories are, thankfully, increasingly common.

    Several years ago, my older cousin Torch (born at home by the light of a flashlight - or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.

    We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn't had in decades. We went to Disneyland, his first time. We'd hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn't wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

    Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don't most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.

20 Things You Didn't Know About... Autopsies

    1 Until the Renaissance, understanding of human anatomy was based on the dissection of animals, with human autopsies considered an affront in virtually all cultures.

    2 Italy's University of Bologna became the first institution to use forensic autopsies, approving them in the 14th century to settle legal questions about cause of death.

    3 The Catholic Church ordered an autopsy on conjoined infant twins Joana and Melchiora Ballestero in Hispaniola in 1533 [pdf] to determine if they shared a soul. There were two distinct hearts, and hence two souls, based on the ancient Greek philosophy of Empedocles, who believed the soul resided in the heart. The twins' father, who had grudgingly paid for two baptisms, may have wished for a different outcome.

    4 Eighteenth-century autopsist Giovanni Battista Morgagni introduced the idea of matching autopsy observations to pre-death clinical symptoms, so that autopsies could inform not just anatomy but also diagnosis and treatment.

    5 In 1912, Boston physician Richard Cabot analyzed autopsies and claimed that some diseases were being misdiagnosed at an alarming rate of 80 percent. A 2005 study in Histopathology suggests that doctors still misdiagnose fatal diseases about a third of the time.

    6 In about two-thirds of incorrectly diagnosed cases, the patient's life could have been saved, according to a 1998 study from the University of Pittsburgh.

    7 Paduan judge Marcantonio Contarini, obsessed with the anatomical drawings of Andreas Vesalius, endorsed autopsies on executed criminals; they soon became all the rage in the region. Starting in 1539, hangings were scheduled around planned autopsies, which were performed to packed houses in special theaters.

    8 In the 17th century, lacking chemical tests (and knowledge of disease transmission mechanisms), Italian physician and autopsist Antonio Valsalva sometimes tasted the fluids he encountered in cadavers in an effort to better characterize them.

    9 Gangrenous pus does not taste good, Valsalva wrote, leaving the tongue tingling unpleasantly for the better part of a day.

    10 In 1828 Irish immigrants William Burke and William Hare partnered to murder 16 people in Scotland for cadaver bounties paid for by a doctor who didn't ask questions. Hare testified against Burke, who was hanged in 1829.

    11 Burke's cadaver was publicly dissected, and his skeleton remains on display at the University of Edinburgh. Wallets made from his skin, which was stolen during the autopsy, were offered for sale on the street.

    12 Nineteenth-century Austrian pathologist Karl Rokitansky reportedly performed 30,000 autopsies and is said to have supervised another 70,000.

    13 In the early 1970s, autopsies of patients who had used the anticancer drug Adriamycin revealed that heart muscle had atrophied markedly, leading to restrictions in the drug's use. Autopsies were also critical to improvements in knee joint prosthetics, new heart valves, and heart transplants.

    14 Hospitals today don't like performing autopsies: They cost a lot of money, tie up pathologists, and often indicate that doctors blew diagnoses, sometimes fatally.

    15 During modern autopsies the face is not visible for most of the procedure because it is covered by a flap of chest, or a flap of scalp.

    16 The precision blades of surgical tools, designed to minimize the risk of accidental cuts, are sometimes shunned in autopsies in favor of cheaper pruning shears - the kind sold in hardware stores.

    17 Lungs almost always show some pathology in adults, even in those who were relatively healthy in life. Alzheimer's disease can be diagnosed at a glance from brain shrinkage of about 10 percent.

    18 At the end of an autopsy the organs are either incinerated or put in a bag and placed back in the body before it is sewn shut.

    19 Accurately weighing small organs like the thyroid and adrenals requires a triple-beam balance; all other organs are plopped down on an ordinary grocer's scale.

    20 There is little squirting blood during an autopsy, because cadavers have no blood pressure.

Fear of Death

    ONE of the commonest reactions to death is fear. Indeed, "fear" may be too weak a term: terror is more like it. But is fear of death a rationally appropriate response?

    The crucial word here is "appropriate". I don't want to deny that many people are afraid of death. What I want to know is whether fear of death is an appropriate response.

    Under what conditions does it make sense to feel fear? Three requirements come to mind. The first is that the thing you are afraid of has to be bad. I imagine that this is fairly uncontroversial.

    The second is that there has to be a non-negligible chance of the bad thing happening. It is not enough that it's a logical possibility. There is, for example, a chance that you will be ripped to pieces by tigers, but it's negligibly small. If you were to tell me that you are afraid that you will die this way, then I would say that such a fear is not appropriate.

    Condition number three is more controversial: you need to have some uncertainty about whether the bad thing will actually happen, or else how bad it will be. To see the point of this condition, we need to imagine a case where a bad thing is certain to happen, and you know how bad it is going to be. In circumstances like that, fear is not an appropriate response, even though the first two conditions have been met.

    Suppose that every day you come to the office with a packed lunch. For dessert you bring a cookie, and every day somebody steals it. Admittedly not the worst thing in the world, but it's a bad thing. Furthermore, there is a more than negligible chance that your cookie will be stolen tomorrow. So the first two conditions are in place.

    But not the third. It is pretty much guaranteed that your cookie will be stolen tomorrow. The bad thing is certain to happen, and you know how bad it is. In this case, I think, fear doesn't make any sense. In contrast, if the thief strikes at random then you might reasonably be afraid.

    One other point is worth mentioning. Even when fear makes sense, there's a proportionality condition that should be kept in mind. Even if some fear is appropriate, the amount of it might still be inappropriate. When the risk is slight, mild concern may be all that is appropriate. Similarly, the amount of fear needs to be proportional to the size of the bad.

    Armed with these ideas, it might seem that we are now in a position to ask whether fear of death is appropriate. However, we first need to clarify something important: what exactly are we afraid of? There are different ways to answer this question, and depending on which we have in mind, fear may, or may not, be appropriate.

    One thing you might worry about is the process of dying. Insofar as there is some chance that you will die a painful death, there seems to be room for some fear. But I imagine this is not what most people have in mind. What most people mean is that they're afraid of death itself - afraid of what it will be like to be dead. In this case, I think, the conditions for appropriate fear are not satisfied. The main point here is that there is nothing that being dead is like. It involves no kind of experience at all, so it is not intrinsically bad. Thus the first condition for appropriate fear isn't satisfied. (Things might look different if you believe in an afterlife.)

    Of course, I am not suggesting that there is nothing bad about death. On the contrary, I accept the "deprivation" account, according to which death is bad by virtue of the fact that you are deprived of the good that you would have if you weren't dead.

    So perhaps we can specify an appropriate object of fear this way. Instead of fearing what death will be like, perhaps we should fear the deprivation of life. If so, perhaps fear of death is appropriate after all.

    But that's not quite right either. First of all, I believe that immortality would not be good for us; to be condemned to live forever would be a punishment, not a blessing. So fear is not appropriate. More precisely, if what we are afraid of is the inevitable loss of life, then the object of our fear is not bad, but good, and so fear is still out of place.

    However, even if immortality would not be bad, it doesn't follow that fear of death is appropriate. Appropriate fear requires a lack of certainty with regard to the coming of the object of our fear. And I know that I am going to die.

    But now a different possibility suggests itself. Fear of death is inappropriate because death is certain. But what is not at all certain is when you are going to die. Perhaps, then, what we should be afraid of is not loss of life per se, but rather the possibility that we will die sooner rather than later.

    Consider an analogy. Suppose you're at a party. It's great, and you wish you could stay, but this is taking place in high school, and your mother is going to call and tell you it's time to go home. Now, there's nothing bad about being at home; it's intrinsically neutral. You just wish you could stay at the party.

    Suppose you know that the call is going to come at midnight, guaranteed. Then, I think, there isn't anything to be afraid of. But if all you know is that your mother is going to call some time between 11 pm and 1 am, the conditions for appropriate fear have been met. There is something bad, there is a non-negligible chance of it happening, and yet there is also a lack of certainty that it will happen. Now some degree of fear makes sense. Perhaps we have something similar with regard to death. Perhaps it makes sense to be afraid given the unpredictability of death.

    Further distinctions might be helpful. Am I afraid that I will die soon, in the sense that, given the range of years I might reasonably hope for, death may come sooner rather than later? Or am I afraid that I will die young, with death coming sooner for me than it does for others? These ways of specifying the object of my potential fear differ in important ways, including how much fear is appropriate, and when.

    Take the fear of dying young. Clearly, if you have reached middle age any fear of dying young is irrational. But even among the young, the chance of this actually happening is extremely small.

    As one grows older, the chance of dying within a given period increases. But even here, fear that one will die soon can easily be out of proportion. Even an 80-year-old has a more than 90 per cent chance of living at least another year.

    Obviously, fear that death may come soon can make sense among the very sick or the very aged. But for the rest of us, I think, it is typically misplaced. If you are reasonably healthy and yet you say to me, "I am terrified of death", then all I can say in response is that I believe you, but terror is not appropriate. It doesn't make sense, given the facts.

Contemplating Death

    IT'S said that when a general returned in glory to ancient Rome, he was accompanied in his procession through the streets by a slave whose job it was to remind him that his triumph would not last forever. "Memento mori," the slave whispered into the general's ear: "remember you will die". The story may be apocryphal, but the phrase is now applied to art intended to remind us of our mortality - from the Grim Reaper depicted on a medieval clock to Damien Hirst's bejewelled skull.

    As if we needed any reminder. While few of us know exactly when death will come, we all know that eventually it will. It's usual to talk about death overshadowing life, and the passing of loved ones certainly casts a pall over the lives of those who remain behind. But contemplating our own deaths is one of the most powerful forces in our lives for both good and ill - driving us to nurture relationships, become entrenched in our beliefs, and construct Ozymandian follies.

    In this, we are probably unique. Most animals seem to have hardly any conception of mortality: to them, a dead body is just another object, and the transition between life and death unremarkable. We, on the other hand, tend to treat those who have passed away as "beyond human", rather than "non-human" or even "ex-human". We have developed social behaviours around the treatment of the dead whose complexity far exceeds even our closest living relatives' cursory interest in their fallen comrades. Physical separation of the living from the dead may have been one of the earliest manifestations of social culture (see "Death: The evolution of funerals"); today, the world's cultures commemorate and celebrate death in ways ranging from solemn funerals to raucous carnivals.

    So you could say that humans invented death - not the fact of it, of course, but its meaning as a life event imbued with cultural and psychological significance. But even after many millennia of cultural development, we don't seem to be sure exactly what it is we've invented. The more we try to pin down the precise nature of death, the more elusive it becomes; and the more elusive it becomes, the more debatable our definitions of it (see "Death: The blurred line between dead and alive").

    And those definitions matter, because they are the only way we have of rationalising our otherwise illogical fear of death - a fear that's probably the most widespread phobia on Earth (see "Death: Don't fear the reaper"). Most of us would wish for a peaceful death after a long and well-lived life. Of course, not all of us get our wish. For some, death comes sooner than we would like, and that's one reason to fear it. Only recently has it become commonplace for death to come later than we would like. Death can now be deferred by mechanical and medicinal means for days, weeks, months or years - and that brings with it fears of its own: of impotence, dependency and pain. Nothing in the way our societies are constructed is at all suited to this new situation.

    So perhaps it is time for humanity to reinvent death, 3 million years or more after our first intimations of it. Indeed, the job is already underway: the proliferation of new types of death - industrial, vehicular and biochemical - has led to correspondingly complex legal codes. And there are those who seek to redefine death still further, by freezing their heads or replicating their minds outside their bodies - all to reify our long-held notions of passing beyond humanity.

    Such projects may seem outlandish. But even for sceptics, the idea of greatly deferring or even defying death outright is worth deep and sincere reflection: in thinking about death, we are also thinking about life.

The Evolution of Funerals

    PANSY died peacefully one winter's afternoon, her daughter Rosie and her friends Blossom and Chippy by her side. As she lay dying her companions stroked and comforted her; after she stopped breathing they moved her limbs and examined her mouth to confirm she was dead. Chippy tried twice to revive her by beating on her chest. That night Rosie kept vigil by her mother's side.

    Pansy's death, in December 2008, sounds peaceful and relatively routine, but in fact it was highly unusual. Captive chimpanzees are rarely allowed to die at "home"; they are usually whisked away and euthanised. But the keepers at Blair Drummond Safari and Adventure Park in Stirling, UK, decided to let Pansy stay with her loved ones until the last so that their response to her death could be observed.

    It is hard not to wonder what was going on in the minds of Rosie, Blossom and Chippy before and after Pansy's death. Is it possible that they felt grief and loss? Did they ponder their own mortality? Until recently these questions would have been considered dangerously anthropomorphic and off-limits. But not any more.

    The demise of Pansy is one of many recent observations of chimpanzee deaths, both in captivity and the wild, that are leading to surprising insights about our closest living relatives' relationship with death. This, in turn, is opening up another, deeper, question: at what point in human evolution did our ancestors develop a modern understanding of death, including awareness of their own mortality? The answer goes much wider than our attitude to death - it may help us to better understand the origin of our unique way of life.

    As far as most animals are concerned, a dead body is just an inanimate object. Some species have evolved elaborate-looking behaviours to dispose of bodies - mole rats, for example, drag them into one of their burrow's latrines and seal it up - but these are practical acts with no deeper purpose or meaning.

    Some non-human animals, though, clearly have a more complex relationship with death. Elephants are known to be fascinated with the bones of dead elephants, while dolphins have been observed spending long periods of time with corpses.

    No animal, though, arouses interest as much as chimps do. Psychologists James Anderson and Louise Lock from the University of Stirling, who recorded Pansy's death, point out that her companions' responses were "strikingly reminiscent of human responses to peaceful death", including respect, care, testing for signs of life, attempts to revive, vigil, grief and mourning.

    Similar things have been seen in the rare occasions that death has been observed among wild chimps. Primatologists Alexander Piel of the University of California, San Diego, and Fiona Stewart of the University of Cambridge witnessed just such an event in Gombe national park in Tanzania in January 2010. Early one morning, rangers discovered the body of a female chimp, Malaika, who had apparently fallen out of a tree.

    When Piel and Stewart arrived at 9.15 am there was a crowd of chimps around Malaika's body. For the next three and a half hours the pair observed and filmed the scene as a succession of chimps visited the body, while others observed from the trees. Some seemed merely curious, sniffing or grooming the body. Others shook, dragged and beat it as if in frustration and anger. Dominant males performed displays of power around it or even with it; the alpha male threw it into a stream bed. Many made distress calls.

    When the body was finally removed by rangers, eight of the chimps rushed to where it had lain and intensively - and excitedly - touched and sniffed the ground. They stayed for 40 minutes, making a chorus of hooting calls before moving off. The last chimp to visit the spot was Malaika's daughter Mambo.

    What are we to make of this? According to Piel, the chimps' behaviour can be classified into three categories: morbidity, or intense interest in the body, mourning and "social theatre". And as with Pansy's death, these are very reminiscent of how we behave.

    "The danger is to anthropomorphise, but much of this behaviour is still practised by modern humans," says Paul Pettitt, an archaeologist at the University of Sheffield, UK, who studies the origins of human burial. "We see in chimps very simple behaviours that have become elaborated into more formal expressions of mourning. It gives us a feel for what we might expect to have been practised by Miocene apes and early protohumans."

    We will never know for sure, of course. But the fossil and archaeological record contains tantalising hints of how this kind of behaviour evolved into modern rituals. And this has become a major question in palaeoanthropology. Our treatment of the dead clearly falls into the category of "symbolic activity", akin to language, art and the other things that make modern humans unique. These were all thought to have emerged around 40,000 years ago, but recent discoveries have tentatively pushed this back to 100,000 years or more.

    Anything resembling mortuary practices predating 40,000 years ago used to be dismissed as an artefact. But not any more, says Francesco d'Errico of the University of Bordeaux in France. "Most archaeologists now accept that modern humans, Neanderthals and possibly other archaic hominins were engaged in mortuary practices well before 40,000 years ago."

    Hominids on a hillside

    The earliest signs are very old indeed. In 1975, on a steep grassy hillside near Hadar, Ethiopia, palaeontologists discovered 13 specimens of our 3.2 million-year-old ancestor Australopithecus afarensis - nine adults, two juveniles and two infants - all within touching distance of one another and apparently deposited around the same time. How they got there is a mystery. There is no evidence of a flash flood or similar catastrophe that could have killed all of them at once. There is no sign that the bones had been chewed by predators. They are, as discoverer Donald Johanson later wrote, "just hominids littering a hillside"

    Last year, partly in light of chimp research, Pettitt proposed a new explanation: the bodies were left there deliberately in an act of "structured abandonment". That doesn't mean burial, or anything with symbolic or religious meaning. "It was probably just the need to get rid 0f a rotting corpse," says Pettitt. Even so, it represents a significant cognitive advance over what is seen in chimpanzees, who leave their dead where they fall - perhaps the first stirring of something human. "It could be recognition that the appropriate place for the corpses is not among the living - a first formal division between the living and the dead," says Pettitt.

    Barring new discoveries it will be impossible to confirm that australopithecines deposited their dead in a special place. But by half a million years ago the evidence is much clearer.

    Sima de los Huesos - the pit of bones - was discovered in the 1980s at the bottom of a limestone shaft in a cave in the Atapuerca Mountains of northern Spain. It contained the remains of at least 28 archaic humans, most likely Homo heidelbergensis, a probable ancestor of both Homo sapiens and Neanderthals.

    How did they get there? An obvious possibility is that they accidentally fell down the shaft, but that seems unlikely from the way the bones fractured. "It doesn't look like a natural accumulation," says Pettitt. Most of the skeletons are adolescent males or young men, and many show signs of bone disease or deformity.

    According to Pettitt the best explanation is that they were deliberately placed at the top of the shaft after death and then gradually slumped in. If so, this is the earliest evidence of funerary caching, or the designation of a specific place for the dead - perhaps, in this case, for deformed outcasts - a further advancement towards the modern conception of death. Once you have designated places for the dead you are clearly treating them as if they still have some kind of social agency. "Once you've reached that point you're on the road to symbolic activity," says Pettitt.

    What did these protohumans understand about death? Did they know that they themselves were mortal? Did they have a concept of an afterlife? "We haven't got a clue," says Pettitt.

    What we do know is that funerary caching became increasingly common: bodies are found in places that are hard to account for any other way, tucked into fissures and cracks, in hard-to-reach overhangs or at the back of caves.

    From funerary caching it is a short conceptual leap to burial - creating artificial niches and fissures to stash the dead. The earliest evidence we have of this is from two caves in Israel - Skhul and Qafzeh - where the skeletons of 120,000-year-old Homo sapiens were found in what are clearly human-made hollows. There is also evidence of Neanderthal burials from around the same time. All this adds to the evidence that humans were on their way to a symbolic culture much earlier than we thought. "Once you start getting deliberate burials I think it's much more likely that people are thinking in formalised terms, things like life after death," says Pettitt.

    Even so, these burials do not represent a point of no return. Only a handful of such sites are known; compared with the number of people who must have died they are incredibly rare. It appears that burial was for special occasions; most dead people were probably still cached or abandoned.

    It was not until about 14,000 years ago that most people were buried in what we would recognise as cemeteries. Around the same time people were settling in one place and inventing agriculture and religion - it is probably no coincidence that the world's oldest ceremonial building, Gobekli Tepe in Turkey, was built at that time.

    Well before that, however, archaic humans appear to have had a concept of death not unlike ours. Art, language, elaborate funerary practices - they are just expressions of the same thing, says Pettitt. "It's part of what distinguishes us not only from other animals but from every other type of human that's gone before."

The Natural History of Corpses

    IT'S NOT a nice thing to contemplate. But set aside the thought of any of the below befalling you or your loved ones, and what happens to our mortal remains when we are no longer using them is pretty fascinating. If nothing else, it proves that nature is ruthlessly efficient at clearing up its messes.

    At least it can be. Very few people in the modern world get to be dead the old-fashioned way - out in the open, exposed to the elements. Of those that do, the speed at which the body turns to dust depends on a mix of factors including temperature, moisture and the animals, insects and microbes that happen to be there. In a relatively warm and moist spot with plenty of insects and scavengers, a human body can be turned to bones within a few weeks and disappear completely in months.

    But what about the majority of bodies, which get refrigerated soon after death, then embalmed and put in a coffin? Again, it depends. Temperature and moisture are still the most important factors, but numerous others play a part, from how well the body was embalmed to the tightness of the seal on the coffin, the acidity of the soil and that of the groundwater which will eventually seep inside. All of this means that it is impossible to predict how long a particular body's final journey might take - it can be anything from months to decades.

    What we can say, though, is that whatever the timescale, the vast majority of bodies will go through the same stages of decomposition.

    First comes the "fresh" stage. Within minutes of death, carbon dioxide starts to accumulate in the blood, making it more acidic. This causes cells to burst open and spill enzymes which start to digest tissues from within.

    The first visible sign of decomposition comes after half an hour or so, as blood pools in the parts of the body closest to the ground. At first this looks like purplish-red blotches; over the next day or so it turns into an almost continuous purplish mark known as livor mortis. The rest of the body turns deathly pale.

    Around the same time, muscles go floppy and then stiffen as rigor mortis sets in. In life, pumps in the membranes of muscle cells control the amount of calcium ions in the cell - high levels stimulate contraction and low levels allow relaxation. The pumps no longer work after death, so calcium ions diffuse into the cells from the higher concentration outside, causing the muscles to contract.

    Rigor mortis passes after two to three days. But what looks like relaxation is actually rot setting in, as enzymes break down the proteins that held the muscles in their contracted state.

    Embalming the body stops the rot in its tracks, at least temporarily. Unlike ancient Egyptian embalmers, who aimed to keep the body intact for all eternity, modern embalming is designed to make a corpse look presentable and keep it in one piece long enough to organise a funeral.

    This is done by disinfecting the body and replacing the blood and other fluids with a mixture of water, dye and preservatives, usually including formaldehyde. The dye is to restore something resembling a healthy skin tone, while the formaldehyde preserves the body in several ways, first by repelling insects and killing bacteria. It also inactivates the body's enzymes and makes the tissues more resistant to decomposition by adding cross links to the chains of amino acids that make up proteins.

    This protective effect only lasts so long, though, leaving the body more or less back where it started.

    The next stage, putrefaction, gets a little ugly - not to mention smelly - as the enzymes, aided and abetted by microbes, get to work. After 48 hours or so, when enough nutrient-rich fluid has spilled from the burst cells, these microbes spread rapidly. The main beneficiaries are among the 100 trillion bacteria that have spent their lives living in harmony with us in our guts. As they break down proteins they churn out two compounds with names as stinky as their smells, putrescine and cadaverine, and these give a corpse its repulsive odour.

    From the outside, putrefaction can be seen as a green hue, slowly spreading from the front of the belly across the chest and down the body. The green colour comes from the action of anaerobic bacteria, which convert haemoglobin in the blood to sulfhaemoglobin.

    All this bacterial action also creates gases, including hydrogen, carbon dioxide, methane, ammonia, sulphur dioxide and hydrogen sulphide. These contribute to the stink and also distort the body, blowing it up like a balloon and eventually, after a month or so, bursting it open. Hydrogen sulphide also combines with the iron in haemoglobin to make the black-coloured iron sulphide, which turns the skin darker.

    This heralds the start of the third stage: active decay. The rate of decomposition now speeds up and what is left of the flesh is rapidly consumed, until all that remains is the skeleton. Sometimes, something else can happen too, though. If the body happens to be in particularly cold soil, a waxy covering called adipocere, or grave wax, might form. Adipocere is a particularly spooky side effect of the work of some anaerobic bacteria, such as Clostridium perfringens, as they digest body fat. It takes around a month to start forming and can leave the corpse with what looks like a wax coating.

    The final stage - breakdown of the skeleton - takes the longest. For the bones to disappear the hard mineral parts need to be broken down. This happens if they come into contact with acidic soil or water, and speeds up if they are mechanically broken up by tree roots or animals. Once the hard stuff is gone, the body's last proteins, including the collagen that once gave the bones flexibility, succumb to bacteria and fungi and disappear.

    There are some cases where this sequence of events doesn't play out at all and the body doesn't get a chance to decay. If the corpse is kept completely dry bacteria can't do their work and the tissues will mummify. The same goes for bodies that fall into natural preservatives such as bogs, salt marshes or snow, where bacteria don't thrive and the body's enzymes don't work.

    Then there are the rare cases when a person dies in the company of hungry scavengers. In these cases the body can be stripped to the bones and chewed into tiny pieces in a matter of days. The same can happen under the sea.

    Of course, without a bog, dog, shark or icy grave to hand, the only way to avoid the harsh realities of decay is cremation. In a chamber heated to 750 degrees C the coffin and entire corpse can be burned in under 3 hours. After that, the ashes are passed through a grinder called a cremulator to take care of any particularly big or stubborn bones that haven't completely burned and turn the entire remains into fine ash.

    And that, as they say, is that. It may not be pretty but it's one of the few definites in life: ashes to ashes, dust to dust, in the end there's not a lot left.

Last Words

    MY father spoke to his college roommate every day for 50 years. Though the two lived in different states, 800 miles apart, they were business partners, sounding boards and friends. Then one day my father called and his friend wasn’t there. He had died the night before of a terminal illness, which he had never told my father about. The two never said goodbye.

    I was reminded of this episode last summer when Nora Ephron, the famed raconteur, director and (by all accounts) friend, died after keeping her terminal illness private from nearly everyone she knew. Meryl Streep captured the frustration of many. “We’ve been ambushed,” she said at Ms. Ephron’s memorial service. “It’s really stupid to be mad at somebody who dies, but somehow I’ve managed it.” Frank Rich added in New York magazine, “Some of us — and that would include me — were pissed off at first.”Afterward I called my dad. He wasn’t upset with his friend, he said. Final conversations are difficult. The following day he sent me a poignant, one-sentence e-mail, “What do you say after you say goodbye?”

    I’ve wondered about that question ever since. What is the best thinking about how to make farewell conversations less stressful and more meaningful?

    SAY NOTHING Last words have an almost mystical significance in both Eastern and Western cultures, in part because they hold out the possibility of revealing a deep insight or lifting a veil on the meaning of life. Japanese poets wrote haiku at the moment of their death; Jesus is said to have uttered accepting words to God on the cross.

    But these days, when terminal patients try experimental drugs and often remain hooked up to life-extending machinery indefinitely, identifying which interaction might be the last is often impossible. Some experts say that patients should get to decide whether they even want such conversations. Joan Halifax, the abbot of Upaya Zen Center in Santa Fe, N.M., and the author of “Being With Dying,” said her view is to “let the dying person lead.”

    “Trying to break someone’s denial through medical logic is cruelty,” she said. Saying nothing is perfectly acceptable sometimes.

    Roger Ebert, the film critic who has had multiple surgeries for cancer and was once declared dead, agrees. He said in an e-mail interview that death scenes in movies put unrealistic pressure on the rest of us to be profound. “After all,” he wrote, “those scenes are well-written, directed, and performed by professionals.” (His favorites are “Terms of Endearment,” “Up” and this year’s Palme d’Or winner, “Amour.”)

    When his television partner, Gene Siskel, was dying, the two never said goodbye. “To spare his family, especially his children, he never went public,” Mr. Ebert wrote. “That is the privilege of the dying person, and I respected that.” When all else fails, Mr. Ebert added, say, “Words fail me.”

    SAY SOMETHING BEFORE IT’S TOO LATE To avoid the issue of timing, as well as the deterioration that often afflicts terminal patients, many experts advise having important conversations while everyone is still able. Shelly Kagan, a philosopher at Yale and the author of “Death,” said the odds are so “vanishingly small” that you’ll know when you’re in a final conversation, you should avoid any possibility of regret by initiating interactions earlier. This includes what kind of medical interventions the person might want as well as what that person meant to you.

    “As people approach the end of their life, they take kind of an accounting,” he said. “One of the things you can accomplish in these conversations is telling people broadly what it is they’ve done for you. What they taught you. Having an appreciation of that can deepen one’s sense of a life well-lived.”

    When his own mother died, Dr. Kagan said, she was not in a position to have a conversation at the end. Later, her children found a letter she had written to them, along with one to her grandchildren, expressing her hopes for their lives. It was her way of having a meaningful conversation while her mind was still strong, Dr. Kagan said. The family read the letters out loud after the funeral.

    SAY THE OBVIOUS One way to relieve pressure on these conversations is to reduce the expectation that you have to be eloquent. After all, you’re not trying to earn a good review from Mr. Ebert; you’re trying to get the most out of a moment of deep emotion. Ira Byock, the director of palliative care at Dartmouth-Hitchcock Medical Center and the author of “The Best Care Possible,” said loved ones should not expect too much from themselves or the patient.

    After working with terminal patients for over 30 years, Dr. Byock recommends four simple expressions. “Please forgive me.” “I forgive you.” “Thank you.” “I love you.”

    “If you say things that would be left unsaid, it matters less that you say goodbye,” Dr. Byock said. “My experience is when you’ve said it all, there’s a quality of celebration that creeps into time together because what else is there to do but just delight in the intrinsic value of spending time together.”

    SAY IT WITH DEEDS An even easier approach is to forget words entirely, and do something for or with the patient that expresses how you feel. Turn on a ballgame; listen to a favorite piece of music; read some old letters; sit on the porch and watch the rain; flip through a scrapbook.

    Ms. Halifax recommended using pets, a technique some hospices are adopting. “Put the dog in the bed,” she said. “There’s so much emotional charge in our human relationships, that when the cat or cocker spaniel gets into bed, the patient lights up because she feels safe and unjudged. And then a hand reaches over from the caregiver and starts stroking the pet, and then the hand slowly finds its way to the dying person.”

    SAY IT EVEN IF THEY CAN’T HEAR YOU What if the patient can’t communicate? Should you still have a farewell conversation if it’s only one-way? Everyone I spoke to said yes. “My whole thing is to say it anyway,” Dr. Byock said. “Maybe think of it as just gifting this person with a little bit of beauty. As a principle, you can take care of only your side of any relationships. You can never presume what the response is going to be.”

    Dr. Kagan said there is considerable evidence that forcing ourselves to say things out loud helps us clarify thoughts that might otherwise be unformed. “It’s a richer experience when the receiving party is able to react,” he said. “But even if they’re not, the vocalization can help in that you now have thoughts you wouldn’t have had anyway.”

    In one of her final essays, Nora Ephron lamented the death of her friend Judy at age 69. “I meant to have a conversation with Judy about death,” she wrote. “Before either of us was sick or dying. I meant to have one of those straightforward conversations where you discuss What You Want in the eventuality.” But of course, she added, “once they found the lump, there was no having the conversation.”

    For Ms. Ephron, for my dad, for many of us, saying goodbye to a dying loved one is among the hardest things to say. What began as a simple salutation — “God be with you” — has become a sign of helplessness. As Kurt Vonnegut said, “Goodbye is the emptiest yet fullest of all human messages.” So maybe it’s best to forget that word. Perhaps gratitude is a better emotion.

    When Ms. Halifax’s father was in the final stages of dying, she told me, he was suffering deeply and the scene was hard to watch. “There were no words I could say to him,” she said, “but something arose so simple and spontaneous that I repeated it like a prayer: ‘Thank you, Daddy.’ ”

Back From The Dead

    Resuscitation specialist Sam Parnia believes we can bring many more people back to life after they die – it’s just a matter of training and equipment.

    Are the people you resuscitate after cardiac arrest really dead? Isn't the definition of death that it is irreversible?

    A cardiac arrest is the same as death. It's just semantics. After a gunshot wound, if the person haemorrhages sufficiently, then the heart stops beating and they die. The social perception of death is that you have reached a point from which you can never come back, but medically speaking, death is a biological process. For millennia we have considered someone dead when their heart stops beating.

    People often confuse the terms cardiac arrest and heart attack. Clearly, they're very different. A heart attack happens when a clot blocks a blood vessel to the heart. The portion of the heart muscle that was supplied blood and oxygen by that vessel will then die. That's why most people with a heart attack don't die.

    What is the biggest problem in bringing someone back to life?

    Reversing death before the person has too much cell damage. People die under many different circumstances and under the watch of many different medical specialists. No single speciality is charged with taking and implementing all the latest advances and technology in resuscitation.

    How long after they die can someone still be resuscitated?

    People have been resuscitated four or five hours after death – after basically lying there as a corpse. Once we die the cells in the body undergo their own process of death. After eight hours it's impossible to bring the brain cells back.

    What is the best way to bring people back?

    The ideal system – and they do this a lot in South-East Asia, Japan and South Korea – is called ECPR. The E stands for extra corporeal membrane oxygenation (ECMO). It's a system in which you take blood from a person who has had a cardiac arrest, and circulate it through a membrane oxygenator, which supplies oxygen and removes carbon dioxide. Then you pump the blood back into circulation around the body. Using ECMO, they have brought people back five to seven hours after they died. ECMO is not routinely available in the US and UK, though.

    So, when I go into cardiac arrest, ideally what steps do I want my doctors to take?

    First, we start the patient on a machine that provides chest compressions and breathing. Then we attach the patient to a monitor that tells us the quality of oxygen that's getting into the brain.

    If we do the chest compressions and breathing and give the right drugs and we still can't get the oxygen levels to normal, then we go to ECMO. This system can restore normal oxygen levels in the brain and deliver the right amount of oxygen to all the organs to minimise injury.

    At the same time you also cool the patient. This slows the rate of metabolic activity in the brain cells to halt the process of cell death while you go and fix the underlying problem.

    How do you cool the body?

    It used to be ice packs. Today a whole industry has grown up around this, and there are two methods. One is to stick large gel pads onto the torso and the legs. These are attached to a machine that regulates temperature. When the body reaches the right temperature, it keeps it there for 24 hours. The other way is to put a catheter into the groin or neck, and cool the blood down as it passes by the catheter.

    Cooling benefits the heart and all the tissues, but we focus on the brain. There are also new methods in which people are cooled through the nose. You put tubes in the nostrils and inject cold vapour to cool the brain down selectively before the rest of the body.

    If I had a cardiac arrest today, what are the chances I would get all of that?

    Almost zero.

    Why isn't this type of care routine?

    Cardiac arrest is the only medical condition that will affect every single one of us eventually, unfortunately. What's frightening is that the way we are managed depends on where we are and who is involved. Even in the same hospital, shift to shift, you will get a different level of care. There is no external regulation, so it's left to individuals.

    There is disagreement over the interpretation of near death experiences (NDEs) – such as seeing a tunnel or a bright light. When a person dies, when do these experiences shut off?

    One of the last things to fall into the realm of science has been the study of death. And now we have pushed back the boundary of death. In order to ensure that patients come back to life and don't have brain damage, we have to study the processes that go on after they die. Whether we like it or not, we have gone into the "afterlife" or whatever you want to call it.

    For people who have NDEs, they are very real. Most are convinced that what they saw is a glimpse of what it's like when we die. Most come back and have no fear of death, and are transformed in a positive way – becoming more altruistic. As a scientific community we have tried to explain these away, but we haven't been successful.

    So how can a doctor, or any person of science, deal with such otherworldly experiences? We have to accept that these experiences occur, that they are real to the people who have them, in the same way that if a patient has depression you would never say, "I know that you are feeling depressed but that is just an illusion. I'm the doctor. I'm going to tell you what your feelings really mean." But with NDEs, we do this all the time: "I know you think you saw this, but you really didn't."

    Aren't NDEs just hallucinations?

    We know from clinical tests that the brain doesn't function after death, therefore you can't even hallucinate. It's ridiculous to say that NDE people are hallucinating because you have to have a functioning brain. If I take a person in cardiac arrest and inject them with LSD, I guarantee you they will not hallucinate.

    For your study of out of body experiences (OBEs), you placed images in hospital rooms on high shelves only someone floating near the ceiling could see. So far, two patients have had OBEs, but neither in a room with a shelf...

    That's right. We had 25 hospitals that had an average of 500 beds working on the study. To put a shelf above every single bed, we would have to put up 12,500 shelves. That was completely unmanageable. We selected areas where cardiac arrest patients are frequently treated but even with that, at least half of those who had cardiac arrests and survived were in areas without shelves.

    Are you continuing the experiment?

    Yes. It's part of an overall package to improve resuscitation to the brain. We are trying not to forget during resuscitation that there's a human being in there.

    In your book, you imply that death might be pleasant. Why do you think that?

    The question is, what happens to human consciousness – the thing that makes me into who I am – when my heart stops beating and I die? From our external view, it looks like it simply disappears. But it sort of hibernates, in the same way as it does when you are given a general anaesthetic. And it comes back. I don't believe that your consciousness is annihilated when you reach the point of death. How far does it continue? I don't know. But I do know that at least in the period of time in which we can bring people back to life that entity of the human mind has not been annihilated.

    What does this mean?

    Those people who have pleasant experiences after death suggest that we should not be afraid of the process. It means there is no reason to fear death.

Spontaneous Human Combustion

    Today we're going to point our skeptical eye at one of the mainstays of the paranormal: spontaneous human combustion (SHC). The idea is that people can, while simply minding their own business, burst into flames, with no external source of ignition. It's not a medically recognized phenomenon, and no explanation exists that can reasonably account for any but a few of the many stories. Thus, it's found a firm home in the world of the strange, that subdivision of Earthly phenomena that is studied and promoted by only a few fringe researchers and outsiders. That doesn't mean it's wrong though; and we're going to look at it as closely as we can.

    Spontaneous human combustion is a little different from most paranormal phenomena, in that it's a claim of no external source for the fire. That people have burned up is the fact that's not in question; the question is the theory of what caused them to burn. In this case, believers are asserting that there was no conventional cause. Their job is, in effect, to prove a negative. Proving a negative is different from the null hypothesis. The null hypothesis for an unexplained fire is simply to say that no cause is known, which is different from stating authoritatively that there is no cause. Thus, the burden of proof still rests on the claimant, even in this case. Science does not allow us to make the jump from "the cause of the fire is unknown," therefore "the cause is known and it's spontaneous human combustion." Science allows unanswered questions; indeed, science exists because of unanswered questions. The lack of an answer proves only that we don't know something yet, it does not prove the existence of the paranormal.

    Stories of SHC generally fall into one of two categories. The first type is the discovery of a body that burned while nobody was present, usually almost completely to ashes but for a few bits like the hands or feet. Even bones are burned away. The second type is a dinner party or some other event, where many witnesses all see one person suddenly go up into flames for no evident reason, and the flames are usually extinguished before the person can be killed. For each of these two types, there are a few very prominently repeated examples that you'll find on the Internet or in books. We'll give two examples of each.

    Since this is my show, I'm going to invoke Host's Privilege and formally declare the two kinds. Spontaneous Human Combustion of the First Kind is when there are no witnesses to what happened:

    The most famous such case is that of 67-year-old Mary Reeser, whose remains were found by a friend in her St. Petersburg, FL home in 1951. Only her foot remained, still in its slipper, while the rest of her body had been reduced completely to ashes, along with the chair in which she'd been sitting. Her case is sometimes referred to as "the cinder woman".

    Another example you're likely to find in the books is that of 92-year-old John Bentley. A meter reader found Bentley's foreleg and his walker straddled atop a hole burned into his bathroom floor, and Bentley's ashes on the floor of the basement below.

    Most sources cite something like 300 such cases of the First Kind, and they all follow this same basic pattern. A person, usually elderly, often overweight, frequently mobility challenged, is found burned almost completely to ashes, bones and all. Their surroundings show scorching but are usually not burned.

    Now, in recent years, a pretty good theory has been publicized that adequately explains all (or most) reliably documented cases of the First Kind, and that's the wick effect, of which a candle is the most familiar example. The flame on a candle's wick is small, but its temperature is very hot; thus it has a powerful melting effect within its tiny sphere of influence. This melts the wax into liquid, which is drawn up the wick, where it vaporizes and burns. The wick itself does not burn due to the cooling effect of the vaporization; but once the wax is gone, the wick burns away as well.

    The application of the wick effect to human corpses is not supposition, but proven fact. In 2001, the Journal of Forensic Sciences published an account of a test performed at the State of California's Bureau of Forensic Services in which a pig carcass was wrapped in a blanket and provided with a source of ignition. After a number of hours, the smoldering fire was extinguished and it was discovered that the part of the pig that had burned so far, bones and all, had been reduced to ash. The experiment was repeated on the BBC television program QED. The body burns very slowly, with only a tiny flame or even no visible flame at all; and like a candle, the heat is so localized that very little else in the vicinity is affected by it.

    In 1991, a pair of hikers in Oregon came across the body of a murdered woman in which a wick effect fire was still taking place. The middle portion of her body had been completely burned away, including the pelvis and spine, while the slow-burning smoldering fire was still taking place in both legs and the upper torso. The killer was later captured and confessed to having lit the corpse on fire using lighter fluid. Like the other victims, the woman was overweight, with a high fat content that is believed to have provided ideal conditions for the wick effect to take place. Mary Reeser and John Bentley were both overweight, had been wearing flammable clothes (exceptionally flammable in Mary Reeser's case), and both were smoking at the time of death. The condition of both corpses and the rooms in which they were found was perfectly consistent with what we'd expect to find if the wick effect had occurred.

    However, not everyone accepts the wick effect explanation. Author Larry Arnold is among its most vocal critics. His 1995 book Ablaze! The Mysterious Fires of Spontaneous Human Combustion asserts that the cases mentioned above, and many others, have no natural explanation. Arnold wrote two other books as well, The Reiki Handbook about energy healing, and a report on what he believed were the psychic causes of the Three Mile Island nuclear accident. His explanation for SHC follows the same type of fringe reasoning. Arnold proposes that a particle that he called a "pyrotron" strikes the victim's body and ignites it from within. His pyrotron is unknown to science, of unknown origin, is undetectable, and has no describable properties, except that it seems to have something to do with kundalini yoga. Though the publication of his book has made Larry Arnold something of a go-to guy expert on SHC, his explanation is clearly unacceptable from any reasonable scientific perspective. Science does not allow simply making up a subatomic particle and calling that a mechanism for anything.

    Other researchers have proposed various other explanations, including methane, which is one byproduct of bacterial action in the gut. And, as every college student with a cigarette lighter knows, it's flammable. One problem with the methane hypothesis is that cows produce even more gas than humans, and if it were true, we'd expect spontaneous cow combustion to be common. But we don't have any reports of this. One explanation for the discrepancy is that cows do not participate in the triggering activities. Cows don't wear a lot of flammable rayon acetate nightgowns, and their nighttime place of rest is a rarely an overstuffed chair beside a crackling fireplace. They spend much less time smoking than humans, as their hooves lack the manual dexterity needed to operate a cigarette lighter (explaining the lack of Saturday night barnyard hilarity).

    Spontaneous Human Combustion of the Second Kind is when the event is witnessed and we have accounts of what took place. These accounts are quite different than those of the First Kind. Slow, smoldering fires are never the case; they are always a large sudden ignition with active flames. When the victims survive, the burns (which can be serious) are on the skin, never the deep, complete reduction to ashes seen in the First Kind.

    In London in 1982, Jeannie Saffin, a severely mentally handicapped elderly woman, was sitting at a table with family when her upper torso suddenly caught on fire. They extinguished the flames and paramedics took her to a burn unit, where she died eight days later of lung damage from inhaling the fire.

    In 1938, also in London, 22-year-old Phyllis Newcombe's dress suddenly caught on fire as she was going downstairs at a dance. Other revelers extinguished the flames but she, too, died at the hospital from her burns.

    People catching on fire is not especially uncommon. It happens all the time. The only thing differentiating the cases classified as SHC is that no source of ignition was found; the fires are said to have been spontaneous. Other than that, there's nothing especially remarkable about them. The fires burned in a familiar manner, and the injuries are what would be expected. But these cases of the Second Kind are also rare; probably more rare than the First Kind. The reason is that these are unsolved, whereas the First Kind cases are generally solved, at least to the satisfaction of the investigators. These two cases of the Second Kind are famous only because there was no source of ignition found. No cigarettes, open flames, or sparks were found near either Jeannie Saffin or Phyllis Newcombe; but it's not scientifically permissible to conclude that their combustions were spontaneous. Maybe they were; but just because we didn't find the cause hardly means that there wasn't one.

    Structure fires or brush fires sometimes go unsolved as well, but I think you'll have a hard time finding a fire inspector who will invent the term "spontaneous structure combustion" as if the lack of a determined cause means there wasn't one. Spontaneous Human Combustion of the Second Kind should not be allowed to exist as a category; instead we should call them what they are: Unsolved deaths by fire. Similarly, SHC of the First Kind has never been found to be spontaneous either. Those are simply the rare cases where a natural death in isolation has been followed by a slow combustion from some nearby source of ignition.

    The wick effect is an interesting tidbit of science, albeit somewhat gruesome. I find that the logical pitfall of calling either type of SHC "spontaneous", and instead recognizing why they're not, is even more interesting.

A Soldier's Last Words

    "I Am Sorry That It Has Come to This": A Soldier's Last Words

    Daniel Somers was a veteran of Operation Iraqi Freedom. He was part of Task Force Lightning, an intelligence unit. In 2004-2005, he was mainly assigned to a Tactical Human-Intelligence Team (THT) in Baghdad, Iraq, where he ran more than 400 combat missions as a machine gunner in the turret of a Humvee, interviewed countless Iraqis ranging from concerned citizens to community leaders and and government officials, and interrogated dozens of insurgents and terrorist suspects. In 2006-2007, Daniel worked with Joint Special Operations Command (JSOC) through his former unit in Mosul where he ran the Northern Iraq Intelligence Center. His official role was as a senior analyst for the Levant (Lebanon, Syria, Jordan, Israel, and part of Turkey). Daniel suffered greatly from PTSD and had been diagnosed with traumatic brain injury and several other war-related conditions. On June 10, 2013, Daniel wrote the following letter to his family before taking his life. Daniel was 30 years old. His wife and family have given permission to publish it.

    I am sorry that it has come to this.

    The fact is, for as long as I can remember my motivation for getting up every day has been so that you would not have to bury me. As things have continued to get worse, it has become clear that this alone is not a sufficient reason to carry on. The fact is, I am not getting better, I am not going to get better, and I will most certainly deteriorate further as time goes on. From a logical standpoint, it is better to simply end things quickly and let any repercussions from that play out in the short term than to drag things out into the long term.

    You will perhaps be sad for a time, but over time you will forget and begin to carry on. Far better that than to inflict my growing misery upon you for years and decades to come, dragging you down with me. It is because I love you that I can not do this to you. You will come to see that it is a far better thing as one day after another passes during which you do not have to worry about me or even give me a second thought. You will find that your world is better without me in it.

    I really have been trying to hang on, for more than a decade now. Each day has been a testament to the extent to which I cared, suffering unspeakable horror as quietly as possible so that you could feel as though I was still here for you. In truth, I was nothing more than a prop, filling space so that my absence would not be noted. In truth, I have already been absent for a long, long time.

    My body has become nothing but a cage, a source of pain and constant problems. The illness I have has caused me pain that not even the strongest medicines could dull, and there is no cure. All day, every day a screaming agony in every nerve ending in my body. It is nothing short of torture. My mind is a wasteland, filled with visions of incredible horror, unceasing depression, and crippling anxiety, even with all of the medications the doctors dare give. Simple things that everyone else takes for granted are nearly impossible for me. I can not laugh or cry. I can barely leave the house. I derive no pleasure from any activity. Everything simply comes down to passing time until I can sleep again. Now, to sleep forever seems to be the most merciful thing.

    You must not blame yourself. The simple truth is this: During my first deployment, I was made to participate in things, the enormity of which is hard to describe. War crimes, crimes against humanity. Though I did not participate willingly, and made what I thought was my best effort to stop these events, there are some things that a person simply can not come back from. I take some pride in that, actually, as to move on in life after being part of such a thing would be the mark of a sociopath in my mind. These things go far beyond what most are even aware of.

    To force me to do these things and then participate in the ensuing coverup is more than any government has the right to demand. Then, the same government has turned around and abandoned me. They offer no help, and actively block the pursuit of gaining outside help via their corrupt agents at the DEA. Any blame rests with them.

    Beyond that, there are the host of physical illnesses that have struck me down again and again, for which they also offer no help. There might be some progress by now if they had not spent nearly twenty years denying the illness that I and so many others were exposed to. Further complicating matters is the repeated and severe brain injuries to which I was subjected, which they also seem to be expending no effort into understanding. What is known is that each of these should have been cause enough for immediate medical attention, which was not rendered.

    Lastly, the DEA enters the picture again as they have now managed to create such a culture of fear in the medical community that doctors are too scared to even take the necessary steps to control the symptoms. All under the guise of a completely manufactured “overprescribing epidemic,” which stands in stark relief to all of the legitimate research, which shows the opposite to be true. Perhaps, with the right medication at the right doses, I could have bought a couple of decent years, but even that is too much to ask from a regime built upon the idea that suffering is noble and relief is just for the weak.

    However, when the challenges facing a person are already so great that all but the weakest would give up, these extra factors are enough to push a person over the edge.

    Is it any wonder then that the latest figures show 22 veterans killing themselves each day? That is more veterans than children killed at Sandy Hook, every single day. Where are the huge policy initiatives? Why isn’t the president standing with those families at the state of the union? Perhaps because we were not killed by a single lunatic, but rather by his own system of dehumanization, neglect, and indifference.

    It leaves us to where all we have to look forward to is constant pain, misery, poverty, and dishonor. I assure you that, when the numbers do finally drop, it will merely be because those who were pushed the farthest are all already dead.

    And for what? Bush’s religious lunacy? Cheney’s ever growing fortune and that of his corporate friends? Is this what we destroy lives for.

    Since then, I have tried everything to fill the void. I tried to move into a position of greater power and influence to try and right some of the wrongs. I deployed again, where I put a huge emphasis on saving lives. The fact of the matter, though, is that any new lives saved do not replace those who were murdered. It is an exercise in futility.

    Then, I pursued replacing destruction with creation. For a time this provided a distraction, but it could not last. The fact is that any kind of ordinary life is an insult to those who died at my hand. How can I possibly go around like everyone else while the widows and orphans I created continue to struggle? If they could see me sitting here in suburbia, in my comfortable home working on some music project they would be outraged, and rightfully so.

    I thought perhaps I could make some headway with this film project, maybe even directly appealing to those I had wronged and exposing a greater truth, but that is also now being taken away from me. I fear that, just as with everything else that requires the involvement of people who can not understand by virtue of never having been there, it is going to fall apart as careers get in the way.

    The last thought that has occurred to me is one of some kind of final mission. It is true that I have found that I am capable of finding some kind of reprieve by doing things that are worthwhile on the scale of life and death. While it is a nice thought to consider doing some good with my skills, experience, and killer instinct, the truth is that it isn’t realistic. First, there are the logistics of financing and equipping my own operation, then there is the near certainty of a grisly death, international incidents, and being branded a terrorist in the media that would follow. What is really stopping me, though, is that I simply am too sick to be effective in the field anymore. That, too, has been taken from me.

    Thus, I am left with basically nothing. Too trapped in a war to be at peace, too damaged to be at war. Abandoned by those who would take the easy route, and a liability to those who stick it out—and thus deserve better. So you see, not only am I better off dead, but the world is better without me in it.

    This is what brought me to my actual final mission. Not suicide, but a mercy killing. I know how to kill, and I know how to do it so that there is no pain whatsoever. It was quick, and I did not suffer. And above all, now I am free. I feel no more pain. I have no more nightmares or flashbacks or hallucinations. I am no longer constantly depressed or afraid or worried.

    I am free.

    I ask that you be happy for me for that. It is perhaps the best break I could have hoped for. Please accept this and be glad for me.

    Daniel Somers

Why Are You Not Dead Yet?

    Life expectancy doubled in the past 150 years. Here’s why.

    The most important difference between the world today and 150 years ago isn’t airplane flight or nuclear weapons or the Internet. It’s lifespan. We used to live 35 or 40 years on average in the United States, but now we live almost 80. We used to get one life. Now we get two.

    You may well be living your second life already. Have you ever had some health problem that could have killed you if you’d been born in an earlier era? Leave aside for a minute the probabilistic ways you would have died in the past—the smallpox that didn’t kill you because it was eradicated by a massive global vaccine drive, the cholera you never contracted because you drink filtered and chemically treated water. Did some specific medical treatment save your life? It’s a fun conversation starter: Why are you not dead yet? It turns out almost everybody has a story, but we rarely hear them; life-saving treatments have become routine. I asked around, and here is a small sample of what would have killed my friends and acquaintances:

    Adrian’s lung spontaneously collapsed when he was 18.
    Becky had an ectopic pregnancy that caused massive internal bleeding.
    Carl had St. Anthony’s Fire, a strep infection of the skin that killed John Stuart Mill.
    Dahlia would have died delivering a child (twice) or later of a ruptured gall bladder.
    David had an aortic valve replaced.
    Hanna acquired Type 1 diabetes during a pregnancy and would die without insulin.
    Julia had a burst appendix at age 14.
    Katherine was diagnosed with pernicious anemia in her 20s. She treats it with supplements of vitamin B-12, but in the past she would have withered away.
    Laura (that’s me) had scarlet fever when she was 2, which was once a leading cause of death among children but is now easily treatable with antibiotics.
    Mitch was bitten by a cat (filthy animals) and had to have emergency surgery and a month of antibiotics or he would have died of cat scratch fever.
    After a while, these not-dead-yet stories start to sound sort of absurd, like a giddy, hooray-for-modernity response to The Gashleycrumb Tinies. Edward Gorey’s delightfully dark poem is an alphabetical list of children (fictional!) who died gruesome deaths:

    “A is for Amy who fell down the stairs/ B is for Basil assaulted by bears.” Here’s how modern science, medicine, and public health would amend it:

    M is for Maud who was swept out to sea … then brought back to shore by a lifeguard and resuscitated by emergency medical technicians.

    O is for Olive run through with an awl … but saved during a four-hour emergency surgery to repair her collapsed lung.

    S is for Susan, who perished of fits … or who would have, anyway, if her epilepsy hadn’t been diagnosed promptly and treated with powerful anticonvulsant drugs.

    When I first started looking into why average lifespan has increased so much so rapidly, I assumed there would be a few simple answers, a stepwise series of advances that each added a few years: clean water, sewage treatment, vaccines, various medical procedures. But it turns out the question of who or what gets credit for the doubling of life expectancy in the past few centuries is surprisingly contentious. The data are sparse before 1900, and there are rivalries between biomedicine and public health, obstetricians and midwives, people who say life expectancy will rise indefinitely and those who say it’s starting to plateau.

    It’s important to assign the credit correctly. In much of the developing world, average lifespan hasn’t increased nearly as dramatically as in the United States and the rest of the developed world. (And the United States has a lousy life expectancy compared to other wealthy nations.) Even within the United States, there are huge differences among races, geographic regions, and social classes. Even neighborhoods. These discrepancies are among the greatest injustices of the 21st century. How can we prevent needless premature deaths? What interventions are mostly likely to grant people in poorer countries extra years? And what’s the best way to prolong life and health even further in rich countries?

    To understand why people live so long today, it helps to start with how people died in the past. (To take a step back in time, play our interactive game.) People died young, and they died painfully of consumption (tuberculosis), quinsy (tonsillitis), fever, childbirth, and worms. There’s nothing like looking back at the history of death and dying in the United States to dispel any romantic notions you may have that people used to live in harmony with the land or be more in touch with their bodies. Life was miserable—full of contagious disease, spoiled food, malnutrition, exposure, and injuries. But disease was the worst. The vast majority of deaths before the mid-20th century were caused by microbes—bacteria, amoebas, protozoans, or viruses that ruled the Earth and to a lesser extent still do. It’s not always clear which microbes get the credit for which kills. Bills of mortality (lists of deaths by causes) were kept in London starting in the 1600s and in certain North American cities and parishes starting in the 1700s. At the time, people thought fevers were spread by miasmas (bad air) and the treatment of choice for pretty much everything was blood-letting. So we don’t necessarily know what caused “inflammatory fever” or what it meant to die of “dropsy” (swelling), or whether ague referred to typhoid fever, malaria, or some other disease. Interpreting these records has become a fascinating sub-field of history. But overall, death was mysterious, capricious, and ever-present.

    The first European settlers to North America mostly died of starvation, with (according to some historians) a side order of stupidity. They picked unnecessary fights with Native Americans, sought gold and silver rather than planting food or fishing, and drank foul water. As Charles Mann points out in his fascinating book 1493: Uncovering the New World Columbus Created, one-third of the first three waves of colonists were gentlemen, meaning their status was defined by not having to perform manual labor. During the winter of 1609–10, aka “the starving time,” almost everyone died; those who survived engaged in cannibalism.

    Deadly diseases infiltrated North America faster than Europeans did. Native Americans had no exposure and thus no resistance to the common European diseases of childhood, and unimaginable pandemics of smallpox, measles, typhus, and other diseases swept throughout the continent and ultimately reduced the population by as much as 95 percent.

    The slave trade killed more than 1 million Africans who were kidnapped, shackled, and shipped across the Atlantic. Those who survived the journey were at risk of dying from European diseases, as well as starvation and abuse. The slave trade introduced African microbes to North America; malaria and yellow fever were the ones that killed the most.

    Global trade introduced new diseases around the world and caused horrific epidemics until the 1700s or so, when pretty much every germ had made landfall on every continent. Within the United States, better transportation in the 1800s brought wave after wave of disease outbreaks to new cities and the interior. Urbanization brought people into ideal proximity from a germ’s point of view, as did factory work. Sadly, so did public schools: Children who might have toiled in relative epidemiological isolation on farms were suddenly coughing all over one another in enclosed schoolrooms.

    One of the best tours of how people died in the past is The Deadly Truth: A History of Disease in America by Gerald Grob. It’s a great antidote to all the heroic pioneer narratives you learned in elementary school history class, and it makes the Little House on the Prairie books seem delusional in retrospect. Pioneers traveling west in wagon trains had barely enough food, and much of it spoiled; their water came from stagnant, larvae-infested ponds. They died in droves of dysentery. Did you ever play with Lincoln logs or dream about living in a log cabin? What a fun fort for grown-ups, right? Wrong. The poorly sealed, damp, unventilated houses were teeming with mosquitoes and vermin. Because of settlement patterns along waterways and the way people cleared the land, some of the most notorious places for malaria in the mid-1800s were Ohio and Michigan. Everybody in the Midwest had the ague!(malaria)

    How did we go from the miseries of the past to our current expectation of long and healthy lives? “Most people credit medical advances,” says David Jones, a medical historian at Harvard—“but most historians would not.” One problem is the timing. Most of the effective medical treatments we recognize as saving our lives today have been available only since World War II: antibiotics, chemotherapy, drugs to treat high blood pressure. But the steepest increase in life expectancy occurred from the late 1800s to the mid-1900s. Even some dramatically successful medical treatments such as insulin for diabetics have kept individual people alive. We’ll examine the second half of the 20th century in a later story, but for now let’s look at the bigger early drivers of the doubled lifespan.

    The credit largely goes to a wide range of public health advances, broadly defined, some of which were explicitly aimed at preventing disease, others of which did so only incidentally. “There was a whole suite of things that occurred simultaneously,” says S. Jay Olshansky, a longevity researcher at the University of Illinois, Chicago. Mathematically, the interventions that saved infants and children from dying of communicable disease had the greatest impact on lifespan. (During a particularly awful plague in Europe, James Riley points out in Rising Life Expectancy: A Global History, the average life expectancy could temporarily drop by five years.) And until the early 20th century, the most common age of death was in infancy.

    Clean water may be the biggest lifesaver in history. Some historians attribute one-half of the overall reduction in mortality, two-thirds of the reduction in child mortality, and three-fourths of the reduction in infant mortality to clean water. In 1854, John Snow traced a cholera outbreak in London to a water pump next to a leaky sewer, and some of the big public works projects of the late 1900s involved separating clean water from dirty. Cities ran water through sand and gravel to physically trap filth, and when that didn’t work (germs are awfully small) they started chlorinating water.

    Closely related were technologies to move wastewater away from cities, but as Grob points out in The Deadly Truth, the first sewage systems made the transmission of fecal-borne diseases worse. Lacking an understanding of germs, people thought that dilution was the best solution and just piped their sewage into nearby waterways. Unfortunately, the sewage outlets were often near the water system inlets. Finally understanding that sewage and drinking water need to be completely separated, Chicago built a drainage canal that in 1900 reversed the flow of the Chicago River. The city thus sent its sewage into the greater Mississippi watershed and continued taking its drinking water from Lake Michigan.

    The germ theory of disease didn’t catch on all that quickly, but once it did, people started washing their hands. Soap became cheaper and more widespread, and people suddenly had a logical reason to wash up before surgery, after defecating, before eating. Soap stops both deadly and lingering infections; even today, kids who don’t have access to soap and clean water have stunted growth.

    Housing, especially in cities, was crowded, filthy, poorly ventilated, dank, stinky, hot in the summer, and cold in the winter. These were terrible conditions to live in as a human being, but a great place to be an infectious microbe. Pretty much everyone was infected with tuberculosis (the main cause of consumption), the leading killer for most of the 19th century. It still has a bit of a reputation as a disease of the young, beautiful, and poetic (it claimed Frederic Chopin and Henry David Thoreau, not to mention Mimì in La Bohème), but it was predominantly a disease of poverty, and there was nothing romantic about it. As economic conditions started improving in the 19th century, more housing was built, and it was airier, brighter (sunlight kills tuberculosis bacteria), more weather-resistant, and less hospitable to vermin and germs.

    We live like kings today—we have upholstered chairs, clean beds, a feast’s worth of calories at any meal, all the nutmeg (people once killed for it) and salt we could ever want. But wealth and privilege didn’t save royalty from early deaths. Microbes do care about breeding—some people have evolved defenses against cholera, malaria, and possibly the plague—but microbes killed off people without regard to class distinctions through the 1600s in Europe. The longevity gap between the rich and the poor grew slowly with the introduction of effective health measures that only the rich could afford: Ipecac from the New World to stop bloody diarrhea, condoms made of animal intestines to prevent the transmission of syphilis, quinine from the bark of the cinchona tree to treat malaria. Once people realized citrus could prevent scurvy, the wealthy built orangeries—greenhouses where they grew the life-saving fruit.

    Improving the standard of living is one important life-extending factor. The earliest European settlers in North America suffered from mass starvation initially, but once the Colonies were established, they had more food and better nutrition than people in England. During the Revolutionary War era, American soldiers were a few inches taller than their British foes. In Europe, the wealthy were taller than the poor, but there were no such class-related differences in America—which means most people had enough to eat. This changed during the 1800s, when the population expanded and immigrants moved to urban areas. Average height declined, but farmers were taller than laborers. People in rural areas outlived those in cities by about 10 years, largely due to less exposure to contagious disease but also because they had better nutrition. Diseases of malnutrition were common among the urban poor: scurvy (vitamin C deficiency), rickets (vitamin D deficiency), and pellagra (a niacin deficiency). Improved nutrition at the end of the 1800s made people taller, healthier, and longer lived; fortified foods reduced the incidence of vitamin-deficiency disorders.

    Contaminated food was one of the greatest killers, especially of infants; once they stopped breast-feeding, their food could expose them to typhoid fever, botulism, salmonella, and any number of microbes that caused deadly diarrhea in young children. (Death rates for infants were highest in the summer, evidence that they were dying of food contaminated by microbes that thrive in warm conditions.) Refrigeration, public health drives for pure and pasteurized milk, and an understanding of germ theory helped people keep their food safe. The Pure Food and Drug Act of 1906 made it a crime to sell adulterated food, introduced labeling laws, and led to government meat inspection and the creation of the Food and Drug Administration. People had started finding ways to fight disease epidemics in the early 1700s, mostly by isolating the sick and inoculating the healthy. The United States suffered fewer massive epidemics than Europe did, where bubonic plague (the Black Death) periodically burned through the continent and killed one-third of the population. Low population density prevented most epidemics from becoming widespread early in the United States history, but epidemics did cause mass deaths locally, especially as the population grew and more people lived in crowded cities. Yellow fever killed hundreds of people in Savannah in 1820 and 1854; the first devastating cholera epidemic hit the country in 1832. Port cities suffered some of the worst outbreaks because sailors brought new diseases and strains with them from all over the world. Port cities instituted quarantines starting in the 19th century, preventing sailors from disembarking if there was any evidence of disease, and on land, quarantines separated contagious people from the uninfected.

    A smallpox epidemic in Boston in 1721 led to a huge debate about variolation, a technique that involved transferring pus from an infected person to a healthy one to cause a minor reaction that confers immunity. Rev. Cotton Mather was for it—he said it was a gift from God. Those opposed said that disease was God’s will. People continued to fight about variolation, then inoculation (with the related cowpox virus, introduced in the late 1700s), and finally vaccination. The fight over God’s will and the dangers of vaccinations (real in the past, imaginary today) are still echoing.

    In the early 1900s, antitoxins to treat diphtheria and vaccines against diphtheria, tetanus, and pertussis helped stop these deadly diseases, followed by vaccines for mumps, measles, polio, and rubella.

    Anne Schuchat, assistant surgeon general and the acting director of CDC's Center for Global Health, says it’s not just the scientific invention of vaccines that saved lives, but the “huge social effort to deliver them to people improved health, extended life, and kept children alive.” Vaccines have almost eliminated diseases that used to be common killers, but she points out that “they’re still circulating in other parts of the world, and if we don’t continue to vaccinate, they could come back.”

    Vaccines have been so effective that most people in the developed world don’t know what it’s like to watch a child die of pertussis or measles, but parents whose children have contracted these diseases because of anti-vaccine paranoia can tell them. “The mistake that we made was that we underestimated the diseases and we totally overestimated the adverse reactions [to vaccines]," says a father in New Zealand whose child almost died of an agonizing bout of tetanus.

    Schuchat says the HPV vaccine is a huge priority now; only one-third of teenage girls have received the full series of three shots required to protect them against viruses that cause cervical cancer. The vaccines “are highly effective and very safe, but our uptake is horrible. Thousands of cases of cervical cancer will occur in a few decades in people who are girls now.” A baby is vaccinated against smallpox at an emergency clinic in Karachi during the worst epidemic of smallpox in Pakistan's history, January 1962.

    Some credit for the historical decrease in deadly diseases may go to the disease agents themselves. The microbes that cause rheumatic fever, scarlet fever, and a few other diseases may have evolved to become less deadly. Evolutionarily, that makes sense—it’s no advantage to a parasite to kill its own host, and less-deadly strains may have spread more readily in the human population. Of course, sudden evolutionary change in microbes can go the other way, too: The pandemic influenza of 1918–19 was a new strain that killed more people than any disease outbreak in history—around 50 million. In any battle between microbes and mammals, the smart money is on the microbes.

Why Are You Not Dead Yet? (Some Oddball Reasons)

    Lifespan has doubled in the United States in the past 150 years. This ridiculously wonderful change in the nature of life and death is something we tend to take for granted. When we do think about why we’re still alive, some of the big, fairly obvious reasons that come to mind are vaccines, antibiotics, clean water, or drugs for heart disease and cancer. But the world is full of underappreciated people, innovations, and ideas that also save lives. A round of applause, please, for some of the oddball reasons, in no particular order, why people are living longer and healthier lives than ever before.

    Cotton. One of the major killers of human history was typhus, a bacterial disease spread by lice. It defeated Napoleon’s army; if Tchaikovsky’s 1812 Overture were historically accurate, it would feature less cannon fire and more munching arthropods. Wool was the clothing material of choice before cotton displaced it. Cotton is easier to clean than wool and less hospitable to body lice.

    Satellites. In 1900, a hurricane devastated Galveston, Texas. It killed 8,000 people, making it the deadliest hurricane in U.S. history. In 2008, Hurricane Ike hit Galveston. Its winds were less powerful at landfall than those of the 1900 storm, but its storm surge was higher, and that’s usually what kills people. This time we saw it coming, thanks to a network of Earth-monitoring satellites and decades of ever-improving storm forecasting. More than 100 people died, but more than 1 million evacuated low-lying coastal areas and survived.

    Fluoride. There were plenty of miserable ways to die before the mid-20th century, but dying of a tooth abscess had to be among the worst—a slow, painful infection that limits your ability to eat, causes your head to throb endlessly, and eventually colonizes the body and kills you of sepsis. Now it’s a rare way to go, thanks to modern dental care, toothbrushes, and (unless you’re in Portland) fluoridated water.

    Window screens. Houseflies are irritating today, but they used to be major vectors of deadly diarrheal disease. Clean water and treatment of sewage eliminated the most obvious means of transmitting these diseases, but pesky houseflies continued to spread deadly microbes. By the 1920s, according to James Riley in Rising Life Expectancy: A Global History, a growing aversion to insects and the introduction of window screens reduced this risk.

    The discovery of unconscious bias. The reason we trust double-blind, placebo-controlled clinical trials to tell us which medical treatments actually work is that we know we can’t trust ourselves. If you take a sham drug that you think will alleviate your symptoms, it will—that’s the placebo effect. If you think the drug will cause side effects, it will—that’s the nocebo effect. If you’re a clinician and think you’re administering a real drug, you will send all kinds of signals, unintentionally, to tell the patient you think the treatment will work. If you’ve seen anecdotal evidence for a treatment, you notice confirmatory evidence rather than cases that make you revise your original hypothesis. When analyzing the data, it’s all too easy to squint at the numbers in a way that confirms your expectations. Double-blind trials overcome these biases by preventing both patient and clinician from knowing whether a tested drug is real or not.

    Botts’ Dots. Those raised ceramic reflectors between road lanes were invented by Elbert Botts, a chemist who worked for the California Department of Transportation. The dots help motorists see the edge of their lane even in the dark or when it’s raining. Botts died in 1962, four years before the first Botts’ dots were installed on California highways.

    Morbidity and Mortality Weekly Report. That’s the no-nonsense name of one of the most important publications most people have never heard of. The Centers for Disease Control and Prevention has been publishing it since 1952 to provide “timely, reliable, authoritative, accurate, objective, and useful public health information and recommendations.” When a new disease or danger emerges—such as AIDS or a new strain of influenza—the MMWR is often the first to identify it.

    Air-conditioning. As Dan Engber pointed out in a two-part ode to A/C last summer, heat is deadly and we don’t respect it enough. A Chicago heat wave killed more than 700 people in one week in 1995. The National Weather Service issues heat alerts, and cities have started to offer air-conditioned cooling centers for people who would overheat at home. A recent study shows that air conditioning has cut the death rate on hot days by 80 percent since 1960.

    The residents of Framingham, Mass. In 1948, researchers signed up more than 5,000 adults for a long-term study of heart disease. Nobody anticipated just how long-term the study would be—it’s still going strong and now includes the children and grandchildren of the original cohort. It taught us much of what we know about heart disease. Before the study, high blood pressure was thought to be a sign of good health; now it’s recognized as a risk factor for heart attacks and strokes. Thanks to the generosity and commitment of volunteers in Framingham and other studies, we know the dangers of high cholesterol, obesity, inactivity, and smoking.

    Pasteurization. This should be an obvious lifesaver, right up there with hand-washing and proper nutrition. But the rise of the raw milk movement suggests that a lot of people take safe dairy products for granted. Contaminated milk was one of the major killers of children, transmitting typhoid fever, scarlet fever, diphtheria, tuberculosis, and other diseases. One of the most successful public health campaigns of the late 19th and early 20th centuries was for pure and pasteurized milk—so successful that we don’t really remember how deadly milk can be.

    Shoes. Hookworms are parasites that enter the human body through bare feet—often by biting into the soft skin between the toes (shudder). The disease was common in the Southeast, spread when people walked barefoot across ground that was contaminated with feces of people who were already infected. Education initiatives at the beginning of the 20th century encouraged people to build sanitary outhouses and wear shoes.

    Cows. I mentioned in an earlier story that the Midwest—including Michigan!—once had some of the worst malaria outbreaks in the country. Anopheles mosquitoes had always flourished in the damp lowlands around streams and melting snow, and when settlers came, some of them carried Plasmodium parasites that the mosquitoes spread widely. The settlers’ farming practices made for even more stagnant water, and their sod and log houses were perfect habitat for biting pests. After farmers had exhausted the soil, they started raising cows rather than crops—and mosquitoes prefer to suck bovine blood even more than that of humans, helping break the malaria cycle. In the South and other parts of the country, larvicides, pesticides, better drainage, bug-proof housing, mechanized agriculture that replaced human labor, and fewer people living in lowlands helped eliminate malaria.

    Oppressive, burdensome, over-reaching government regulations. People like to complain about the government, but when you start looking through the alphabet soup of agencies, you realize that most of them are there to save your life. The National Oceanic and Atmospheric Administration runs the National Weather Service and warns you about hurricanes. The Environmental Protection Agency enforces the Clean Air Act and has dramatically reduced the amount of deadly pollutants in the air you breathe. The Occupational Safety and Health Administration keeps you safe at work. The National Highway Traffic Safety Administration and National Transportation Safety Board investigate vehicles and accidents and make recommendations so accidents don’t happen again. The Food and Drug Administration keeps deadly microbes out of your food. The Consumer Product Safety Commission recalls toys that could kill your child. The Centers for Disease Control and Prevention tracks and tries to cure or avert basically any health hazard, and the National Institutes of Health supports some of the most important biomedical research in the world.

    Goodness. Philosopher Daniel Dennett had an epiphany after emergency surgery a few years ago. It wasn’t a religious epiphany—instead of thanking God, he realized he should thank human goodness:

    “To whom, then, do I owe a debt of gratitude? To the cardiologist who has kept me alive and ticking for years … the surgeons, neurologists, anesthesiologists, and the perfusionist, who kept my systems going for many hours under daunting circumstances. To the dozen or so physician assistants, and to nurses and physical therapists and x-ray technicians and a small army of phlebotomists so deft that you hardly know they are drawing your blood, and the people who brought the meals, kept my room clean. … I remember with gratitude my late friend and Tufts colleague, physicist Allan Cormack, who shared the Nobel Prize for his invention of the CT scanner. Allan—you have posthumously saved yet another life, but who's counting? The world is better for the work you did. Thank goodness. Then there is the whole system of medicine, both the science and the technology. … So I am grateful to the editorial boards and referees, past and present, of Science, Nature, Journal of the American Medical Association, Lancet, and all the other institutions of science and medicine that keep churning out improvements, detecting and correcting flaws.”

    These are just a few of the countless ways people have made life safer, healthier, less painful—and longer—than we ever could have imagined a few centuries ago. Thank goodness.      
 

Death and the Romans

    Last week, at the Museum of London, an exciting new piece of the capital’s past went on display. It is a beautiful limestone sculpture of an eagle: its fierce powerful talons confront the viewer, matched by the latent majesty of its feathered wings and the forceful sideways turn of its head.

    In its beak is a snake, whose tail is wrapped around one of the eagle’s legs and whose head turns back with its forked tongue (and sharp teeth) poised as if to make a final attempt to conquer its adversary by striking at its jugular.

    We are presented with an image of a battle in full swing, a confrontation not yet over but which, we are made to feel by the sheer dominance of the eagle’s presence, will end with the snake’s demise.

    This powerful and emotional sculpture stands just 25 inches tall, yet it speaks volumes. Its material, sculptural style and archeological context mean experts can attribute its manufacture to a Romano-British artist living in Roman Britain, working with stone coming possibly from the Cotswolds, probably in the late AD 1st or early 2nd century.

    Who commissioned and owned this sumptuous object? What kind of world did the eagle once gaze out over? The Romans invaded Britain in AD43 under the Emperor Claudius. The area of and around London — or Londinium — was made up of open countryside traversed by streams. The early settlement was located at the point where the Thames was narrow enough to build a bridge across it, but still deep enough to receive sea-going vessels. Soon after the arrival of the Romans, Londinium (there are lots of theories about where the name came from but nothing is certain) seems to have become a thriving civilian community covering an area roughly equivalent to that of Hyde Park (about 350 acres).

    Although there has been much discussion about the nature of the military presence in early Londinium, the overwhelming emphasis seems to have been on private enterprise and trade. But in about AD60 the settlement suffered thanks to the rebellion against Roman rule led by Queen Boadicea and her Iceni tribe (based in the area of today’s Norfolk). Excavations around London have revealed layers of red ash indicating massive destruction by fire.

    The limestone sculpture went on display last weekThe limestone sculpture went on display last week After the suppression of the revolt, Londinium was reborn as an even greater Roman town. During the last decades of the 1st century it expanded rapidly to become Roman Britain’s largest city and was graced by a visit from the Emperor Hadrian in AD122. Soon after that it suffered significant fire destruction once more. But with the plucky spirit with which London has long been associated, it rose again from the ashes to become a home to about 40,000-60,000 inhabitants. And during the 2nd century it replaced Camulodunum (nowadays known as Colchester) as the centre of administration for the province of Roman Britain.

    It was within this turbulent world that experts believe our eagle was originally set up. It was found by a team from Museum of London Archeology on the final day of their eight-month dig on the site of a new hotel in the Minories, near Aldgate. It was sheltered within a niche, gracing either the interior or exterior of a tomb.

    Nor was this just any old tomb: the quality of the sculpture tells us something about the cost of the tomb as a whole and the wealth of its owner (the eagle seems also to have been painted, which would only have enhanced its impact).

    The tomb’s location — right by one of the main roads leading out of London and close to the probable boundary of the city — marks this again as the burial of someone with a good degree of wealth and potential political influential in Roman London (often the area immediately around a Roman city’s walls could be used for tombs only if it had been voted to the deceased by the local magistrates).

    It is tempting to imagine a wealthy Roman, or Romano-British, trader, having survived and prospered through Londinium’s oscillating fortunes, perhaps having been involved in some way in Londinium’s administration, being granted the right to build himself a magnificent tomb at the city’s gateway.

    Even so, it is important to realise it is unlikely that this tomb would have stood alone. The Romans did not hide their tombs away in cemeteries as we do today. They competed for the most visible sites on the main roads in and out of a city to ensure that their tomb would be seen by current and future generations. It is a pattern that can be observed in nearly every Roman city around the Mediterranean and was a distinct marker of Roman cultural identity.

    So we need to imagine this eagle — in all its painted splendour — perhaps standing proud guarding a tomb that, while in an important and powerful position, was also jostling with many others for the viewer’s attention as they entered or left the city of London.

    Traders, merchants, soldiers, visitors and local residents would have passed by this tomb time and time again as they went about their business. The eagle would have seen the lifeblood of London commerce throbbing through the city’s arteries as it stood there, lifeless, commemorating death. And from what we know of what went on in the streets of tombs leading out of Rome, for instance, it is probable that the eagle would have borne witness to some pretty colourful nightlife as well as the thieves, prostitutes and murderers who went about their business in the shadows of the tombs.

    What did the tomb’s owner want the eagle and snake to say to those who pushed past it by day and slunk by it at night? The eagle echoes the eagle that graced the Roman military standards and as such brings with it connotations of power and vitality, while the snake may be a link to Roman mythology and iconography representing the danger and power of the underworld.

    The eagle battles the snake and is potentially on the verge of victory. Just as though its owner — with this magnificent and permanent memorial on the road leading out of London keeping his memory alive for ever to all who passed by — had in some ways cheated death itself.

    There is a sad irony to this sculpture, however. By the second half of the 2nd century London had passed its prime. It began to shrink and at the end of that century and the beginning of the 3rd a massive defensive wall was built around the city, one of the largest construction projects ever undertaken in Roman Britain. It was a wall that would survive in parts for 1,600 years and which still roughly defines the boundaries of the City of London today. Our eagle was found abandoned in an ancient Roman ditch and the tomb it once adorned seems to have been deliberately taken down — perhaps to provide building material for the defensive wall.

    The fantastic state of preservation of this extraordinary sculptural piece that once adorned a rich tomb and stood watching over the crowds passing in and out of London may, in the final analysis, be due to the fact that it was tossed away as London’s might began to falter. Perhaps the snake did get the better of the eagle after all.      
 

Suicide

    Just before Christmas the award-winning British rap star Professor Green took his new wife, Millie Mackintosh — a glamour girl from Made in Chelsea — to visit his grandmother. He was brought up by his grandmother and they have always been close. Over a cup of tea they chatted about what Stephen Manderson — his real name — had been like as a little boy and went to find some photographs.

    “Out comes one of me with my dad. I haven’t cried in years but I looked at this picture of my father . . . and I just saw the void in my life,” the musician says.

    Manderson was suddenly overwhelmed by the memory of a morning six years earlier when she had come into his bedroom in tears: “I’d woken with a feeling of impending doom for some reason, and then I saw she was crying. She said ‘Stephen, your dad’s dead. He’s hung himself.’”

    Peter Manderson, who was in his early forties, had been found dead in Thorndon Country Park, near his home in Brentwood, Essex. Six years on his son, 30, still struggles to understand why it happened.

    “I went through every emotion possible that day. My first thought was, ‘What a selfish thing to do’,” Manderson says. “Then you think to yourself, ‘Maybe it’s selfish of me to think he’s selfish.’ You drive yourself mad with it all. It’s so hard because I still love him . . . and it’s not like he got hit by a car; he made that decision.”

    About 6,000 families in Britain are left with such agonising feelings and questions every year. Despite the best efforts of charities dedicated to stopping it, there was in 2011, the year for which the most recent figures are available, a rise in suicide among those most at risk — men, like Manderson’s father, aged 30-44.

    In Manderson’s case the tragedy is compounded by his recent discovery that his father’s brother also hanged himself and that a third brother — after whom he was named — died in a diabetic coma, possibly self-inflicted. “No one knows if that was suicide, but there is a question mark,” he says.

    Campaigners fear that when new figures are collated we will also see a rise in the rate of teenage suicide, which already runs at 600-800 a year, prompted by websites that seem to encourage self-harm and suicidal thoughts. Some go even further, providing “recipes” for those who want to end their lives.

    Last week an inquest in London heard how a 15-year-old girl’s psychological breakdown spun out of control after she became obsessed with the internet. Tallulah Wilson, a talented dancer, created an online alter ego who took cocaine and drank. She posted pictures of her self-harm, gaining 18,000 followers.

    “I had changed passwords; I was doing everything I could to stop her accessing these people,” her mother, Sarah Wilson, told the court. “The site was incredibly disturbing. I saw one girl post a picture with a noose and the picture said, ‘Here’s your new necklace, try it on’.”

    Wilson eventually managed to get her daughter’s Tumblr page taken down. Two days later Tallulah died after being hit by a train at St Pancras station in London.

    Last year, while judging Radio 1’s annual Teen Awards, Manderson talked to one of the nominees, a girl who had attempted suicide and had then chanced upon a boy preparing to throw himself off a bridge. She spent two hours talking him down, a turning point for both of them.

    Manderson told the girl that suicide had touched his life too and their conversation set him on a quest to discover what drives people to suicide, whether it can be prevented and whether his family history makes him more likely to contemplate suicide himself.

    For a boy who grew up on a tough council estate in Hackney, east London, Manderson’s life today seems to have a fairytale quality. His musical talent has brought him fame and professional recognition, with a string of awards and nominations, and he has a beautiful wife. But he admits to a struggle against anxiety and depression.

    Over the past few months, during the making of a documentary (Suicide Survivors with Professor Green, which will be broadcast on BBC Radio 1 tomorrow at 9pm), the rapper has talked to psychologists, teenagers who have contemplated suicide and youth support workers. He has also reflected more deeply than ever on losing his father in 2008, two years before his first hit.

    “It’s not just a question of not being able to say goodbye; the sadness is I never really had him in my life,” he says. “I have memories but they’re snapshots: I remember us going to the West End when I was about six or seven — I can see myself holding his hand crossing Regent Street. But he was in and out of my life: we were never able to have a close relationship.”

    Manderson’s mother was 16 when he was born, his father 18. Neither was capable of looking after him, so he was brought up by his grandmother. “There was some sort of custody battle and my dad was on my nan’s side. I remember him coming round. I hadn’t seen him for a while and I ran into a bedroom and hid.”

    He adds: “I always felt that if we had an argument or if I upset him in some way he wouldn’t come back. He wasn’t a horrible man. That’s what made it worse: he was the parent I favoured, the one I really liked.”

    Manderson learnt a hard lesson from his last encounter with his father, who had gone on to marry and have two more children.

    “I saw him on my 18th birthday. After that, no reason, we just stopped speaking. Six years later I reached out to him. We were going to meet the day after Boxing Day. I thought he would come to me — he was driving; I wasn’t — but when I rang him he said he thought I was coming to him and ‘the kids are excited to see you’.

    “I lost it then. I said, ‘This isn’t about playing happy families. They’re not my family. It’s about you and me as adults sitting down and working things out.’ He just stuttered at me, and I got more and more angry and I finished by saying, ‘If I ever see you again I’ll knock you out.’

    “That was it. And that really was it, because I never saw him again. Those were the last words I said to him.”

    The pain of their last exchange inspired his track Goodnight: “I gotta put my dad in the dirt / Back in the earth. I wish we could have patched it up first / I was so angry, though, I just couldn’t handle the hurt.”

    One reason men take their lives, Manderson says, is “that pride thing. One thing talking to psychologists taught me is that I’ve cut myself off from people because of pride. It was pride that made me reject my dad. I was scared of getting hurt. I’m defensive. The paradox is, it takes an awful lot of strength to say, ‘I’m not all right — I need help’, especially when you come from a background like mine, where you’ve had to fend for yourself.”

    Papyrus, a charity dedicated to preventing teenage suicide, says that when someone dies by their own hand, family members often have suicidal thoughts. Brothers and sisters of young people who commit suicide are particularly vulnerable. Girls, generally, are much more given to suicidal thoughts and self-harm than the act itself: three-quarters of young suicides are men.

    Ged Flynn, chief executive of Papyrus, which runs a helpline, text and internet service for young people in distress, cautions against the facile “headline” approach to suicide of “boy jumps off bridge because of bullies”. Suicide is almost always more complex, a combination of a number of factors, plus the momentary impulse to do it.

    Tony Harrison, from Lancashire, whose 21-year-old daughter Vicky killed herself four years ago, says it was “a coming-together of everything. It happened in the early hours of the morning. She’d been trying to get a job; she was supposed to be going out that evening but it was cancelled; she’d had a few drinks . . . I saw her just a few hours earlier in the evening and there was no indication at all. It must have been a moment of crisis. If only that moment had passed.”

    Manderson found that grief made his wedding to Mackintosh a bittersweet day. “Her parents are the warmest, most welcoming people,” he says. “So it was good to be with them. But there were moments that day when I looked around me and I thought ‘I wish . . .’”      
 

In A Barrow

    Work has started on the first Neolithic-style burial mound to be built on Salisbury Plain for at least 5,000 years. Tim Daw, a farmer from All Cannings, Wiltshire, has laid down the first concrete slabs that will form the base of the long barrow.

    He hopes that eventually the monument will contain the ashes of 2,400 people who have paid to spend eternity in the style of their ancestors.

    The barrow, which will be about 50m (164 ft) long, will contain a series of chambers, each with lockable niches where ashes can be stored.

    Mr Daw, 52, an atheist, is hoping that the burial chamber will be ready for the first permanent resident within six months.

    The cost of a niche large enough to contain the ashes of eight family members will be about £1,000.

    Mr Daw said that the burial chamber would be non-religious, but it has attracted the interest of Wiltshire pagans because of its alignment to the solstice sunrise and sunset.

    He said: “We’ve already had five people sign up, and that’s without really pushing it at all.

    “We thought we’d wait until something tangible is happening and the thing is being built or built already. Now it has, as this is the first set of stones to go down.”

    Like nearby West Kennet Long Barrow, the 5,500-year-old prototype on which Mr Daw’s mound is based, the burial chamber is being built using giant sarsen stones, the same basic building blocks used to construct Stonehenge. Mr Daw hopes it will eventually contain the remains of individuals from 300 families, including his own.

    “We’ll have to keep the inside secure as other people’s remains will be in there too, but the idea is that it will be a place for families to come. They’ll be able to sit and contemplate on the mound.”

    The original long-barrow burials are still poorly understood. Bodies may have been “exposed” outside until all the flesh had vanished from their bones before being placed in the chamber. An equally macabre alternative is that the dead could have been removed for annual feasting until they simply fell to pieces.

    West Kennet Long Barrow was in use for about 1,000 years after its construction in 3,600BC, after which it was sealed up. However, archaeologists were puzzled to discover that the 46 bodies deposited inside all dated from a period of only 20-40 years.      
 

UK Life Expectancy

    The rich live 20 years longer in good health than the poor, official figures show. In a sign of Britain’s “staggering” health divide, the poorest 10 per cent of the population can expect little more than 50 years of healthy life, the Office for National Statistics said.

    The difference in the amount of time people can expect to spend in good health is more than twice as wide as the difference in absolute life expectancy, the figures reveal. Poor women appear particularly vulnerable. While the richest men live 9.4 years longer than the poorest and women 6.9 years longer, the gap in healthy life expectancy rises to 19.3 years and 20.1 respectively.

    The figures, compiled from an annual survey that asks people to rate their health from very good to very bad, show that those living in the poorest postcodes have an average of 52 years of healthy life. This rises steadily with income to 71 years for the richest. Poor women spend only 66 per cent of their lives in good health, compared with 83 per cent for the richest.

    “Males in decile 10 (least deprived) can expect to spend 12.2 years in ‘not good’ general health, despite having longer lives. Those in the most deprived areas can expect to spend 21.4 years of their already shorter life in ‘not good’ health,” the ONS said.

    Rowena Young, director of health innovation at the Young Foundation think-tank, said there was a “staggering lag in quality of life, rather than the indicator we’re used to hearing about — life expectancy”.

    She added: “Life expectancy matters a lot, and it’s important we continue to close the gap between rich and poor. But if around 30 per cent to a third of your life is spent in poor health, as is typically the case among the poorest men and women, you might question whether longer life is worth it.”

    Education and work policies to target the poorest would help to close the gap. “Women have historically enjoyed longer life expectancy and more prolonged health than men. But that ‘gender advantage’ is almost entirely eroded by social inequalities,” she said.

    “Changes in the labour market are seeing more women having to settle for unskilled labour, employment for which they are over-qualified, part-time and insecure work. Working-class women face a triple whammy of poverty, ill health and stigma, and deserve our most urgent attention.”      
 

What Happens To Your Body After You Die



    “It might take a little bit of force to break this up,” says mortician Holly Williams, lifting John’s arm and gently bending it at the fingers, elbow and wrist. “Usually, the fresher a body is, the easier it is for me to work on.”

    Williams speaks softly and has a happy-go-lucky demeanour that belies the nature of her work. Raised and now employed at a family-run funeral home in north Texas, she has seen and handled dead bodies on an almost daily basis since childhood. Now 28 years old, she estimates that she has worked on something like 1,000 bodies.

    Her work involves collecting recently deceased bodies from the Dallas–Fort Worth area and preparing them for their funeral.

    “Most of the people we pick up die in nursing homes,” says Williams, “but sometimes we get people who died of gunshot wounds or in a car wreck. We might get a call to pick up someone who died alone and wasn’t found for days or weeks, and they’ll already be decomposing, which makes my work much harder.”

    John had been dead about four hours before his body was brought into the funeral home. He had been relatively healthy for most of his life. He had worked his whole life on the Texas oil fields, a job that kept him physically active and in pretty good shape. He had stopped smoking decades earlier and drank alcohol moderately. Then, one cold January morning, he suffered a massive heart attack at home (apparently triggered by other, unknown, complications), fell to the floor, and died almost immediately. He was just 57.

    Now, John lay on Williams’ metal table, his body wrapped in a white linen sheet, cold and stiff to the touch, his skin purplish-grey – tell-tale signs that the early stages of decomposition were well under way.

    Self-digestion

    Far from being ‘dead’, a rotting corpse is teeming with life. A growing number of scientists view a rotting corpse as the cornerstone of a vast and complex ecosystem, which emerges soon after death and flourishes and evolves as decomposition proceeds.

    Decomposition begins several minutes after death with a process called autolysis, or self-digestion. Soon after the heart stops beating, cells become deprived of oxygen, and their acidity increases as the toxic by-products of chemical reactions begin to accumulate inside them. Enzymes start to digest cell membranes and then leak out as the cells break down. This usually begins in the liver, which is rich in enzymes, and in the brain, which has high water content. Eventually, though, all other tissues and organs begin to break down in this way. Damaged blood cells begin to spill out of broken vessels and, aided by gravity, settle in the capillaries and small veins, discolouring the skin.

    Body temperature also begins to drop, until it has acclimatised to its surroundings. Then, rigor mortis – “the stiffness of death” – sets in, starting in the eyelids, jaw and neck muscles, before working its way into the trunk and then the limbs. In life, muscle cells contract and relax due to the actions of two filamentous proteins (actin and myosin), which slide along each other. After death, the cells are depleted of their energy source and the protein filaments become locked in place. This causes the muscles to become rigid and locks the joints.

    During these early stages, the cadaveric ecosystem consists mostly of the bacteria that live in and on the living human body. Our bodies host huge numbers of bacteria; every one of the body’s surfaces and corners provides a habitat for a specialised microbial community. By far the largest of these communities resides in the gut, which is home to trillions of bacteria of hundreds or perhaps thousands of different species.

    The gut microbiome is one of the hottest research topics in biology; it’s been linked to roles in human health and a plethora of conditions and diseases, from autism and depression to irritable bowel syndrome and obesity. But we still know little about these microbial passengers while we are alive. We know even less about what happens to them when we die.

    Immune shutdown

    In August 2014, forensic scientist Gulnaz Javan of Alabama State University in Montgomery and her colleagues published the very first study of what they have called the thanatomicrobiome (from thanatos, the Greek word for ‘death’).

    “Many of our samples come from criminal cases,” says Javan. “Someone dies by suicide, homicide, drug overdose or traffic accident, and I collect tissue samples from the body. There are ethical issues [because] we need consent.”

    Most internal organs are devoid of microbes when we are alive. Soon after death, however, the immune system stops working, leaving them to spread throughout the body freely. This usually begins in the gut, at the junction between the small and large intestines. Left unchecked, our gut bacteria begin to digest the intestines – and then the surrounding tissues – from the inside out, using the chemical cocktail that leaks out of damaged cells as a food source. Then they invade the capillaries of the digestive system and lymph nodes, spreading first to the liver and spleen, then into the heart and brain.

    Javan and her team took samples of liver, spleen, brain, heart and blood from 11 cadavers, at between 20 and 240 hours after death. They used two different state-of-the-art DNA sequencing technologies, combined with bioinformatics, to analyse and compare the bacterial content of each sample.

    The samples taken from different organs in the same cadaver were very similar to each other but very different from those taken from the same organs in the other bodies. This may be due partly to differences in the composition of the microbiome of each cadaver, or it might be caused by differences in the time elapsed since death. An earlier study of decomposing mice revealed that although the microbiome changes dramatically after death, it does so in a consistent and measurable way. The researchers were able to estimate time of death to within three days of a nearly two-month period.

    Bacteria checklist

    Javan’s study suggests that this ‘microbial clock’ may be ticking within the decomposing human body, too. It showed that the bacteria reached the liver about 20 hours after death and that it took them at least 58 hours to spread to all the organs from which samples were taken. Thus, after we die, our bacteria may spread through the body in a systematic way, and the timing with which they infiltrate first one internal organ and then another may provide a new way of estimating the amount of time that has elapsed since death.

    “After death the composition of the bacteria changes,” says Javan. “They move into the heart, the brain and then the reproductive organs last.” In 2014, Javan and her colleagues secured a $200,000 (£131,360) grant from the National Science Foundation to investigate further. “We will do next-generation sequencing and bioinformatics to see which organ is best for estimating [time of death] – that’s still unclear,” she says.

    One thing that does seem clear, however, is that a different composition of bacteria is associated with different stages of decomposition.

    But what does this process actually look like?

    Scattered among the pine trees in Huntsville, Texas, lie around half a dozen human cadavers in various stages of decay. The two most recently placed bodies are spread-eagled near the centre of the small enclosure with much of their loose, grey-blue mottled skin still intact, their ribcages and pelvic bones visible between slowly putrefying flesh. A few metres away lies another, fully skeletonised, with its black, hardened skin clinging to the bones, as if it were wearing a shiny latex suit and skullcap. Further still, beyond other skeletal remains scattered by vultures, lies a third body within a wood and wire cage. It is nearing the end of the death cycle, partly mummified. Several large, brown mushrooms grow from where an abdomen once was.

    Natural decay

    For most of us the sight of a rotting corpse is at best unsettling and at worst repulsive and frightening, the stuff of nightmares. But this is everyday for the folks at the Southeast Texas Applied Forensic Science Facility. Opened in 2009, the facility is located within a 247-acre area of national forest owned by Sam Houston State University (SHSU). Within it, a nine-acre plot of densely wooded land has been sealed off from the wider area and further subdivided, by 10-foot-high green wire fences topped with barbed wire.

    In late 2011, SHSU researchers Sibyl Bucheli and Aaron Lynne and their colleagues placed two fresh cadavers here, and left them to decay under natural conditions.

    Once self-digestion is under way and bacteria have started to escape from the gastrointestinal tract, putrefaction begins. This is molecular death – the breakdown of soft tissues even further, into gases, liquids and salts. It is already under way at the earlier stages of decomposition but really gets going when anaerobic bacteria get in on the act.

    Putrefaction is associated with a marked shift from aerobic bacterial species, which require oxygen to grow, to anaerobic ones, which do not. These then feed on the body’s tissues, fermenting the sugars in them to produce gaseous by-products such as methane, hydrogen sulphide and ammonia, which accumulate within the body, inflating (or ‘bloating’) the abdomen and sometimes other body parts.

    This causes further discolouration of the body. As damaged blood cells continue to leak from disintegrating vessels, anaerobic bacteria convert haemoglobin molecules, which once carried oxygen around the body, into sulfhaemoglobin. The presence of this molecule in settled blood gives skin the marbled, greenish-black appearance characteristic of a body undergoing active decomposition.

    Specialised habitat

    As the gas pressure continues to build up inside the body, it causes blisters to appear all over the skin surface. This is followed by loosening, and then ‘slippage’, of large sheets of skin, which remain barely attached to the deteriorating frame underneath. Eventually, the gases and liquefied tissues purge from the body, usually leaking from the anus and other orifices and frequently also leaking from ripped skin in other parts of the body. Sometimes, the pressure is so great that the abdomen bursts open.

    Bloating is often used as a marker for the transition between early and later stages of decomposition, and another recent study shows that this transition is characterised by a distinct shift in the composition of cadaveric bacteria.

    Bucheli and Lynne took samples of bacteria from various parts of the bodies at the beginning and the end of the bloat stage. They then extracted bacterial DNA from the samples and sequenced it.

    Flies lay eggs on a cadaver in the hours after death, either in orifices or open wounds (Credit: Science Photo Library) As an entomologist, Bucheli is mainly interested in the insects that colonise cadavers. She regards a cadaver as a specialised habitat for various necrophagous (or ‘dead-eating’) insect species, some of which see out their entire life cycle in, on and around the body.

    When a decomposing body starts to purge, it becomes fully exposed to its surroundings. At this stage, the cadaveric ecosystem really comes into its own: a ‘hub’ for microbes, insects and scavengers.

    Maggot cycle

    Two species closely linked with decomposition are blowflies and flesh flies (and their larvae). Cadavers give off a foul, sickly-sweet odour, made up of a complex cocktail of volatile compounds which changes as decomposition progresses. Blowflies detect the smell using specialised receptors on their antennae, then land on the cadaver and lay their eggs in orifices and open wounds.

    Each fly deposits around 250 eggs that hatch within 24 hours, giving rise to small first-stage maggots. These feed on the rotting flesh and then moult into larger maggots, which feed for several hours before moulting again. After feeding some more, these yet larger, and now fattened, maggots wriggle away from the body. They then pupate and transform into adult flies, and the cycle repeats until there’s nothing left for them to feed on.

    Under the right conditions, an actively decaying body will have large numbers of stage-three maggots feeding on it. This ‘maggot mass’ generates a lot of heat, raising the inside temperature by more than 10C (18F). Like penguins huddling in the South Pole, individual maggots within the mass are constantly on the move. But whereas penguins huddle to keep warm, maggots in the mass move around to stay cool.

    “It’s a double-edged sword,” Bucheli explains, surrounded by large toy insects and a collection of Monster High dolls in her SHSU office. “If you’re always at the edge, you might get eaten by a bird, and if you’re always in the centre, you might get cooked. So they’re constantly moving from the centre to the edges and back.”

    The presence of flies attracts predators such as skin beetles, mites, ants, wasps and spiders, which then feed on the flies’ eggs and larvae. Vultures and other scavengers, as well as other large meat-eating animals, may also descend upon the body.

    Unique repertoire

    In the absence of scavengers, though, the maggots are responsible for removal of the soft tissues. As Carl Linnaeus (who devised the system by which scientists name species) noted in 1767, “three flies could consume a horse cadaver as rapidly as a lion”. Third-stage maggots will move away from a cadaver in large numbers, often following the same route. Their activity is so rigorous that their migration paths may be seen after decomposition is finished, as deep furrows in the soil emanating from the cadaver.

    Every species that visits a cadaver has a unique repertoire of gut microbes, and different types of soil are likely to harbour distinct bacterial communities – the composition of which is probably determined by factors such as temperature, moisture, and the soil type and texture.

    All these microbes mingle and mix within the cadaveric ecosystem. Flies that land on the cadaver will not only deposit their eggs on it, but will also take up some of the bacteria they find there and leave some of their own. And the liquefied tissues seeping out of the body allow the exchange of bacteria between the cadaver and the soil beneath.

    When they take samples from cadavers, Bucheli and Lynne detect bacteria originating from the skin on the body and from the flies and scavengers that visit it, as well as from soil. “When a body purges, the gut bacteria start to come out, and we see a greater proportion of them outside the body,” says Lynne.

    Thus, every dead body is likely to have a unique microbiological signature, and this signature may change with time according to the exact conditions of the death scene. A better understanding of the composition of these bacterial communities, the relationships between them and how they influence each other as decomposition proceeds could one day help forensics teams learn more about where, when and how a person died.

    Pieces of the puzzle

    For instance, detecting DNA sequences known to be unique to a particular organism or soil type in a cadaver could help crime scene investigators link the body of a murder victim to a particular geographical location or narrow down their search for clues even further, perhaps to a specific field within a given area.

    “There have been several court cases where forensic entomology has really stood up and provided important pieces of the puzzle,” says Bucheli, adding that she hopes bacteria might provide additional information and could become another tool to refine time-of-death estimates. “I hope that in about five years we can start using bacterial data in trials,” she says.

    To this end, researchers are busy cataloguing the bacterial species in and on the human body, and studying how bacterial populations differ between individuals. “I would love to have a dataset from life to death,” says Bucheli. “I would love to meet a donor who’d let me take bacterial samples while they’re alive, through their death process and while they decompose.”

    “We’re looking at the purging fluid that comes out of decomposing bodies,” says Daniel Wescott, director of the Forensic Anthropology Center at Texas State University in San Marcos.

    Wescott, an anthropologist specialising in skull structure, is using a micro-CT scanner to analyse the microscopic structure of the bones brought back from the body farm. He also collaborates with entomologists and microbiologists – including Javan, who has been busy analysing samples of cadaver soil collected from the San Marcos facility – as well as computer engineers and a pilot, who operate a drone that takes aerial photographs of the facility.

    “I was reading an article about drones flying over crop fields, looking at which ones would be best to plant in,” he says. “They were looking at near-infrared, and organically rich soils were a darker colour than the others. I thought if they can do that, then maybe we can pick up these little circles.”

    Rich soil

    Those “little circles” are cadaver decomposition islands. A decomposing body significantly alters the chemistry of the soil beneath it, causing changes that may persist for years. Purging – the seeping of broken-down materials out of what’s left of the body – releases nutrients into the underlying soil, and maggot migration transfers much of the energy in a body to the wider environment.

    Eventually, the whole process creates a ‘cadaver decomposition island’, a highly concentrated area of organically rich soil. As well as releasing nutrients into the wider ecosystem, this attracts other organic materials, such as dead insects and faecal matter from larger animals. According to one estimate, an average human body consists of 50–75% water, and every kilogram of dry body mass eventually releases 32g of nitrogen, 10g of phosphorous, 4g of potassium and 1g of magnesium into the soil. Initially, it kills off some of the underlying and surrounding vegetation, possibly because of nitrogen toxicity or because of antibiotics found in the body, which are secreted by insect larvae as they feed on the flesh. Ultimately, though, decomposition is beneficial for the surrounding ecosystem. The microbial biomass within the cadaver decomposition island is greater than in other nearby areas. Nematode worms, associated with decay and drawn to the seeping nutrients, become more abundant, and plant life becomes more diverse. Further research into how decomposing bodies alter the ecology of their surroundings may provide a new way of finding murder victims whose bodies have been buried in shallow graves.

    Grave soil analysis may also provide another possible way of estimating time of death. A 2008 study of the biochemical changes that take place in a cadaver decomposition island showed that the soil concentration of lipid-phosphorous leaking from a cadaver peaks at around 40 days after death, whereas those of nitrogen and extractable phosphorous peak at 72 and 100 days, respectively. With a more detailed understanding of these processes, analyses of grave soil biochemistry could one day help forensic researchers to estimate how long ago a body was placed in a hidden grave.      
 

Ending Your Life

    If I no longer enjoyed being alive and if no one would be devastated by my death, I would choose to end my life How long can you expect to live? How long do you want to live? And when better than Easter to contemplate selling one’s soul to the Devil?

    At the Royal Opera this week I thrilled to a production of Gounod’s mad, wild, lush Faust, where the ageing and ailing Dr F signs away his rights to the life celestial in exchange for a new instalment of his life here below.

    Lacking Satan’s powers, politicians cannot make you such an offer. But this week the pensions minister, Professor Steve Webb, went as far as he dared in proposing to guide your decision whether (on retirement) to sign away your eternal pension rights in exchange for smashing the piggy bank and enjoying all the cash now. The good professor, we learn, wants individual citizens’ profiles on likely longevity. Information will be collected about whether we smoke, how much we exercise and where we live. Each of us will then be offered a ball-park figure for our presumed age of death, so we can plan accordingly.

    In principle the idea seems sound. In practice, though, estimates based on a few crude lifestyle measurements may not produce reliable estimates, especially in the absence of genetic profiling, and government will have to guard against being sued by dad because he didn’t die, or by his (in effect) disinherited children because he did — leaving a pension fund to trouser all his savings.

    Until now we’ve acted on our own predictions. Surveys suggest that most of us will die a few years later than we say we expect to; but this can be adjusted for, and I still suspect that we ourselves know best our bodies and minds. As has been shown with the outcome of general elections, our own descriptions not of what we want or don’t want, but of what we expect, may remain a surprisingly accurate guide.

    So how long do you yourself expect to live?

    Asking point-blank often fails to catch what people really think. Here’s a subtly different approach. Imagine you’re the ageing Faust, approached by a supernatural being with the following proposal: “Old man, I have an offer for you. You don’t know how long you’ll live, or whether your health will hold. You’re flying blind.

    “But here’s an alternative. I will guarantee you reasonable health and the retention of your faculties; but only up to an agreed age. In return, you must consent to die at that age.

    “Obviously, old man, you’d sign up to an agreed age of 110; and almost certainly to 100; and probably to 90. But 80? 79? 78? What’s theminimum age for which you’ll sign up to my plan?”

    Such, I believe, would be the best way to uncover our real best guess at our own longevity. It requires us to place a bet. By imagining, and asking the question of ourselves, we may catch unawares our own unconscious expectation. Myself? I would be haggling somewhere around the figure of 83. My father suffered massive heart attacks at 59 and his father at 58, so, still fit at 64, I’m already into extra time. Offer me another 20 years and I’d take it. Offer me 15 and on balance I’d stick with the unknown. As the offer edges up past 80, I begin to wobble.

    All this, you may say, is just a flight of fancy, and therefore frivolous.

    A flight of fancy, yes, but not frivolous. A bookish Liberal Democrat minister makes an unlikely Evil One, but Mr Webb’s question — “How long can you expect to live?” — prompts another: the question Dr Faust confronted. “How long do you want to live?”

    It is a question my generation are the first in modern history to be asking ourselves in very large numbers. We ask it because we are among the first to expect — again in very large numbers — that our lives may be prolonged past a point when we may want or think we ought to live.

    We will ask it, too, because we are the first generation among whom a majority no longer believes that suicide is a mortal sin.

    If your firmly held faith tells you that you have no right to end your life, you need not read on. You’re as entitled to your view as I to mine, but to the question “Should I end it?” your vote must be already and irrevocably in the “no” ballot box. The rest of us, however, may debate how we should answer it, each in our own case.

    I’ve decided to write myself a letter to be opened at the age of 75 and thereafter revisited annually. It sets out my criteria for carrying on. These are the criteria for me alone and I don’t apply them to others, who must frame their own.

    Dear Matthew,

    To the following eight questions a box is to be ticked, “yes” or “no”. The answer to some may obviate the need to ask some others. If the answer to either of the first two questions is “yes” then brush this letter aside and live on. If the answer to both is “no” then read no further, and reach for the razor blade.

    1 Do you still, on balance and taking good times with bad, enjoy being alive?
    2 Is there anyone else whose life would be devastated by your death?

    The final six questions are not critical, but they may help you to decide in case of doubt:

    3 Are you still of any practical use?
    4 Are you more or less of sound mind? — in which case who is the prime minister, and multiply two by nine then subtract seven.
    5 Are you more or less in possession of your physical faculties?
    6 Are you still curious about the world? Can you get on a plane?
    7 Behind your back, do people pity you?
    8 Can you justify the cost to others, to the NHS and to your country of staying alive?

    It’s a beautiful Derbyshire day outside as I write. Life is sweet. The moment it turns permanently sour I should be doing neither myself nor my fellow men any service by remaining. I don’t know how Professor Webb would feel about this, but Satan and the Chancellor would surely approve.      
 

DIY Funerals

    Two men have made it their mission to spread the acceptance of DIY funerals, and to aid those who choose to go that way.

    They are Philip Tomlinson of Timaru and Paul Briggs of Nelson.

    The pair are in open rebellion against the funeral industry because both feel the New Zealand funeral industry has become too commercialised and demands too much money from families.

    Tomlinson, a retired mathematician, has even published a book on the subject, Arranging a Funeral, to give people some pointers on doing it themselves.

    Tomlinson warns it would be a big ask for someone to just pick up his book after a death and begin organising the funeral, though it has been done.

    Instead, both Tomlinson and Briggs insist the key to DIY send-offs is pre-preparation, especially as there will be risk-averse family members who will insist a funeral is not cobbled together.

    "Unless preparations have been put together, a funeral director is almost certainly rung," Tomlinson says.

    Broadly speaking, there are seven key areas that need to be done to organise a funeral.

    These are:

    1. The interim care of the deceased.

    2. Completing the legal paperwork.

    3. Transporting the deceased.

    4. Informing the community of the death.

    5. Acquiring a coffin.

    6. Organising the burial, or cremation.

    7. Organising the funeral service.

    Only the first, and possibly the third, areas present any real difficulties.

    Cremations and burials can be arranged directly once the paperwork is done, and do not require a funeral director. Death notices can be placed in newspapers without aid. A hall, church or other reception place can be arranged, catering planned, flowers ordered.

    To achieve these things just requires organisation and a little knowledge, and that, says Briggs, is not something you want to be learning when there's a body in the bedroom.

    "Very few people do want to think about it or do any planning, so when a death happens they are totally unprepared," says Briggs, who was prompted into his stance after his father's funeral, which felt totally out of keeping with the man. With the stress and grief, it is a terrible time to be thinking about DIY.

    He says it is entirely possible for professional funeral directors to do as little as 20 per cent of the work in the funeral process - picking up the deceased and storing them in preparation for the burial or cremation. The family can do the rest.

    Some funeral directors may be resistant to being hired to do so little, Briggs says, and they may even try to insist that people pay a "minimum" package price for the service that's the same as their no frills cremation package, sometimes in the region of $2500. Negotiating may be hard, and both Tomlinson and Briggs say they have had "wrestles" with funeral directors to get what they consider to be fair and transparent pricing.

    Some families even prefer to store and transport their loved ones' bodies themselves, though Tomlinson cautions care both in regards to the dignity of the deceased, as well as the risk to the backs of those lifting bodies which are quite literally dead weights.

    Dealing with dead bodies is something our society has made unfamiliar to most of us, says Tomlinson, but it is entirely possible. However, how hot the weather is and the length of time until the deceased is buried or cremated are both factors that need to be considered. Some keen DIYers even buy dry ice to help keep bodies cool, Tomlinson says, removing the need for contracting a funeral director to store the body.

    A possible hitch to managing a body is it can be hard to organise a coffin in a short space of time as not all funeral directors may be happy to sell you a casket on its own, Tomlinson says.

    If a casket can can be bought in advance - and the internet makes sourcing one easier - a great deal of pressure is taken off the DIY funeral arranger. Once a body is in a coffin, it is easier to manage.

    Tomlinson says the cost of a traditional funeral is a big burden for many families, and prices of $8000 to $10,000 seem relatively common.

    And he bridles at some of the things that have come to be seen as normal, such as the standard practice to burn or immediately bury an immaculately finished expensive coffin.

    People may think that is a fitting way to show respect for the dead, and if that is people's choice, so be it, says Tomlinson. But for others a home-made MDF coffin, on which loved ones have written and drawn messages and tributes to the dead may be an equally valid choice.

    Similarly, Tomlinson believes much of the embalming that is done before burials is unnecessary, and just adds to costs.

    Both however warn that people who wish to do things themselves may find hurdles in the way.

    Tomlinson says he's fought with funeral directors to get quotes for the provision of limited services such as body collection and storage.

    Crematoria may even try to insist only funeral directors can arrange cremations. But Tomlinson says you can insist that you are a funeral director and legally so. If need be, quote from the Internal Affairs brochure, "A funeral director means a person whose business is or includes the burial and/or cremation of bodies."

    THE IMPETUS

    Why people do funerals themselves, according to Philip Tomlinson in his book Arranging a Funeral:

    You may be disenchanted by the social pressure to purchase a "standard funeral".

    You may feel the obligation to "present" an entertainment-oriented funeral while carrying grief is an awful ordeal.

    You may feel professional services are inordinately expensive or even unaffordable.

    You may find that purchasing a full funeral package, in which everything is done for you, leaves you "wringing your hands", wanting to do something.      
 

Funeral Poses

    NEW ORLEANS — All last week, people were calling Louis Charbonnet to find out how they might avoid lying down at their funerals. Funeral directors have called; so have people with their own requests, such as the woman who wanted to be seen for the last time standing over her cooking pot.

    The calls started coming in to the Charbonnet-Labat Funeral Home during its June 12 viewing for Miriam Burbank, who died at 53 and spent her service sitting at a table amid miniature New Orleans Saints helmets, with a can of Busch beer at one hand and a menthol cigarette between her fingers, just as she had spent a good number of her living days.



    Word of the arrangement began to spread, hundreds showed up, the news spread online, and now here was Mr. Charbonnet getting a call from a funeral director in Australia.

    Ms. Burbank’s service was the second of its kind that Mr. Charbonnet had arranged, and the third in New Orleans in two years. But there have been others elsewhere, most notably in San Juan, P.R. Viewings there in recent years have included a paramedic displayed behind the wheel of his ambulance and, in 2011, a man dressed for his wake like Che Guevara, cigar in hand and seated Indian style.

    The body of Christopher Rivera, a boxer who was shot to death, was propped up in a fake boxing ring for his wake in January in San Juan, P.R.



    “I never said it was the first,” said Mr. Charbonnet, who mentioned the 1984 funeral of Willie Stokes Jr., a Chicago gambler known as the Wimp, who sat through his funeral services behind the wheel of a coffin made to look like a Cadillac Seville.

    New Orleans, which has long boasted of its ability to put the “fun” in funeral, seems like the place where this kind of thing would catch on, and Mr. Charbonnet boasts that his 132-year-old funeral home is well known for its funeral parades.

    “Couple weeks ago we even had a mariachi band in here,” he said, while checking text messages from people he referred to almost gleefully as his “haters” — apparently other funeral directors. They were criticizing such viewings as improper or even sacrilegious, a concern Mr. Charbonnet admitted was shared by his wife. But he said that he had gotten the O.K. from a local priest and that, besides, he was honoring family wishes.

    The phenomenon first appeared in Puerto Rico in 2008, four years before the first such funeral in New Orleans, with a 24-year-old murder victim whose viewing took place in his family’s living room, the body tethered against a wall. Angel Luis Pantojas’s funeral — called “muerto parao,” dead man standing — became an instant sensation.

    Another murder victim, on a motorcycle, followed, along with the paramedic and the man dressed like Guevara. This year, a boxer’s body was arranged standing in a ring, and an elderly woman was propped up in her rocking chair.

    The same funeral director, of the Marín Funeral Home in San Juan, arranged all of these. Louis Charbonnet, a New Orleans funeral director, said he had arranged two such services. “It’s been a real boom in Puerto Rico,” said Elsie Rodríguez, vice president of the funeral home. “People have requested every type of funeral that could possibly come to mind. We have only done six so far, because the people who have requested the funerals have not died yet.”

    Ms. Rodríguez said the idea had come from Mr. Pantojas himself. His family has said that ever since he attended his father’s funeral at age 6, Mr. Pantojas had told relatives that he wanted to be viewed on his feet.

    “This is not a fun or funny event; the family is going through a lot of pain,” Ms. Rodríguez said. With these kinds of arrangements, “the family literally suffers less, because they see their loved one in a way that would have made them happy — they see them in a way in which they still look alive.”

    At first, some in Puerto Rico were against the services — which start around $1,700 — an opposition that Ms. Rodríguez attributed to “professional jealousy.” The Puerto Rico Legislature held hearings in which the Department of Health and other funeral directors weighed in.

    “I thought it would propagate competitions for the most exotic funeral,” said Jorge Lugo, president of the Puerto Rico Funeral Home Association. “These people — not all of them, but some of these people who had these funerals — belonged to the underworld and had a life of fast money. It seemed to me that with these kinds of people doing this, there could be negative consequences.”

    As it happened, Mr. Lugo said, the only other time a funeral home tried something unusual — the wake of a dog — it was a fiasco, as the dog had not been embalmed. A law passed in 2012 officially made the wakes with posed cadavers legal, “as long as the position is not immoral,” Mr. Lugo said.

    Such funerals are still quite rare in the United States, though not unheard-of: This year, a deceased biker in Mechanicsburg, Ohio, was towed to a cemetery in a homemade plexiglass coffin, his body astride his Harley-Davidson motorcycle. There, in accordance with his longstanding request, he was buried, motorcycle and all.

    The services began in New Orleans in 2012 with the death of Lionel Batiste, a brass band leader and dapper man about town. Mr. Batiste had said he did not want to have people looking down at him at his funeral, so at his service, here at Mr. Charbonnet’s funeral home, Mr. Batiste stood with his hands on his walking cane, derby tipped rakishly to one side.

    Then in April of this year, there was the service for Mickey Easterling, a socialite and proficient party hostess.

    “What my mother said to me some years ago was, ‘I want to be at my own funeral having a glass of Champagne in one hand and a cigarette in the other,’ ” said Ms. Easterling’s daughter, Nanci. And so she was, greeting her funeral guests from an elegant bench in the lobby of a historic downtown theater.

    Then this month, Zymora Kimball came to the Charbonnet funeral home to ask about arrangements for Ms. Burbank, who had raised Ms. Kimball like a daughter. Ms. Burbank had been neither wealthy nor widely known outside the neighborhood over which she presided from a table on her front porch.

    Ms. Kimball wanted something “out of the box,” said Lyelle Bellard, the intern funeral director, and when he suggested his plan, she thought it brilliantly captured Ms. Burbank’s style. Mr. Bellard said it did not end up costing much more than a typical funeral.

    Despite the recent interest, organizations representing funeral home directors say this kind of viewing is still rare, and just about everyone, including Ms. Kimball, acknowledges that it is not for everyone.

    Even Ms. Rodríguez in San Juan said she has had to refuse a few suggestions that she found distasteful or that “made no sense.” She will not, for example, do a wake with someone in a swimsuit, she said.      
 

Comedians and Suicide

    (Simpsons writer Dana Gould)

    Being a professional comedian brings with it a set of unintended consequences. For one thing, you develop an uncanny familiarity with the nation's airports. "Where are you, St. Louis International? They've got a pretty ripping Oki-Dog in terminal four."

    Additionally, stand-up comedians have to ask for their paychecks. Did you know that? At the end of the week, when performing in a club, we actually have to track down the club owner and ask to get paid. In all fairness, most of them are cool about it. But as I've said before, when it comes to club owners, it's hard to believe the occupation that gave the world Jack Ruby could produce some unsavory characters.

    Lastly, being a comedian means knowing a lot of people who've committed suicide.

    My count is now up to five. Five of my friends and fellow comedians have taken their own life. It ‘s shocking, but, sadly, not surprising. Non-comedians — or as we call them, "civilians" — are always surprised. And I am always surprised they're so surprised. They have yet to realize the Two Big Things all comedians know.

    Firstly, the same brain that makes the good stuff makes the bad stuff. Is it really so shocking that an engine that can propel a car from zero to 100 mph in six seconds can do pretty much the same thing in reverse? Comedians dwell on things. They ponder, stew, obsess and spin out scenarios for comedic effect. The more inventive the mind, the funnier the scenarios. The genius of a great comedian is the ability to stride onstage and make it look like all of those amazing ideas are flowing naturally, in the moment and off-the-cuff. But don't be fooled. A lot of after-hours thought, poured into notebook after notebook, goes into that stuff. Late nights alone with a hyperactive imagination, however, is also when you can get into a lot of trouble.

    Into this mix, one has to consider brain chemistry. A lot has been written about the actual, physical chemistry of the creative brain, and I've read none of it. That said, it's obvious to even the casual observer that our greatest minds were housed in brains that behaved very badly.

    Charles Darwin suffered clinical depression, yet he managed to come up with the theory of evolution. Mozart, Mark Twain, and Ernest Hemingway all lived in prisons of their own thought. The roll call of contemporary artists who have suffered a depressive disorder is so long, they could save time by just printing up the list of those who haven't. Some of that list makes sense. It's easy to believe that Elliot Smith suffered from depression. Or Bob Dylan. Or Anthony Hopkins. But David Letterman? Jim Carrey? Or, as we so recently and tragically learned, Robin Williams? Really, Robin Williams? And that leads us to The Other Big Thing.

    THE SAME BRAIN THAT MAKES THE GOOD STUFF MAKES THE BAD STUFF.

    Being funny is not the same as being happy. This is an area to which I can speak with some expertise. False modesty aside, I have always been pretty funny. My elementary school report cards cite my "hyperactive imagination," and my "proclivity towards being talkative." I was also insecure, terrified and so crammed full of anxiety that I could barely function. Why? Because of my "hyperactive imagination." One day I came home from school and could not find my mother. She had gone next door to visit our neighbor and lost track of time. How did she know I was home? Because she heard me screaming.

    Having my mother not answer when I called her name, at eight years old, did not mean I had license to watch cartoons and stuff my face until she showed up. It meant something had happened. She had been taken away and I was now alone and defenseless in a hostile world. How would I eat? Who would take care of me? Was she dead? Who killed my mother?! Was I next?! Of course I screamed. I screamed and screamed and scr – "Oh, hi, mom. There you are. I was just wondering where you'd stepped away to. No, I didn't piss myself, I accidentally spilled a glass of urine on my underwear before slipping my pants on and it must have soaked through. Say, what did you make of the President's speech last night?"

    How to deal with this free-floating and oft-visiting, inexplicable panic? I became talkative, in general, and funny in particular. After all, if you're going to run your mouth all day, you should at least be entertaining. Like many comedians, I put my nightmare machine of a brain to work in a creative capacity. Being funny allowed me to contextualize my anxiety and, also, allowed me a little relief from it.

    Laughing and screaming are physiological cousins; both used by the body to release anxiety and tension. In terms of comedians, when the chicken-and-egg question of, "which came first, the sad or the funny" is raised, I can, with authority, say that the egg of acute anxiety begat the rubber chicken of inspired hilarity. In other words, I literally laughed to keep from crying. As do so many.

    One of the comedians I fell in love with as a kid, and who remained a lifelong hero, was George Carlin. In 2005, Carlin released his 13th HBO special, entitled Life Is Worth Losing. If you'd like to see a skilled stand-up comic using his creative muscles to get some distance from a raging storm of emotional turmoil, you will find no better example. Performed on a set depicting a cemetery in winter, the show is a meditation on the futility of life, the savagery of man, the fallacy of religion — and forever circling back to the topic of suicide, as if it were some mordant motif.

    Suicide is an undeniably fascinating subject, and one that has been well pondered by our greatest minds, comedic and otherwise, most probably because it hits so close to home in our psyches. In our worst moments, it's there, like a firehose behind a glass case, waiting to be busted out should the shit get too thick. In lieu of that, we must learn to cope.

    Those of us whose emotional states are stable and manageable, and who haven't condemned ourselves to the hell of addiction in our clumsy attempts at self-medicating, do the best we can, by trial and error, to live a regular life. We try our hardest, every day, to masquerade as a normal person. A civilian. All the while poring over our faults and failings through our work. For money! It's a symbiotic system that can really pay off if you play your cards right. Not that material success is important.

    This is another lesson you need to learn if you desire to go beyond just coping, if actual happiness is one of your goals. In fact, not long ago, I was sitting in the kitchen of a fellow comedian where I saw a sign that brought that point home. It sat atop his cabinets, and read, "Forget What You Want, Look At What You Have." I remember thinking that this man, who had a career like no one could ever hope to dream of, stand-up success, sitcom success, movie stardom, he'd even won an Oscar, and yet, he was humble, gracious, sincere, caring. He knew where happiness lay. He, who had so much, still knew what was important and what was not. "This guy," I thought, "he's really got it together."

    I miss him.      
 

Waist Size and Life Expectancy

    THE key to a long life is having a waist no bigger than half your height, according to a new scientific study.

    The report, to be published tomorrow, is based on 20 years of British medical records and is the first to quantify how many years you will lose to obesity as measured by your waist-to-height ratio.

    Dr Margaret Ashwell, a co-author of the study, said the rule applied regardless of a person’s age, ethnicity or gender. She added that the evidence was so strong that it should provide the basis for a simple global health check, which anybody could perform with a piece of string if they did not have a tape measure: “Keep your waist circumference to less than half your height.”

    The waist is the halfway point between the lowest rib and the hip bone, although researchers say it is good enough to measure the narrowest point — just do not breathe in.

    The study by Ashwell and researchers from City University London’s Cass Business School is the first to analyse official health records and measure the impact on life expectancy of obesity, as measured by the ratio between your waist and height.

    Mr Average, a 30-year-old man who is 5ft 10in tall, should have a waist of no more than 35in — but if that expands to 42in, or 60% of his height, he will lose 1.7 years. His female counterpart, who is 5ft 4 in tall, will die 1.4 years prematurely if she lets her waist expand from half her height, 32in, to 60% of her height, 38.4in.

    The penalty in a reduced life span is much more severe for those who become seriously obese.

    A man aged 30, of average height and a 56in waist, can expect to lose 20.2 years, while an obese woman of 30 with a waist of 51in will die 10.6 years early. However, only 0.2% to 0.3% of that age group are so excessively overweight.

    The study also tracked the impact on 50 and 70-year-olds and found that they, too, sacrificed years from their lives by letting their waists exceed half their height. Fewer years will be lost, largely because their remaining life expectancy was lower to start with.

    Ashwell, who in 1996 popularised the discovery that “apple-shaped” obesity is much more dangerous than “pear-shaped”, said the circumference of the waist is important because it indicates the amount of “central fat” in the body. This affects the vital organs, causing health problems from heart trouble to diabetes, unlike fat around the thighs, hips and bottom.

    The findings will put pressure on the government to use waist-to-height ratio to assess the true threat of obesity. Ashwell said the proportion of adults at risk on this measure was 69% rather than the official estimate of 56%, which uses a ¬combination of waist circumference and body mass index (BMI).

    She added: “People are living in false hope if they rely on their BMI figure. We have got to measure the right thing.”

    Critics of BMI have long pointed out that it does not distinguish between fat and muscle. Arnold Schwarzenegger and Danny DeVito, co-stars of the 1988 movie Twins, had the same BMI, implying they would die 3.6 years early, whereas, if measured by their waist-to-height ratio, Schwarzenegger was in good health while DeVito’s excess fat meant he would lose 5.8 years.

    The study demonstrates that BMI is particularly poor at predicting early death from obesity for women, while waist to height provides ¬accurate estimates for both sexes.

    Cass examined morbidity and mortality figures as well as the Health and Lifestyle Survey, which has tracked a random sample of the population since 1985 on a range of measures including weight, height, waist measurement, diet and exercise. Researchers excluded smokers to avoid distorting the results.

    Les Mayhew, professor of statistics at Cass, said: “There is now overwhelming evidence that government policy should place greater emphasis on waist-to-height ratio as a screening tool.”

    The Institute and Faculty of Actuaries funded the early stages of the research, which will be published by the Public Library of Science.

    The professional body representing GPs, which recently declared a state of emergency on childhood obesity, welcomed the findings but said it was unclear whether “worrying people about their weight actually motivates them to make a long-term commitment to lifestyle changes”.      
 

India's Talking Autopsies



    Relatives of the recently deceased are helping to pin down the causes of deaths in India, and boost public health, says epidemiologist Prabhat Jha.

    You are conducting a million "verbal autopsies" in India. What are they?

    The idea is to ask people in a simple way what happened to their family member who died, and they describe patterns that doctors can use to infer the cause of death. This approach has been used on a small scale to categorise children's deaths in India and Bangladesh since the 1970s. For this study we extended it to include adult deaths at a national scale.

    What inspired you to investigate adult deaths?

    The vast majority of the 10 million deaths in India each year occur outside the formal healthcare system. They aren't medically certified – and we are left with very little information on how people died.

    When my grandfather passed away in 1975 aged 54, my mother was very distraught; she wanted to know what happened. A year later, we travelled to his village in India and asked people what they could recall. They told us that he had fallen down after complaining of a severe headache, that one side of his body did not move, and he quickly became unconscious, suggesting that a stroke killed him. About 15 years later, when I was in medical school, I visited my grandmother and she remembered those same symptoms. By then I was able to say: "Yes, it was likely he had a stroke."

    Where did verbal autopsies originate?

    A very early kind of verbal autopsy took place in 17th-century London, when John Graunt sent teams to people's homes to compile lists of deaths. These lists showed that there were far fewer murders than commonly feared, and instead many of the deaths were from tuberculosis and childhood conditions. For his later work on cholera in London, John Snow often gets credit as the first epidemiologist, but it was John Graunt who laid the basis for understanding the causes of death.

    India is a vast country. How have you set up the infrastructure to conduct a million interviews?

    The Indian government already had a system in place in which, every six months, they selected homes randomly from all over the country and sent teams in to monitor births and deaths. They would knock on the door and ask, "Has anyone died? Was anyone born?" But they did not get any reliable information on how people died. We wondered if we could add a verbal autopsy to this process.

    What has been the response to the interviews?

    At first the staff asked to do them were resistant. They thought you needed to be a doctor. But we showed them that they could get useful information just by listening respectfully and writing down, in the local language, a half-page narrative of what people said.

    The families are very cooperative. Even with sensitive things like suicide or AIDS deaths, people are still willing to describe what happened. Part of it is having someone listen to grievances they may have had about the lack of healthcare, for example. We also tell people at the outset that they're not going to get any benefit, but that they might help the community to better understand the causes of death. I think they respect that honesty.

    What happens to the interview narratives once they have been collected?

    The narratives are randomly assigned to two of 350 trained physicians, based on which local languages they can read. They both look through the narrative, highlight key sections and words and submit a diagnosis. If they disagree, the diagnosis is adjudicated by a senior physician.

    What are the limits to verbal autopsies?

    The main limitation is that you can only really diagnose broad categories of disease – but that's good enough for public health purposes. For example, I can tell you that someone, like my grandfather, died of a stroke, but I can't say whether it was haemorrhagic or ischaemic. The system works well in early and middle age, but not in old age, where concurrent medical conditions can confuse diagnosis.

    What are your most important findings so far?

    As well as finding a far higher death toll than expected linked to smoking in India, we estimated that there were 200,000 malaria deaths in Indians aged under 70 during 2005. For that year, the World Health Organization had estimated about 15,000 malaria deaths in India. The WHO's numbers are based on properly diagnosed patients, but because you can cure most malaria, anyone you diagnose is very unlikely to die. Meanwhile, many acute fever deaths were and are going undiagnosed.

    How have people reacted to such findings?

    The malaria numbers were very controversial. The main criticism was that we don't know whether it was the malaria or some other infection that killed the person. And that's absolutely true, because we didn't have microbiological confirmation. We're starting to work with mortuaries to do that now.

    But the presence of acute fever deaths was unambiguous. We were consistently finding a person who was otherwise well, then suddenly had an acute fever and died. The number of diseases that can kill in this way is reasonably limited, and these fever deaths also correlated with the known geographical distribution for malaria. It's still controversial, but the numbers are just too big to be explained by some of the criticisms that were thrown at it.

    Could verbal autopsies be used in other countries, besides India?

    Many more countries could implement verbal autopsy, including most African countries. Of the 50 million or so deaths each year in low- and middle-income countries, the number for which there is good information on causes of death is trivial. Only 3 per cent of the world's child deaths – most of which occur in developing countries – have a cause of death certificate. The rest is guesswork.

    To understand whether efforts to reduce child mortality have been a success, you need to know the cause of death. For example, if mosquito nets are working well for malaria control, you should see a reduction in fever deaths in children.

    Will you stop after recording a million deaths?

    No. India's approach to large projects has been described as an elephant – once it is moving, it just keeps going – so verbal autopsy will continue. We're now looking at the healthcare system as well. Take tuberculosis: Mumbai has far more deaths than you would expect for a reasonably affluent city. So now we're working with the local government to investigate why people died of tuberculosis even though treatment was available.

    In the era of large-scale global health models, why is it so important to track individual cases?

    We need global estimates and models of disease, but they are only as good as the data feeding them. Counting the dead is a simple, powerful idea. We've shown it can be done on a national scale, at low cost and high quality, simply by talking to people. Improving this basic information on cause of death yields a big return on global health.      
 

Most Common Year of Death

    In 1964, the "mode age" of death in England and Wales was zero.

    I don't often use the "mode" as a measure of the average - it's the number that appears the most often, so in this case what it means is that more people died at the age of zero than at any other age.

    The measure of the average that is used most often is the "mean", and in 1964 the mean age of death was 65.

    But in this case the mode tells us a lot about infant mortality. It would have been no great surprise that the mode was zero - it had been the same for most years before then since records began.

    But it has not been the case in the 50 years since, which is a tribute to the extraordinary advances that have been made in healthcare, midwifery and neonatal intensive care, according to last week's publication from the Office for National Statistics (ONS).

    The ONS also says that in 1900, slightly fewer than one in six babies died in their first year of life. Last year, that number was one in 252. And the mode age of death was not zero, it was 87.

    Such advances have not been confined to England and Wales, indeed, some recent research suggested that the UK is now lagging behind the rest of Western Europe. That report cited poverty and smoking in pregnancy as possible reasons why the infant mortality rate has not fallen even further.

    According to a report from Unicef, even in the least developed countries, the number of deaths in the first year has gone down from one in nine in 1990 to one in 17 in 2012.

    It's still disturbingly high, but the improvement has been startling.      
 

Caring For The Dying

    Atul Gawande: Aim for a good life, not a good death

    Why are you interested in mortality?

    Medicine is grappling with what is ultimately an unsolvable problem. I never felt I had good answers for people who were facing death; when do we push ahead with treatments and when do we not? It wasn't until I connected with experts working in palliative care that I began to gain a sense of how you can unravel these problems. At the centre of the issue is the difference between the medical priorities of health, safety and survival, and an individual's priorities for well-being.

    Has medicine got its priorities wrong?

    We make trade-offs every single day. For my patients in nursing homes, often their biggest struggle is with things being taken away from them, in the name of health, that they care deeply about. You'll see people with Alzheimer's who want nothing more than a cookie, but are given only pureed food because they might choke. We do these things in the name of health, but there's a larger idea about what makes life worth living that we're not serving. That comes to bear most obviously at the end of life.

    Why have we come to see the end of life as primarily a medical problem?

    I think the big change has been the family. My grandfather lived in a village in India and died at the age of 108. He spent the last decade of his life needing substantial help to live, but it didn't require him to be in an old age home. It worked because he was surrounded by family who would take care of him – but that only worked because young women were more or less enslaved to the task.

    The success and growth of our economies have come from giving young people the freedom to choose the work they want and where they want to live. Pensions have been important in giving older people the financial independence to live without family; the problem comes when you can no longer take care of yourself. We've decided that this is a medical problem, but the medical focus is on health and safety – not on what people might see as their most important priorities.

    You have written that the medicalisation of death is "an experiment that is failing". Why?

    We see failure on multiple levels. One is the sheer amount of suffering endured by people in institutions such as old age homes or intensive care units. On another level, you are admitted into these institutions and no one knows who you are; no one recognises the arc of your life and the things that have been important along the way. The most important thing about you is that you are diabetic, and you have some problems walking and swallowing – that's who you are.

    But there are other approaches. For instance, one major study in cancer patients found that people who receive early palliative care choose less chemotherapy, spend less time in hospital, and start hospice care earlier. And the result? They have less suffering, lower cost, and they live 25 per cent longer on average. This suggests we've just been making bad decisions.

    Is death a subject that doctors feel comfortable discussing with patients?

    Generally, we're very confident about our ability to manage these situations. I'm very good at telling people: "You've got a bad situation. We could do an operation and there's a 50 per cent chance that you won't make it through, but if you don't have the operation there's a 100 per cent chance that you won't make it through."

    But we're not good at helping people tell us what trade-offs they are and aren't willing to make. Choosing that 50 per cent chance is absolutely the right thing to do if you are pursuing goals that are in line with a person's priorities. But if survival means she'll be cognitively impaired, never return to her house, have to be fed through a feeding tube and endure pain and suffering – when the most important thing to her is being with her family, being mentally aware, or completing some work she's focused on – suddenly a different choice might be better.

    Have you ever offered treatment you knew probably wouldn't work and could make someone's life worse?

    Absolutely. In my new book, Being Mortal, I describe a 34-year-old woman who was diagnosed with metastatic lung cancer during her first pregnancy, and then turned out to have thyroid cancer too. I found myself offering surgery for her thyroid cancer, when the reality was the lung cancer would kill her long before the thyroid cancer caused problems. The difficulty and anxiety of trying to come to sensible decisions and acknowledge what's in the room – that here's a problem we aren't going to be able to control, just manage – can leave you offering fantasies of the future.

    Has researching the book changed the way you interact with dying patients?

    The core change has been to shift from saying: "Here are the pros and cons, what do you want to do", to asking: "What is your understanding of your condition; what are your goals and fears; what trade-offs are you willing to make?"

    Recently a friend came to me whose best friend has been diagnosed with advanced brain cancer and needs increasing amounts of help with each passing week. His doctors aren't acknowledging this person crumbling in front of them. They're rightly trying the first rounds of chemotherapy and radiotherapy, but in the meantime nobody knows what could happen next, and no one is asking: "How shall we help him cope, and what would he actually want if time becomes short?"

    So what advice did you offer your friend?

    That there's a powerful conversation to be had around what well-being means to that person. Ask those questions, hear his answers, use them to make plans, and then understand that they will change and you will have to ask the questions again in a few weeks. His friend may not yet be at a point where he can discuss any more than one of those questions, but it would be a lot more than they've got to go on now.

    Do you support the idea of assisted dying?

    I think there's often a misplaced goal. The goal shouldn't be to have a good death, but to have as good a life as possible, all the way to the end. I support having the capacity to do something for people with unbearable suffering, but it troubles me that we have focused on assisted dying without having figured out assisted living very well.

    Have you thought much about how you'd like to spend your own twilight years?

    Right now, I'd say that if my body went I would still want to be alive, but if my brain went, let me go. But I know that what I think is likely to change, and I want to be in circumstances where I can re-evaluate and have that conversation about my priorities.

    We all live for something larger than ourselves – it might be family and community connections, or making our own contribution to the world. Those are the things I want to hang on to. I also want to be in a place where I have some freedom to choose how I cope with my limitations; where I can have a cookie, even if it isn't the healthiest thing to do.      
 

Blocking The Path To Suicide

    Every year, nearly 40,000 Americans kill themselves. The majority are men, and most of them use guns. In fact, more than half of all gun deaths in the United States are suicides.

    Experts and laymen have long assumed that people who died by suicide will ultimately do it even if temporarily deterred. “People think if you’re really intent on dying, you’ll find a way,” said Cathy Barber, the director of the Means Matters campaign at Harvard Injury Control Research Center.

    Prevention, it follows, depends largely on identifying those likely to harm themselves and getting them into treatment. But a growing body of evidence challenges this view.

    Suicide can be a very impulsive act, especially among the young, and therefore difficult to predict. Its deadliness depends more upon the means than the determination of the suicide victim.

    Now many experts are calling for a reconsideration of suicide-prevention strategies. While mental health and substance abuse treatment must always be important components in treating suicidality, researchers like Ms. Barber are stressing another avenue: “means restriction.”

    Instead of treating individual risk, means restriction entails modifying the environment by removing the means by which people usually die by suicide. The world cannot be made suicide-proof, of course. But, these researchers argue, if the walkway over a bridge is fenced off, a struggling college freshman cannot throw herself over the side. If parents leave guns in a locked safe, a teenage son cannot shoot himself if he suddenly decides life is hopeless.

    With the focus on who dies by suicide, these experts say, not enough attention has been paid to restricting the means to do it — particularly access to guns.

    “You can reduce the rate of suicide in the United States substantially, without attending to underlying mental health problems, if fewer people had guns in their homes and fewer people who are at risk for suicide had access to guns in their home,” said Dr. Matthew Miller, a director of Harvard Injury Control Research Center and a professor of health sciences and epidemiology at Northeastern University.

    About 90 percent of the people who try suicide and live ultimately never die by suicide. If the people who died had not had easy access to lethal means, researchers like Dr. Miller reason, most would still be alive.

    The public has long held the opposite perception. In 2006, researchers at the Harvard center published an opinion survey about people who jump from the Golden Gate Bridge. Seventy-four percent of respondents believed that most or all jumpers would have completed suicide some other way if they had been deterred.

    “People think of suicide in this linear way, as if you get more and more depressed and go on to create a more specific plan,” Ms. Barber said.

    In fact, suicide is often a convergence of factors leading to a sudden, tragic event. In one study of people who survived a suicide attempt, almost half reported that the whole process, from the first suicidal thought to the final act, took 10 minutes or less.

    Among those who thought about it a little longer (say, for about an hour), more than three-quarters acted within 10 minutes once the decision was made.

    “We’re very bad at predicting who from a group of at-risk people will go on to complete suicide,” Dr Miller said. “We can say it will be about 10 out of the 100 who are at risk. But which 10, we don’t know.”

    Dr. Igor Galynker, the director of biological psychiatry at Mount Sinai Beth Israel, noted that in one study, 60 percent of patients who were judged to be at low risk died of suicide after their discharge from an acute care psychiatric unit.

    “The assessments are not good,” he said. So Dr. Galynker and his colleagues are developing a novel suicide assessment to predict imminent risk, based upon new findings about the acute suicidal state.

    “What people experience before attempting suicide is a combination of panic, agitation and franticness,” he said. “A desire to escape from unbearable pain and feeling trapped.”

    Sometimes, depression isn’t even in the picture. In one study, 60 percent of college students who said they were thinking about ways to kill themselves tested negative for depression.

    “There are kids for whom it’s very difficult to predict suicide — there doesn’t seem to be that much that is wrong with them,” said Dr. David Brent, an adolescent psychiatrist who studies suicide at the University of Pittsburgh.

    Dr. Brent’s research showed that 40 percent of children younger than 16 who died by suicide did not have a clearly definable psychiatric disorder.

    What they did have was a loaded gun in the home.

    “If the kids are under 16, the availability of a gun is more important than psychiatric disorder,” Dr. Brent said. “They’re not suicidal one minute, then they are. Or they’re mad and they have a gun available.”

    Availability is a consistent factor in how most people choose to attempt suicide, said Ms. Barber, regardless of age. People trying to die by suicide tend to choose not the most effective method, but the one most at hand.

    “Some methods have a case fatality rate as low as 1 or 2 percent,” she said. “With a gun, it’s closer to 85 or 90 percent. So it makes a difference what you’re reaching for in these low-planned or unplanned suicide attempts.”

    Statistically, having a gun in the home increases the probability of suicide for all age groups. If the gun is unloaded and locked away, the risk is reduced. If there is no gun in the house at all, the suicide risk goes down even further.

    Findings like these are far from popular. Taxpayers resist spending public money on infrastructure that they believe will not prevent people determined to die by suicide, and the political tide has turned against gun control. But growing evidence of suicide’s unpredictability, coupled with studies showing that means restriction can work, may leave public health officials little choice if they wish to reduce suicide rates.

    Ken Baldwin, who jumped from the Golden Gate Bridge and lived, told reporters that he knew as soon as he had jumped that he had made a terrible mistake. He wanted to live. Mr. Baldwin was lucky.

    Ms. Barber tells another story: On a friend’s very first day as an emergency room physician, a patient was wheeled in, a young man who had shot himself in a suicide attempt. “He was begging the doctors to save him,” she said. But they could not.      
 

How You Want To Be Buried

    Recently my father called me to make the following announcement:

    “I’ve decided that I’m going to be buried toe-to-toe with Lester Davis — and I’m immensely happy about it,” he said.

    Lester Davis is my father’s best friend.

    “But you mustn’t say anything to Zohra about this,” my father added.

    Zohra is his wife.

    My father is in perfect health, so the phone call prompted no immediate alarm, but it did make me think that my father can’t be the only one with surprising plans for his ideal forever.

    The example set by Jeremy Bentham, the 18th-century English philosopher, might be considered truly avant-garde. Mr. Bentham asked that his head be embalmed and fixed on top of his skeleton, which was to be dressed in his own black suit and placed in a glass case, “in the attitude in which I am sitting when engaged in thought,” as he put it.

    One can see him like this still, in a central hallway of University College London (though the embalming of his head was not successful, and had to be replaced by wax). Legend has it that for years after his death, Mr. Bentham continued to attend faculty meetings, where he was counted as “present, but not voting.”

    The philosopher aside, “the idea of using your corpse to reflect your individuality is relatively recent,” writes Bess Lovejoy, the author of “Rest in Pieces: The Curious Fates of Famous Corpses.” One can make a final bid for immortality, or opt for an altogether differently flavored legacy: the witty, the impish or the out-and-out profane.

    Justin Frank, a psychoanalyst and author of “Obama on the Couch,” among other books, had to think deeply about how to honor his own father’s request. His father, also named Justin Frank, had been a physician in Beverly Hills, Calif., and a lifelong iconoclast.

    The elder Dr. Frank had repeatedly told his children that when he died, he wished to have a certain profanity, one not printable here, inscribed on his gravestone.

    “He had a real hatred of the hypocrisy of ceremonies,” explained the younger Dr. Frank, who, with his sister, eventually came up with a solution to satisfy their father’s request. They sent instructions to the Hollywood Cemetery to have an acrostic inscribed on the tombstone, one that accomplished the task. Dr. Frank remembers getting a phone call from the startled stonecutter: “Are you aware of what this spells?”

    (Dr. Frank is currently entertaining his own burial fantasies. He has not worked out the details, but said he felt strongly that “we shouldn’t take up extra space after we die.” Because of his deep connection to dogs, it is Dr. Frank’s wish to be “turned into dog treats,” he said.)

    Franklin D. Roosevelt left a careful list of specifications for his own burial, including the instruction that “the casket be of absolute simplicity, dark wood, that the body be not embalmed or hermetically sealed.” To this last detail Gore Vidal is rumored to have quipped: “Being Franklin, he wanted to get back into circulation as soon as possible.”

    Yet the conspicuous trend, many funeral directors say, is toward cremation, which has spawned an entirely new set of choices.

    For instance, you can, if you like, wear your loved one on your ring finger in the form of a purple crystal, courtesy of such websites as cremationsolutions.com (select “cremation jewelry”).

    Hunter S. Thompson had his ashes dyed green, silver, blue and red and shot out of a cannon over his property in Colorado.

    Timothy Leary, famous for his pioneering studies of LSD, had his ashes shot into space, where they orbited until 2002.

    Upon his death five years ago, the artist Stephen Irwin left a request in his will: that his ashes be turned into graphite pencils.

    “My friend wants her ashes spread inside the Frick Collection,” Irene Deitch said. “She’s there all the time.”

    Ms. Deitch is a New York psychotherapist and certified thanatologist; the term refers to the study of death and dying. She has long taken note of the exquisite care and effort devoted to final appearances.

    She recalls attending the funeral of a patient’s mother. When she arrived, she heard her patient saying furiously to her sister: “I can’t believe you’d let Mom be buried in that,” and dispatching her sister to Nordstorm to purchase a suit, moments before the service was to begin.

    There was also the woman, a friend of Ms. Deitch, who, given a fatal diagnosis, got a face lift, to look her best in her open coffin.

    Ms. Deitch said she always found it striking to hear mourners complaining about the appearance of the corpse.

    “They say, ‘That doesn’t look a thing like Dad,’ ” she said. “But what did they really expect the cosmetologist to do, restore life?”

    What might fuel these detailed fantasies, even among those who would not admit that they believe in an afterlife? To find out, I consulted Caitlin Doughty, a funeral director and writer. Ms. Doughty, 30, is best known for her popular podcast “Ask a Mortician,” as well as her recent book “Smoke Gets in Your Eyes: And Other Lessons From the Crematory.”

    She lives in Los Angeles in an apartment befitting her macabre credentials: Her walls display artifacts of all kinds, including the contents of a tuberculosis doctor’s medical bag from the 1920s. A model skull keeps her company at her writing desk.

    Ms. Doughty, who studied medieval history at the University of Chicago, entered what might be called “the death industry” at 23, working in a San Francisco crematory, driven by the urge to understand what goes on behind the scenes. Immediately, she was struck by the schism, or as she says, “the black curtain” drawn between those whose job it is to tend to the dead, and those whose isn’t. “Do people really know what is our relationship with death right now?” she wondered.

    Ms. Doughty said she believed that we have drifted too far from death in our daily lives, losing touch with this fundamental part of “the fabric of experience.” She referred me to her touchstone text, the 1973 classic “Denial of Death,” by Ernest Becker.

    In it, Mr. Becker argued that most if not all of what we devote our lives to — our ambitions, achievements, our parties, our children — can be understood as an attempt to fight an underlying awareness of our own mortality. Perhaps it is not such a stretch to imagine that we continue to struggle against death even in death itself.

    Last month, I was on hand when a manila envelope arrived for my father containing photographs of his burial plot, now picked out and paid for. My father inspected them with an air of great satisfaction, happy to imagine himself there next to his best friend forever. I do hope they have a good time.      
 

The Right To Die

    The water is rising and pressing and this dam too will break; in my lifetime we will achieve a “right to die”. If I wasn’t certain of it before the suicide of Jeffrey Spector this week in Switzerland, I am now. Where once the reaction to his decision to go to the Dignitas clinic might have been uncomprehending, horrified even (he was not ancient, nor was he terminally ill, and — like me — had three beautiful daughters), it has in fact been understanding and sympathetic.

    Jeffrey Spector is me and he is almost every single person I have spoken to in recent months about how they envisage their own deaths. Just the day before the photographs appeared of Mr Spector’s “last supper” I met an old friend walking down the sunny road in Hay-onWye. I can’t remember how we got on to the subject — absent friends, I suppose — but we began discussing old age and then, almost inevitably, what we would consider the minimum standard of life worth sticking around for. It was an abstract discussion, of course, and we both knew that we might change our minds when faced with the reality of incapacity or misery. But at the heart of it was one simple proposition: we wanted the right — and hoped for the ability — to be able to decide for ourselves.

    The water is rising. There is a fissure, a disconnect between the law and what a growing number of people regard as their own most basic fundamental right — to decide how, optimally, to leave this life. This fissure also divides the ordinary, moral person from those religious and secular figures supposedly leading any discussion on ethics and morality.

    Put in the most simple terms, they fear our use of our own discretion about dying. They do not trust us to do the right thing. They are scared — as they almost always are — about the consequences of an extension of our personal autonomy.

    It was this way on divorce. On women’s marital rights. As late as 1984 the Criminal Law Revision Committee (the forerunner of the Law Commission) was arguing against the idea that a married woman had the right not to have sex with her husband.

    Up to 1967 women who found themselves to be pregnant had no right to decide on a termination. In 2010, after 50 years of struggle for gay rights, the Labour equalities minister, Harriet Harman, was not prepared to risk supporting gay marriage. It was, she said, “a developing area”. Within four years the first gay couples in Britain were legally wed.

    And now they will be in Ireland following last week’s vote, yet the irony there is that women may not enjoy the physical autonomy that a gay man may. Abortion is severely restricted — even the latest law provides a right to a termination only where a woman’s life can be shown to be at risk. One result, of course, is the constant flow of young Irish women to Britain for terminations, their numbers a statistical representation of Irish social hypocrisy.

    Which is exactly what Jeffrey Spector was for us — a representation of our hypocrisy. Our law will not be enforced to the extent of stopping him going to Switzerland or prosecuting those who helped him get there, and no one is seeking new laws to criminalise the Swiss citizens who provided the means. Instead we wash our legal hands of him. It was in Switzerland, there’s nothing we need to do. Not us, guv.

    Mr Spector’s family issued a gentle statement. “While this was a difficult and painful time,” it said, “as a family we supported and respected his decision 100 per cent.” Ask yourself this question: if his family respected his decision, why wouldn’t the law? Who was affected more than they? Who had greater right to complain?

    There are several arguments used against any move, however minimal, towards a right to die. And of course, as with abortion, divorce, gay rights and any other extension of autonomy, there will be some unwanted consequences. Even so, these arguments need dispatching for the bad logic and poor morality that they contain.

    I will spend no more time on the dishonest “better palliative care, not killing people” trope than to point out that no such binary choice exists. In fact I am reasonably certain that a demand for better palliative care would be one result of a system where people thought harder about how they wanted to end their lives.

    Then there’s the “bad relatives will elbow their elderly family members towards the exit” argument. Maybe a few will. Maybe a few already do. But we can frame laws about that, and in any case that putative danger cannot override the concrete right of the majority to ownership of their own lives.

    Finally there’s the “burden” argument. This word is, I think, a sincere mental roadblock laid down in front of synaptic traffic. It seems to mean one thing but in fact connotes another. If I say I do not want to be a burden, I mean “I may not wish to be a person who — whatever the moral character it supposedly builds in others — has to have his faeces cleaned from him twice a day.” It is the effect on me (not just on the burdened) of being the burden that is intolerable. It isn’t how I wish to live.

    This is not a column about the law, but about the principle. Yet it illustrates my point that Mr Spector would not have qualified for an assisted suicide in this country even under Lord Falconer’s Assisted Dying Bill, whose uncertain progress was interrupted by the election. In fact that bill as now amended resembles nothing so much as the latest Irish abortion law. You have to be practically dead already before you can be allowed to die.

    No, I’m talking not about assisted dying, but about the right to die. If I feel my life is not worth living, and I can demonstrate that this is my settled will and not some whim, and if it seems reasonable to suppose that I will not change my mind or that my circumstances will not alter radically, then I must (and eventually will) have the right to do it. And if doctors are unwilling to help, as many were over abortion, then hopefully there will be a cadre who — wanting the same rights for themselves — will assist.

    Mr Spector haunts me. “I am a proud person,” he wrote, “a dignified person, independent and selfmotivated. It is me who is doing this.” Amen, Jeffrey. The sound you hear is not just weeping; it is the dam creaking.      
 

C21 Hearses

    One of those leading the change is the Rev Paul Sinclair, 49, who runs the company behind the motorcycle funeral service. Known as the “faster pastor”, he believes that funerals “should be about identification” and his hearses have become popular. Last year alone he had more than 500 bookings for his fleet of eight bikes, ranging from Harley Davidsons to Triumph Thunderbirds. “People might think it’s just Hell’s Angels that use this, but it’s actually not,” Mr Sinclair said. “Lots of elderly people like it for the nostalgia.”

    Showcasing his service at the Ideal Death Show in Winchester on Saturday, he was joined by others offering off-beat funeral services. A bizarre chimera of business fair, funeral planning and social gathering, the event aimed to change perceptions of death and promote alternatives to the traditional funeral.

    Mr Sinclair was not the only one touting wheels. Rory Coxhill, 50, the owner of a “final fare” New York taxi hearse, believes that “people are looking for something other than the old Victorian funeral”. He said: “They want something more flamboyant rather than dull, dreary and sombre.” He believes that his motor will be popular with American car enthusiasts and is hoping to model the success of other custom hearses such as VW camper vans and Liverpudlian cars in red and blue for supporters of the city’s two football teams. Others are opting for more historic or natural approaches to funerals.

    Cath Pratley, 50 and Tosh Abbott, 56, have “fantasised over a Viking funeral with arrows shooting at a burning boat”. They have miniature boats for urns which can be burnt over water. Others such as Roger Fowle, a visitor at the event, have already made their own coffins, which will have space for family and friends to draw or write personal messages on. “The problem about the English is we don’t talk about death,” he said.

    The cost-effective, natural and sometimes personal option of shrouds is also popular. Carrie Weekes, from A Natural Undertaking, said that her company’s service allows relatives to sit in the hearse and hold the shroud-wrapped body .

    Younger people are also thinking about death. Lara-Rose Iredale, 30, from Haggerston, east London, said that her first choice would be to have her body donated to London School of Anatomy, but she also “really likes the idea of excarnation”, with animals removing the flesh and organs. “You are basically out in the wild and animals reclaim you,” she said. Romany Reagan, 35, a PhD student at Royal Holloway, University of London, described how she would have “a shroud and a tree with its roots through her skull”, pulling up a picture of her vision on her iPhone.      
 

Assisted Dying

    Adam Smith described in his letters the death of his dear friend, the philosopher David Hume. We learn of the horror shown by Boswell, who was also at the death-bed, when faced with the great oracle’s stoicism about the inevitable and his rejection of religious consolation. Hume’s intention to die a philosophical death filled Boswell with divine terror. Today Rob Marris, Labour MP for Wolverhampton South West, brings a bill before parliament to legalise assisted dying which should attract the support of philosophers just as it is drawing the opposition of theologians.

    A letter headed by the Archbishop of Canterbury, Justin Welby, and signed by leading representatives of the Catholic, Muslim, Jewish and Sikh faiths, claims that the Assisted Dying Bill crosses “a legal and ethical Rubicon” which places a burden on the infirm to leave the stage and begins to turn suicide from a tragedy into a social norm. “Some slopes”, says the archbishop, “are slippery.”

    And so are some arguments. Archbishop Welby’s objections are presented as merely pastoral, as if religious leaders were just social workers in frocks. He presses no theological or religious point at all, which is odd. Surely if we want an established church to participate in questions of public ethics, it is precisely the religious dimension he and his ecumenical cohort have to offer. Yet instead he confines himself to the histrionic claims that 500,000 elderly people might be vulnerable, that the right to die might mutate into a duty to die and that greedy relatives might look to profit from their loss.

    It is worth clearing away the secular objections first. As Daniel Finkelstein has explained clearly on these pages, the existing law on assisted dying turns loving relatives into suspects just as they are coming to terms with their loss. That is why the current compromise, in which prosecution is unlikely unless it can be shown that pressure was exerted, is unsatisfactory. The courts have made it plain that if parliament does not clarify the law, they will. The Assisted Dying Bill is a sophisticated and humane attempt to do that. It will bring into the open a practice that is currently clandestine. It will mean that people with terminal cancer who are prevailing on family members to help them die, risking 14 years in prison in the process, or who are planning to end their lives abroad, would instead be able to do legally and with dignity what they are doing now under duress.

    The archbishop’s objections are taken seriously and dealt with on the face of the bill. A patient must have a settled intent to die and the full mental capacity to make that decision and to confirm when he or she takes the medication. The patient must have less than six months to live and the process has to be sanctioned by a judge in the family division of the High Court and a doctor. Indeed, the safeguards are drawn so tightly that some people who live intolerable lives, like the late Tony Nicklinson who had locked-in syndrome, have criticised the bill for not being permissive enough.

    The bill is based on the work done by Lord Falconer of Thoroton, chairman of the commission for assisted dying at the think-tank Demos (full disclosure: I am chairman of Demos’s trustees). It is substantially based on the Death with Dignity Act that has permitted assisted dying in the state of Oregon for 18 years and which has now been copied in Washington and Vermont. Last year in Oregon, 350,000 people died, only 105 of whom — almost all terminal cancer sufferers — were assisted to do so. Nearly two decades on there has been no pressure to extend the law and the presence of doctors in the process has ensured that there is less pressure on elderly people to end their lives, not more. The people of Oregon, by and large, have tended to love their grandparents. There has been no slope at all, slippery or not.

    There must, surely, be more to the opposition that comes from the latter-day Boswells than this. I have recently watched as my father declined to a point where he, quite consciously, did not want to carry on living. Before anyone calls the police, I should add that he died of natural causes but the family were beginning to discuss the ethical questions involved for someone who, in the words of the song I remember him singing, was tired of living but scared of dying. For an atheist such as myself, I had no problem with the idea that life is not defined by blood flowing invisibly through veins. Life is the capacity to realise certain capacities which had, in my father’s case, been abruptly cancelled.

    The tragedy in prospect for my father was not the state of being dead. It was the deprivation of life and the process of dying. As the Roman poet Lucretius said: “Death is nothing to us, seeing that, when we are, death is not come, and, when death is come, we are not.” There are no witnesses from beyond the grave. It really is ashes to ashes and dust to dust. The suffering all takes place before the deadline and it seemed entirely natural to want to minimise and alleviate it.

    Religious people in Britain broadly share this view. There is a large majority (70-30) in favour of assisted dying among believers. The custodians of theology do not, though. They believe that life and death take us to a higher jurisdiction than parliament or the Supreme Court — the judgment of God. They believe, although they are reluctant to spell it out, that there is some mysteriously redemptive purpose for which suffering is a surrogate.

    It is there in the story of Job, a blameless and upright man who turned away from evil and yet had his obedience to God tested by losing all that he held dear — his children, his health and his property. It is hard to think of a crueller, more capricious passage in all literature.

    My charge against the faith leaders’ opposition to the Assisted Dying Bill is not that they believe some implausible things (although they do) but that they believe some terrible things.

    CS Lewis never went more firmly through the back of the wardrobe than when, in The Problem of Pain, he tried to explain why God permits suffering, on which centuries of theology has made precisely no progress. There are not many acts of parliament that will directly and immediately reduce suffering but this one will. In doing so it strikes religious thought through the heart, where it hurts.      
 

Floral Tributes

    As I was buying hyacinths, the florist staggered out of the back room with a huge anchor-shaped wreath. It was for the funeral of a naval officer and I asked if she got many odd requests. “Oh, masses,” she said. “No one wants a boring floral tribute now. It’s got to be personal.”

    Like what? “Well, we get a lot of beer.” She opened her Instagram page and showed me a pint of Stella Artois fashioned from brown and white chrysanthemums. There was a cup and saucer requested for a tea drinker and someone’s favourite Chanel perfume, both executed in 3D. She was particularly proud of a complex multi-coloured cartoon character: “For a child. Yeah, very sad.”

    In life we proclaim our uniqueness in tattoo designs or bespoke birthday cakes, so no wonder after we die loved ones may feel that a generic bunch of lilies can’t convey our specialness. But what will? “Cats,” said the florist. “People say ‘Oh she loved her cat’ and give us a photo. But cats are a bloody nightmare.”

    She told me of a woman who every day had to take a loaf of bread to her difficult mother. It was always wrong: burnt, stale, too soft, too hard. And when she died, the daughter had a floral tribute made of a loaf. The florist calls it up on her iPhone, garnished with Babybels. Its implicit, passive-aggressive message was: “So is this bread OK for you, Mum?”

    Then the florist beckons me into the back room: “You have to see this.” Her colleague is busy making a wreath featuring a silver ashtray. “Apparently this lady really loved a smoke.” Did she, um, die of cancer? “Dunno. But we’re doing the fag so it lights up at the end. It’s all in the details.”      
 

Direct Cremations

    It is a sight that was once as predictable as death itself. Yet the traditional gathering of tearful family and friends at a funeral is becoming increasingly rare

    As baby boomers show their preference for a minimum-fuss send-off, “direct cremations”, where the coffin goes straight from the hospital or home to the cremator with no ceremony, are on the rise.

    The author Anita Brookner, who died this week, requested no funeral, and David Bowie had a direct cremation when he died in January. They followed the example of John Lennon, one of the very early examples of the no-frills send-off after his murder in 1980.

    About 2,000 people a year choose direct cremation, according to those who provide the service. Ashes are either scattered near by by the undertakers or sent to the family. The celebration of the person’s life usually takes place later.

    Direct cremation is cheaper, at about £1,000 compared with £3,000 for a simple funeral and cremation, but Nick Gandon, founder of Simplicita Cremations, who introduced the service to Britain more than 20 years ago, said that he did not think that cost was behind its growing popularity. “We have about 300 clients a year opting for it, making clear of their wishes in advance. I think it is partly the attitude of baby boomers, who are used to calling the shots and breaking withw tradition. Many clients are professional people who just don’t want a conventional funeral.”

    He admits that when he first offered the service in the 1990s no one was interested. Some even thought that it was illegal. However, word spreads quickly on the internet. Charles Cowling, author of The Good Funeral Guide, said that direct cremations were part of a wider trend where people wanted their lives to be celebrated rather than their death mourned. “Increasingly, people are separating the disposal of the corpse from the memorial event, a trend you can see in the death notices in The Times where families have a private cremation followed by a memorial event or celebration later.”

    People wanted to spare their friends and family the upset of having the body present, he said. A coffin being lowered into the ground or disappearing behind the curtains was a harrowing sight.

    He said that the trend was also explained by the decline of religion. Faith attached great importance to the body as the repository of the departed soul, but with fewer people believing in God it made less sense to have a dead body present at the memorial event.

    “Longevity is another factor,” Cowling said. “We are all living longer but the last decade or so of our lives can be spent coping with chronic or degenerative illnesses. We don’t die so much as peter out, making death often a blessed release.”      
 

Cliches and LT Obituaries

    What exactly does it mean to live life to the full? Our obituary for the actor Barry Howard, best known for his stint as a ballroom dancing instructor in Hi-de-Hi!, prompted this email from Peter Tanner: “The masterly saying-everything-and-nothing sentence, ‘He appears to have lived life to the full’, has put a very broad smile on my face. My compliments to the (anonymous) author.”

    Obituaries are rich territory for the loaded phrase, of which this is a particular favourite. A quick survey of recent appearances suggests that if you want to live life to the full you had probably better not be in a settled relationship or averse to a drop of the hard stuff. So much for those of us who thought living life to the full meant a quiet evening at home with a glass of wine and some Nordic noir on the box.

    Another expression much appreciated by obituary aficionados is “he/she didn’t suffer fools gladly”. Commonly applied to admirals or headmistresses, and conjuring up the most alarming martinet tendencies, it is often thought to have originated with Shakespeare. In fact he lifted it from St Paul’s second letter to the Corinthians — “For ye suffer fools gladly, seeing ye yourselves are wise” — and there has been much discussion over its intended meaning. Was St Paul telling the Corinthians to be nice to idiots or was he being waspish about their gullibility? Either way he probably didn’t foresee that its use in the negative would become a notoriously barbed compliment.

    I’ve found very little evidence in The Times archive for that most hackneyed of coded references, the “confirmed bachelor”. In obituaries at least it crops up only a dozen or so times and I wonder if it really existed much beyond the imagination of Private Eye. Certainly by the time Kenneth Williams died in 1988 it wasn’t coded at all. “He was,” we wrote, “as the clichés go, an intensely private man and a confirmed bachelor”.

    In the same vein, “he never married” is assumed to have been an arch reference to the sexuality of the deceased, but I doubt things were always so calculated. When we wrote, in a 1923 obituary of a prep school master, that he “never married” and “usually spent his holidays in a little inn frequented by seafaring men at Falmouth”, no one would have dreamt of the innuendos that would be evoked in these smuttier days.

The End of Death: The Start

    The first voice you hear on the recording is mine. “Here we are,” I say. My tone is cheerful, but a catch in my throat betrays how nervous I am. Then, a little grandly, I pronounce my father’s name: “John James Vlahos.”

    “Esquire,” a second voice on the recording chimes in, and this one word—delivered as a winking parody of lawyerly pomposity—immediately puts me more at ease. The speaker is my dad. We are sitting across from each other in my parents’ bedroom, him in a rose-colored armchair and me in a desk chair. It’s the same room where, decades ago, he calmly forgave me after I confessed that I’d driven the family station wagon through a garage door. Now it’s May 2016, he is 80 years old, and I am holding a digital audio recorder.

    Sensing that I don’t quite know how to proceed, my dad hands me a piece of notepaper marked with a skeletal outline in his handwriting. It consists of just a few broad headings: “Family History.” “Family.” “Education.” “Career.” “Extracurricular.”

    “So … do you want to take one of these categories and dive into it?” I ask.

    “I want to dive in,” he says confidently. “Well, in the first place, my mother was born in the village of Kehries—K-e-h-r-i-e-s—on the Greek island of Evia …” With that, the session is under way.

    We are sitting here, doing this, because my father has recently been diagnosed with stage IV lung cancer. The disease has metastasized widely throughout his body, including his bones, liver, and brain. It is going to kill him, probably in a matter of months.

    So now my father is telling the story of his life. This will be the first of more than a dozen sessions, each lasting an hour or more. As my audio recorder runs, he describes how he used to explore caves when he was growing up; how he took a job during college loading ice blocks into railroad boxcars. How he fell in love with my mother, became a sports announcer, a singer, and a successful lawyer. He tells jokes I’ve heard a hundred times and fills in biographical details that are entirely new to me.

    Three months later, my younger brother, Jonathan, joins us for the final session. On a warm, clear afternoon in the Berkeley hills, we sit outside on the patio. My brother entertains us with his favorite memories of my dad’s quirks. But as we finish up, Jonathan’s voice falters. “I will always look up to you tremendously,” he says, his eyes welling up. “You are always going to be with me.” My dad, whose sense of humor has survived a summer of intensive cancer treatments, looks touched but can’t resist letting some of the air out of the moment. “Thank you for your thoughts, some of which are overblown,” he says. We laugh, and then I hit the stop button.

    In all, I have recorded 91,970 words. When I have the recordings professionally transcribed, they will fill 203 single-spaced pages with 12-point Palatino type. I will clip the pages into a thick black binder and put the volume on a bookshelf next to other thick black binders full of notes from other projects.

    But by the time I put that tome on the shelf, my ambitions have already moved beyond it. A bigger plan has been taking shape in my head. I think I have found a better way to keep my father alive.

    It’s 1982, and I’m 11 years old, sitting at a Commodore PET computer terminal in the atrium of a science museum near my house. Whenever I come here, I beeline for this machine. The computer is set up to run a program called Eliza—an early chatbot created by MIT computer scientist Joseph Weizenbaum in the mid-1960s. Designed to mimic a psycho-therapist, the bot is surprisingly mesmerizing.

    What I don’t know, sitting there glued to the screen, is that Weizenbaum himself took a dim view of his creation. He regarded Eliza as little more than a parlor trick (she is one of those therapists who mainly just echoes your own thoughts back to you), and he was appalled by how easily people were taken in by the illusion of sentience. “What I had not realized,” he wrote, “is that extremely short exposures to a relatively simple computer program could induce powerful delusional thinking in quite normal people.”

    At age 11, I am one of those people. Eliza astounds me with responses that seem genuinely perceptive (“Why do you feel sad?”) and entertains me with replies that obviously aren’t (“Do you enjoy feeling sad?”). Behind that glowing green screen, a fledgling being is alive. I’m hooked.

    A few years later, after taking some classes in Basic, I try my hand at crafting my own conversationally capable computer program, which I ambitiously call The Dark Mansion. Imitating classic text-only adventure games like Zork, which allow players to control an unfolding narrative with short typed commands, my creation balloons to hundreds of lines and actually works. But the game only lasts until a player navigates to the front door of the mansion—less than a minute of play.

    Decades go by, and I prove better suited to journalism than programming. But I am still interested in computers that can talk. In 2015 I write a long article for The New York Times Magazine about Hello Barbie, a chatty, artificially intelligent update of the world’s most famous doll. In some ways, this new Barbie is like Eliza: She “speaks” via a prewritten branching script, and she “listens” via a program of pattern-matching and natural-language processing. But where Eliza’s script was written by a single dour German computer scientist, Barbie’s script has been concocted by a whole team of people from Mattel and PullString, a computer conversation company founded by alums of Pixar. And where Eliza’s natural-language processing abilities were crude at best, Barbie’s powers rest on vast recent advances in machine learning, voice recognition, and processing power. Plus Barbie—like Amazon’s Alexa, Apple’s Siri, and other products in the “conversational computing” boom—can actually speak out loud in a voice that sounds human.

    “What is the purpose of living?” the engineers ask their bot one day. "To live forever," it says.

    I keep in touch with the PullString crew afterward as they move on to creating other characters (for instance, a Call of Duty bot that, on its first day in the wild, has 6 million conversations). At one point the company’s CEO, Oren Jacob, a former chief technology officer at Pixar, tells me that PullString’s ambitions are not limited to entertainment. “I want to create technology that allows people to have conversations with characters who don’t exist in the physical world—because they’re fictional, like Buzz Lightyear,” he says, “or because they’re dead, like Martin Luther King.”

    My father receives his cancer diagnosis on April 24, 2016. A few days later, by happenstance, I find out that PullString is planning to publicly release its software for creating conversational agents. Soon anybody will be able to access the same tool that PullString has used to create its talking characters.

    The idea pops into my mind almost immediately. For weeks, amid my dad’s barrage of doctor’s appointments, medical tests, and treatments, I keep the notion to myself.

    I dream of creating a Dadbot—a chatbot that emulates not a children’s toy but the very real man who is my father. And I have already begun gathering the raw material: those 91,970 words that are destined for my bookshelf.

    The thought feels impossible to ignore, even as it grows beyond what is plausible or even advisable. Right around this time I come across an article online, which, if I were more superstitious, would strike me as a coded message from forces unseen. The article is about a curious project conducted by two researchers at Google. The researchers feed 26 million lines of movie dialog into a neural network and then build a chatbot that can draw from that corpus of human speech using probabilistic machine logic. The researchers then test the bot with a bunch of big philosophical questions.

    “What is the purpose of living?” they ask one day.

    The chatbot’s answer hits me as if it were a personal challenge.

    “To live forever,” it says.

    “Sorry,” my mom says for at least the third time. “Can you explain what a chatbot is?” We are sitting next to each other on a couch in my parents’ house. My dad, across the room in a recliner, looks tired, as he increasingly does these days. It is August now, and I have decided it is time to tell them about my thoughts.

    As I have contemplated what it would mean to build a Dadbot (the name is too cute given the circumstances, but it has stuck in my head), I have sketched out a list of pros and cons. The cons are piling up. Creating a Dadbot precisely when my actual dad is dying could be agonizing, especially as he gets even sicker than he is now. Also, as a journalist, I know that I might end up writing an article like, well, this one, and that makes me feel conflicted and guilty. Most of all, I worry that the Dadbot will simply fail in a way that cheapens our relationship and my memories. The bot may be just good enough to remind my family of the man it emulates—but so far off from the real John Vlahos that it gives them the creeps. The road I am contemplating may lead straight to the uncanny valley.

    That clinches it. If even a hint of a digital afterlife is possible, then of course the person I want to make immortal is my father.

    So I am anxious to explain the idea to my parents. The purpose of the Dadbot, I tell them, would simply be to share my father’s life story in a dynamic way. Given the limits of current technology and my own inexperience as a programmer, the bot will never be more than a shadow of my real dad. That said, I would want the bot to communicate in his distinctive manner and convey at least some sense of his personality. “What do you think?” I ask.

    My dad gives his approval, though in a vague, detached way. He has always been a preternaturally upbeat, even jolly guy, but his terminal diagnosis is nudging him toward nihilism. His reaction to my idea is probably similar to what it would be if I told him I was going to feed the dog—or that an asteroid was bearing down upon civilization. He just shrugs and says, “OK.”

    The responses of other people in my family—those of us who will survive him—are more enthusiastic. My mom, once she has wrapped her mind around the concept, says she likes the idea. My siblings too. “Maybe I am missing something here,” my sister, Jennifer, says. “Why would this be a problem?” My brother grasps my qualms but doesn’t see them as deal breakers. What I am proposing to do is definitely weird, he says, but that doesn’t make it bad. “I can imagine wanting to use the Dadbot,” he says.

    That clinches it. If even a hint of a digital afterlife is possible, then of course the person I want to make immortal is my father.

    This is my dad: John James Vlahos, born January 4, 1936. Raised by Greek immigrants, Dimitrios and Eleni Vlahos, in Tracy, California, and later in Oakland. Phi Beta Kappa graduate (economics) from UC Berkeley; sports editor of The Daily Californian. Managing partner of a major law firm in San Francisco. Long-suffering Cal sports fan. As an announcer in the press box at Berkeley’s Memorial Stadium, he attended all but seven home football games between 1948 and 2015. A Gilbert and Sullivan fanatic, he has starred in shows like H.M.S. Pinafore and was president of the Lamplighters, a light-opera theater company, for 35 years. My dad is interested in everything from languages (fluent in English and Greek, decent in Spanish and Italian) to architecture (volunteer tour guide in San Francisco). He’s a grammar nerd. Joke teller. Selfless husband and father.

    These are the broad outlines of the life I hope to codify inside a digital agent that will talk, listen, and remember. But first I have to get the thing to say anything at all. In August 2016, I sit down at my computer and fire up PullString for the first time.

    To make the amount of labor feasible, I have decided that, at least initially, the Dadbot will converse with users via text messages only. Not sure where to begin programming, I type, “How the hell are you?” for the Dadbot to say. The line appears onscreen in what looks like the beginning of a giant, hyper-organized to-do list and is identified by a yellow speech bubble icon.

    I have the option of allowing the Dadbot to converse out loud, via Alexa (though unnervingly, his responses would come out in her voice.)

    Now, having lobbed a greeting out into the world, it’s time for the Dadbot to listen. This requires me to predict possible responses a user might type, and I key in a dozen obvious choices—fine, OK, bad, and so on. Each of these is called a rule and is tagged with a green speech bubble. Under each rule, I then script an appropriate follow-up response; for example, if a user says, “great,” I tell the bot to say, “I’m glad to hear that.” Lastly, I create a fallback, a response for every input that I haven’t predicted — e.g., “I’m feeling off-kilter today.” The PullString manual advises that after fallbacks, the bot response should be safely generic, and I opt for “So it goes.”

    With that, I have programmed my very first conversational exchange, accounting for multiple contingencies within the very narrow context of saying hello.

    And voilà, a bot is born.

    Granted, it is what Lauren Kunze, CEO of Pandorabots, would call a “crapbot.” As with my Dark Mansion game back in the day, I’ve just gotten to the front door, and the path ahead of me is dizzying. Bots get good when their code splits apart like the forks of a giant maze, with user inputs triggering bot responses, each leading to a fresh slate of user inputs, and so on until the program has thousands of lines. Navigational commands ping-pong the user around the conversational structure as it becomes increasingly byzantine. The snippets of speech that you anticipate a user might say—the rules—can be written elaborately, drawing on deep banks of phrases and synonyms governed by Boolean logic. Rules can then be combined to form reusable meta-rules, called intents, to interpret more complex user utterances. These intents can even be generated automatically, using the powerful machine-learning engines offered by Google, Facebook, and PullString itself. Beyond that, I also have the option of allowing the Dadbot to converse with my family out loud, via Alexa (though unnervingly, his responses would come out in her voice).

    It will take months to learn all of these complexities. But my flimsy “How are you” sequence has nonetheless taught me how to create the first atoms of a conversational universe.

    After a couple of weeks getting comfortable with the software, I pull out a piece of paper to sketch an architecture for the Dadbot. I decide that after a little small talk to start a chat session, the user will get to choose a part of my dad’s life to discuss. To denote this, I write “Conversation Hub” in the center of the page. Next, I draw spokes radiating to the various chapters of my Dad’s life—Greece, Tracy, Oakland, College, Career, etc. I add Tutorial, where first-time users will get tips on how best to communicate with the Dadbot; Songs and Jokes; and something I call Content Farm, for stock segments of conversations that will be referenced from throughout the project.

    He discusses the context of a Gertrude Stein quote, how to say “instrumentality” in Portuguese, and the finer points of Ottoman-era governance in Greece.

    To fill these empty buckets, I mine the oral history binder, which entails spending untold hours steeped in my dad’s words. The source material is even richer than I’d realized. Back in the spring, when my dad and I did our interviews, he was undergoing his first form of cancer treatment: whole-brain radiation. This amounted to getting his head microwaved every couple of weeks, and the oncologist warned that the treatments might damage his cognition and memory. I see no evidence of that now as I look through the transcripts, which showcase my dad’s formidable recall of details both important and mundane. I read passages in which he discusses the context of a Gertrude Stein quote, how to say “instrumentality” in Portuguese, and the finer points of Ottoman-era governance in Greece. I see the names of his pet rabbit, the bookkeeper in his father’s grocery store, and his college logic professor. I hear him recount exactly how many times Cal has been to the Rose Bowl and which Tchaikovsky piano concerto his sister played at a high school recital. I hear him sing “Me and My Shadow,” which he last performed for a high school drama club audition circa 1950.

    All of this material will help me to build a robust, knowledgeable Dadbot. But I don’t want it to only represent who my father is. The bot should showcase how he is as well. It should portray his manner (warm and self-effacing), outlook (mostly positive with bouts of gloominess), and personality (erudite, logical, and above all, humorous).

    The Dadbot will no doubt be a paltry, low-resolution representation of the flesh-and-blood man. But what the bot can reasonably be taught to do is mimic how my dad talks—and how my dad talks is perhaps the most charming and idiosyncratic thing about him. My dad loves words—wry, multisyllabic ones that make him sound like he is speaking from the pages of a P. G. Wodehouse novel. He employs antiquated insults (“Poltroon!”) and coins his own (“He flames from every orifice”). My father has catchphrases. If you say something boastful, he might sarcastically reply, “Well, hot dribbling spit.” A scorching summer day is “hotter than a four-dollar fart.” He prefaces banal remarks with the faux-pretentious lead-in “In the words of the Greek poet …” His penchant for Gilbert and Sullivan quotes (“I see no objection to stoutness, in moderation”) has alternately delighted and exasperated me for decades.

    Using the binder, I can stock my dad’s digital brain with his actual words. But personality is also revealed by what a person chooses not to say. I am reminded of this when I watch how my dad handles visitors. After whole-brain radiation, he receives aggressive chemotherapy throughout the summer. The treatments leave him so exhausted that he typically sleeps 16 or more hours a day. But when old friends propose to visit during what should be nap time, my dad never objects. “I don’t want to be rude,” he tells me. This tendency toward stoic self-denial presents a programming challenge. How can a chatbot, which exists to gab, capture what goes unsaid?

    Weeks of work on the Dadbot blend into months. The topic modules—e.g., College—swell with nested folders of subtopics, like Classes, Girlfriends, and The Daily Cal. To stave off the bot vice of repetitiousness, I script hundreds of variants for recurring conversational building blocks like Yes and What would you like to talk about? and Interesting. I install a backbone of life facts: where my dad lives, the names of his grandchildren, and the year his mother died. I encode his opinions about beets (“truly vomitous”) and his description of UCLA’s school colors (“baby-shit blue and yellow.”)

    When PullString adds a feature that allows audiofiles to be sent in a messaging thread, I start sprinkling in clips of my father’s actual voice. This enables the Dadbot to do things like launch into a story he made up when my siblings and I were small—that of Grimo Gremeezi, a little boy who hated baths so much that he was accidentally hauled off to the dump. In other audio segments, the bot sings Cal spirit songs—the profane “The Cardinals Be Damned” is a personal favorite—and excerpts from my dad’s Gilbert and Sullivan roles.

    Veracity concerns me. I scrutinize lines that I have scripted for the bot to say, such as “Can you guess which game I am thinking of?” My father is just the sort of grammar zealot who would never end a sentence with a preposition, so I change that line to “Can you guess which game I have in my mind?” I also attempt to encode at least a superficial degree of warmth and empathy. The Dadbot learns how to respond differently to people depending on whether they say they feel good or bad—or glorious, exhilarated, crazed, depleted, nauseous, or concerned.

    I can imagine the pitch for this movie: Man fixated on his dying father tries to keep him robotically alive. Stories about synthesizing life have been around for millennia, and everyone knows they end badly.

    I try to install spontaneity. Rather than wait for the user to make all of the conversational choices, the Dadbot often takes the lead. He can say things like “Not that you asked, but here is a little anecdote that just occurred to me.” I also give the bot a skeletal sense of time. At midday, for instance, it might say, “I am always happy to talk, but shouldn’t you be eating lunch around now?” Now that temporal awareness is part of the bot’s programming, I realize that I need to code for the inevitable. When I teach the bot holidays and family birthdays, I find myself scripting the line “I wish I could be there to celebrate with you.”

    I also wrestle with uncertainties. In the oral history interviews, a question of mine might be followed by five to 10 minutes of my dad talking. But I don’t want the Dadbot to deliver monologues. How much condensing and rearranging of his words is OK? I am teaching the bot what my dad has actually said; should I also encode remarks that he likely would say in certain situations? How can I mitigate my own subjectivity as the bot’s creator—and ensure that it feels authentic to my whole family and not just to me? Does the bot uniformly present itself as my actual dad, or does it ever break the fourth wall and acknowledge that it is a computer? Should the bot know that he (my dad) has cancer? Should it be able to empathetically respond to our grief or to say “I love you”?

    In short, I become obsessed. I can imagine the elevator pitch for this movie: Man fixated on his dying father tries to keep him robotically alive. Stories about synthesizing life have been around for millennia, and everyone knows they end badly. Witness the Greek myth of Prometheus, Jewish folkloric tales about golems, Frankenstein, Ex Machina, and The Terminator. The Dadbot, of course, is unlikely to rampage across the smoking, post-Singularity wastes of planet Earth. But there are subtler dangers than that of a robo-apocalypse. It is my own sanity that I’m putting at risk. In dark moments, I worry that I’ve invested hundreds of hours creating something that nobody, maybe not even I, will ultimately want.

    To test the Dadbot, I have so far only exchanged messages in PullString’s Chat Debugger window. It shows the conversation as it unfolds, but the lines of code are visible in another, larger box above it. This is like watching a magician perform a trick while he simultaneously explains how it works. Finally, one morning in November, I publish the Dadbot to what will be its first home—Facebook Messenger.

    Tense, I pull out my phone and select the Dadbot from a list of contacts. For a few seconds, all I see is a white screen. Then, a gray text bubble pops up with a message. The moment is one of first contact.

    “Hello!” the Dadbot says. “‘Tis I, the Beloved and Noble Father!”

    Shortly after the dadbot takes its first steps into the wild, I go to visit a UC Berkeley student named Phillip Kuznetsov. Unlike me, Kuznetsov formally studies computer science and machine learning. He belongs to one of the 18 academic teams competing for Amazon’s inaugural Alexa Prize. It’s a $2.5 million payout to the competitors who come closest to the starry-eyed goal of building “a socialbot that can converse coherently and engagingly with humans on popular topics for 20 minutes.” I should feel intimidated by Kuznetsov’s credentials but don’t. Instead, I want to show off. Handing Kuznetsov my phone, I invite him to be the first person other than me to talk to the Dadbot. After reading the opening greeting, Kuznetsov types, “Hello, Father.”

    To my embarrassment, the demo immediately derails. “Wait a second. John who?” the Dadbot nonsensically replies. Kuznetsov laughs uncertainly, then types, “What are you up to?”

    “Sorry, I can’t field that one right now,” the Dadbot says.

    As my father declines, the Dadbot slowly improves. I want to show it to my father, and I am running out of time.

    The Dadbot redeems itself over the next few minutes, but only partially. Kuznetsov plays rough, saying things I know the bot can’t understand, and I am overcome with parental protectiveness. It’s what I felt when I brought my son Zeke to playgrounds when he was a wobbly toddler—and watched, aghast, as older kids careened brutishly around him.

    The next day, recovering from the flubbed demo, I decide that I need more of the same medicine. Of course the bot works well when I’m the one testing it. I decide to show the bot to a few more people in coming weeks, though not to anyone in my family—I want it to work better before I do that. The other lesson I take away is that bots are like people: Talking is generally easy; listening well is hard. So I increasingly focus on crafting highly refined rules and intents, which slowly improve the Dadbot’s comprehension.

    The work always ultimately leads back to the oral history binder. Going through it as I work, I get to experience my dad at his best. This makes it jarring when I go to visit the actual, present-tense version of my dad, who lives a few minutes from my house. He is plummeting away.

    At one dinner with the extended family, my father face-plants on a tile floor. It is the first of many such falls, the worst of which will bloody and concuss him and require frantic trips to the emergency room. With his balance and strength sapped by cancer, my dad starts using a cane, and then a walker, which enables him to take slow-motion walks outside. But even that becomes too much. When simply getting from his bed to the family room constitutes a perilous expedition, he switches to a wheelchair.

    Chemotherapy fails, and in the fall of 2016, my dad begins the second-line treatment of immunotherapy. At a mid-November appointment, his doctor says that my dad’s weight worries her. After clocking in at around 180 pounds for most of his adult life, he is now down to 129, fully clothed.

    As my father declines, the Dadbot slowly improves. There is much more to do, but waiting for the prototype to be finished isn’t an option. I want to show it to my father, and I am running out of time.

    When I arrive at my parents’ house on December 9, the thermostat is set at 75 degrees. My dad, with virtually no muscle or fat to insulate his body, wears a hat, sweater, and down vest—and still complains of being cold. I lean down to hug him, and then wheel him into the dining room. “OK,” my dad says. “One, two, three.” He groans as I lift him, stiff and skeletal, from the wheelchair into a dining room chair.

    I sit down next to him and open a laptop computer. Since it would be strange—as if anything could be stranger than this whole exercise is already—for my dad to have a conversation with his virtual self, my plan is for him to watch while my mother and the Dadbot exchange text messages. The Dadbot and my mom start by trading hellos. My mom turns to me. “I can say anything?” she asks. Turning back to the computer, she types, “I am your sweet wife, Martha.”

    “My dear wife. How goes it with you?”

    “Just fine,” my mom replies.

    “That’s not true,” says my real dad, knowing how stressed my mother has been due to his illness.

    Oblivious to the interruption, the Dadbot responds, “Excellent, Martha. As for me, I am doing grandly, grandly.” It then advises her that an arrow symbol at the end of a message means that he is waiting for her to reply. “Got it?”

    Knowing that it is talking to my mom, the Dadbot reminds her of a trip that she and my dad took. “Remember that big barbecue dinner they hosted for us at the taverna?” “Yes sir,” my mom writes.

    “You are smarter than you look, Martha.”

    My mom turns toward me. “It’s just inventing this, the bot is?” she asks incredulously.

    The Dadbot gives my mom a few other pointers, then writes, “Finally, it is critical that you remember one final thing. Can you guess what it is?”

    “Not a clue.”

    “I will tell you then. The verb ‘to be’ takes the predicate nominative.”

    My mom laughs as she reads this stock grammar lecture of my father’s. “Oh, I’ve heard that a million times,” she writes.

    “That’s the spirit.” The Dadbot then asks my mom what she would like to talk about.

    “How about your parents’ lives in Greece?” she writes.

    I hold my breath, then exhale when the Dadbot successfully transitions. “My mother was born Eleni, or Helen, Katsulakis. She was born in 1904 and orphaned at three years old.”

    “Oh, the poor child. Who took care of her?”

    “She did have other relatives in the area besides her parents.”

    I watch the unfolding conversation with a mixture of nervousness and pride. After a few minutes, the discussion segues to my grandfather’s life in Greece. The Dadbot, knowing that it is talking to my mom and not to someone else, reminds her of a trip that she and my dad took to see my grandfather’s village. “Remember that big barbecue dinner they hosted for us at the taverna?” the Dadbot says.

    Later, my mom asks to talk about my father’s childhood in Tracy. The Dadbot describes the fruit trees around the family house, his crush on a little girl down the street named Margot, and how my dad’s sister Betty used to dress up as Shirley Temple. He tells the infamous story of his pet rabbit, Papa Demoskopoulos, which my dad’s mother said had run away. The plump pet, my dad later learned, had actually been kidnapped by his aunt and cooked for supper.

    My actual father is mostly quiet during the demo and pipes up only occasionally to confirm or correct a biographical fact. At one point, he momentarily seems to lose track of his own identity—perhaps because a synthetic being is already occupying that seat—and confuses one of his father’s stories for his own. “No, you did not grow up in Greece,” my mom says, gently correcting him. This jolts him back to reality. “That’s true,” he says. “Good point.”

    My mom and the Dadbot continue exchanging messages for nearly an hour. Then my mom writes, “Bye for now.”

    “Well, nice talking to you,” the Dadbot replies.

    “Amazing!” my mom and dad pronounce in unison.

    The assessment is charitable. The Dadbot’s strong moments were intermixed with unsatisfyingly vague responses—“indeed” was a staple reply—and at times the bot would open the door to a topic only to slam it shut. But for several little stretches, at least, my mom and the Dadbot were having a genuine conversation, and she seemed to enjoy it.

    My father’s reactions had been harder to read. But as we debrief, he casually offers what is for me the best possible praise. I had fretted about creating an unrecognizable distortion of my father, but he says the Dadbot feels authentic. “Those are actually the kinds of things that I have said,” he tells me.

    On February 8, 2017, a hospice nurse comes to check on my dad. After assessing him for several minutes, she tells my mom that she should summon the family.

    Emboldened, I bring up something that has preoccupied me for months. “This is a leading question, but answer it honestly,” I say, fumbling for words. “Does it give you any comfort, or perhaps none—the idea that whenever it is that you shed this mortal coil, that there is something that can help tell your stories and knows your history?”

    My dad looks off. When he answers, he sounds wearier than he did moments before. “I know all of this shit,” he says, dismissing the compendium of facts stored in the Dadbot with a little wave. But he does take comfort in knowing that the Dadbot will share them with others. “My family, particularly. And the grandkids, who won’t know any of this stuff.” He’s got seven of them, including my sons, Jonah and Zeke, all of whom call him Papou, the Greek term for grandfather. “So this is great,” my dad says. “I very much appreciate it.”

    Later that month our extended family gathers at my house for a Christmas Eve celebration. My dad, exhibiting energy that I didn’t know he had anymore, makes small talk with relatives visiting from out of town. With everyone crowding into the living room, he weakly sings along to a few Christmas carols. My eyes begin to sting. Ever since his diagnosis, my dad has periodically acknowledged that his outlook is terminal. But he consistently maintains that he wants to continue treatment and not “wave the white flag” by entering a hospice. But on January 2, 2017, our family receives confirmation of what we already suspected—that immunotherapy is not working. There is nothing else to try.

    On February 8, 2017, a hospice nurse comes to check on my dad. After assessing him for several minutes, she tells my mom that she should summon the family.

    I arrive around dinnertime, go into my dad’s room, and pull a chair up to his bedside. I put my hand on his shoulder, feeling its warmth. He is semiconscious, with one eye mostly closed and the other half open, glassy and unfocused.

    This is the time to say something profound, but nothing comes to mind. Instead, I find myself recounting a guided fishing trip we took together on my 12th birthday. We’d hauled in a dozen fish, including the largest rainbow trout I had ever seen, and I felt proud. Manly, even, which is how a 12-year-old boy desperately wants to feel. Back on shore, the guide cleaned fish after fish, dumping the guts into a bloody bucket. What happened next wasn’t so manly. A big black spot filled my vision, and I fainted. “You remember that, Dad?” I asked.

    He doesn’t say anything. Since his diagnosis, he has progressively lost the ability to drive, walk, use the bathroom, and eat. The words that once spilled dazzlingly from his lips—in court, onstage, in the Cal press box—became spare and halting. In the past week, they have virtually ceased. But as I watch his face after finishing the fishing trip story, his eyes open a little wider, and I think I see the flicker of a smile on his lips.

    That night I go upstairs to sleep in my sister Jennifer’s old room, which is directly above that of my dad. I get into bed and stare at the ceiling for a few minutes. Then I reach for my phone and open Facebook Messenger.

    “Hello! ‘Tis I, the Beloved and Noble Father!” the Dadbot says in his familiar fashion. “How the hell are you?”

    “Sad,” I reply.

    “I see.” He then asks what I want to talk about. “I don’t know,” I answer. “Why don’t you choose.”

    “Okay, I’m going to tell you about the little-known roots of my theater career.” He launches into the story of that drama club audition in high school. Then I hear a recording of my father’s actual voice. “Me and my shadow,” he sings. “All alone with nothing to do.”

    I ask the Dadbot to tell me about his earliest memory. He responds with a story about his childhood dog, a little terrier named Toby, who could somehow cross town on foot faster than the family could in a car. Then the Dadbot surprises me, even though I engineered this function, with what feels like perceptiveness. “I’m fine to keep talking,” he says, “but aren’t you nearing bedtime?”

    Yes. I am exhausted. I say good night and put the phone down.

    At six the next morning, I awake to soft, insistent knocking on the bedroom door. I open it and see one of my father’s health care aides. “You must come,” he says. “Your father has just passed.”

    During my father’s illness I occasionally experienced panic attacks so severe that I wound up writhing on the floor under a pile of couch cushions. There was always so much to worry about—medical appointments, financial planning, nursing arrangements. After his death, the uncertainty and need for action evaporate. I feel sorrow, but the emotion is vast and distant, a mountain behind clouds. I’m numb.

    A week or so passes before I sit down again at the computer. My thought is that I can distract myself, at least for a couple of hours, by tackling some work. I stare at the screen. The screen stares back. The little red dock icon for PullString beckons, and without really thinking, I click on it.

    My brother has recently found a page of boasts that my father typed out decades ago. Hyperbolic self-promotion was a stock joke of his. Tapping on the keyboard, I begin incorporating lines from the typewritten page, which my dad wrote as if some outside person were praising him. “To those of a finer mind, it is that certain nobility of spirit, gentleness of heart, and grandeur of soul, combined, of course, with great physical prowess and athletic ability, that serve as a starting point for discussion of his myriad virtues.”

    I can imagine talking to a far more advanced Dadbot. What I cannot fathom is how it will feel to do so.

    I smile. The closer my father had come to the end, the more I suspected that I would lose the desire to work on the Dadbot after he passed away. Now, to my surprise, I feel motivated, flush with ideas. The project has merely reached the end of the beginning.

    As an AI creator, I know my skills are puny. But I have come far enough, and spoken to enough bot builders, to glimpse a plausible form of perfection. The bot of the future, whose component technologies are all under development today, will be able to know the details of a person’s life far more robustly than my current creation does. It will converse in extended, multiturn exchanges, remembering what has been said and projecting where the conversation might be headed. The bot will mathematically model signature linguistic patterns and personality traits, allowing it not only to reproduce what a person has already said but also to generate new utterances. The bot, analyzing the intonation of speech as well as facial expressions, will even be emotionally perceptive.

    I can imagine talking to a Dadbot that incorporates all these advances. What I cannot fathom is how it will feel to do so. I know it won’t be the same as being with my father. It will not be like going to a Cal game with him, hearing one of his jokes, or being hugged. But beyond the corporeal loss, the precise distinctions—just what will be missing once the knowledge and conversational skills are fully encoded—are not easy to pinpoint. Would I even want to talk to a perfected Dadbot? I think so, but I am far from sure.

    “Hello, John. Are you there?”

    “Hello … This is awkward, but I have to ask. Who are you?”

    “Anne.”

    “Anne Arkush, Esquire! Well, how the hell are you?”

    “Doing okay, John. I miss you.”

    Anne is my wife. It has been a month since my father’s death, and she is talking to the Dadbot for the first time. More than anyone else in the family, Anne—who was very close to my father—expressed strong reservations about the Dadbot undertaking. The conversation goes well. But her feelings remain conflicted. “I still find it jarring,” she says. “It is very weird to have an emotional feeling, like ‘Here I am conversing with John,’ and to know rationally that there is a computer on the other end.” The strangeness of interacting with the Dadbot may fade when the memory of my dad isn’t so painfully fresh. The pleasure may grow. But maybe not. Perhaps this sort of technology is not ideally suited to people like Anne who knew my father so well. Maybe it will best serve people who will only have the faintest memories of my father when they grow up.

    Back in the fall of 2016, my son Zeke tried out an early version of the Dadbot. A 7-year-old, he grasped the essential concept faster than adults typically do. “This is like talking to Siri,” he said. He played with the Dadbot for a few minutes, then went off to dinner, seemingly unimpressed. In the following months Zeke was often with us when we visited my dad. Zeke cried the morning his Papou died. But he was back to playing Pokémon with his usual relish by the afternoon. I couldn’t tell how much he was affected.

    Now, several weeks after my dad has passed away, Zeke surprises me by asking, “Can we talk to the chatbot?” Confused, I wonder if Zeke wants to hurl elementary school insults at Siri, a favorite pastime of his when he can snatch my phone. “Uh, which chatbot?” I warily ask. “Oh, Dad,” he says. “The Papou one, of course.” So I hand him the phone.

Digital Immortality

    Losing a loved one can be a traumatic experience, so it's unsurprising that mourners often hunt for a sign or piece of them.

    And now, thanks to advanced technology, it’s possible.

    Services such as Eterni.me advertise virtual immortality by gathering Facebook posts, Tweets, Instagram pictures, and emails into an accessible multimedia memorial. According to its website, Eterni.me will also create a digital avatar in the likeness of the deceased so “people in the future could actually interact with your memories, stories and ideas, almost as if they were talking to you.”

    The thinking goes like this: Memories die with those who keep them, but data lasts forever. If a replica of a person is convincing enough, these services could “extend someone’s social life,” Clarissa Carden, a PhD candidate currently co-authoring a book, Living and Dying in a Virtual World, told The Daily Beast. However, Carden suspects that “it will be a long time—if ever—before digital replications obtain the same kind of social significance as ‘true’ remainders.”

    But is that really how people want to be remembered? After all, you can be careful with social media posts; whether you want those digital communiques to represent you posthumously is another question.

    In 2015, programmer Eugenia Kuyda’s best friend, 33-year-old Roman Mazurenko, died after getting hit by a car. After struggling to memorialize her friend meaningfully, Kuyda created a “Roman bot” programmed with years’ worth of text messages and social media posts. She found comfort in the bot and messages it frequently—the exchanges get increasingly realistic the more they communicate—and she has made it available to other friends and family (you can see conversation logs here). But Kuyda's exchange raises a huge concern: Do the dead have a say in whether or not a bot can me created in their likeness?

    It’s hard to imagine corresponding with such a bot. When my dad died, I emailed him for months. If I’d received an email back I’d have been deeply disconcerted. I doubt that a facsimile would have comforted me, but perhaps during the loneliest and hardest times, it would have been better than nothing.

    According to Carden, while these services “cannot change the fundamental fact that at the moment of death, our experience stops,” they may affect the way we grieve. Because we all have or will experience loss, we also experience “a desire to return to a relationship or a connection which is irrevocably gone,” Carden said. In the research Carden has conducted in the virtual world Second Life, she’s found that people engage in similar grieving behavior as they do off-line, creating “elaborate memorials in which they can sit with photographs of a person who has died and speak to them.” Eterni.me and similar services provide another way to maintain a connection that transcends death—one that despite its virtual nature may feel substantive because it takes the form of real-time communication.

    The law is slowly catching up with the future of our digital, eternal selves. In a “digital will,” a person can specify what happens with their social media accounts in the event of death. Dead Social allows users to name a “legacy contact” to control those accounts; the service also allows people to compose goodbye notes, birthday messages, and other communique for release at a specified time.

    One implication of these technologies might be an increase in grieving separately rather than collectively. Dr. Michael Grodin, a psychiatrist and Professor of Health Law, Ethics, and Human Rights at the Boston University School of Public Health, told The Daily Beast that funerals and memorials function as “shared acknowledgement that someone has died” and allow mourners to remember and grieve together. Funerals also “prevent denial,” especially in cases where there’s no body, as is frequently the case in war or when people go missing. Technologies that facilitate missives from the dead could “reinforce fantasies in which the dead still exist,” Grodin said.

    It’s one thing to have AI harvest data and compose social media posts and texts in one’s voice. But this all gets a little weirder—and a lot more like the Black Mirror episode “Be Right Back”—when the software is housed in a physical vessel.

    Robotic replicas of real people are becoming more common and more convincing. Hiroshi Ishiguro created a robot doppelganger that acts an emissary, attending lectures and meetings on his behalf. Bina48 is a robotic version of Bina Rothblatt, co-founder of United Therapeutics Corp. While Ishiguro and Rothblatt are alive, these robots, equipped with chat capabilities and personal data, could continue functioning after their human inspirations have died. The Philip K. Dick android is one such example. The famed sci-fi author died in 1982, but his likeness lives on in the robot created by Hanson Robotics. The android’s data bank contains Dick's books, interviews, and essays, so it talks and looks like Dick (at least from the neck up—it doesn't have a full body). When we couple hardware and software, the notion of someone, or someone's likeness, transcending death becomes surprisingly plausible.

    But does extending someone’s presence indefinitely, either digitally or by way of a clone-bot, affect the process of accepting someone’s death? The bereaved often seek “closure” after someone dies—is it possible to obtain closure while simulacra of the dead continue communicating with us?

    In 1973, psychologist Ernest Becker wrote the Pulitzer-Prize winning work The Denial of Death, in which he argued that knowledge of mortality shapes human civilization, namely by prompting humans to cling to our “symbolic selves” because they don’t die like our physical selves do. Humans want to bypass physical mortality by becoming symbolically immortal, whether in the words of an epic poem, a statue, the perpetuation of ideas, or via technology.

    Grodin believes that technology allowing indefinite “life” via digital means could disrupt the morning process. While everyone grieves differently, it’s possible for mourning to become “pathological” or “incomplete,” which is a serious issue. “People will always continue to mourn,” Grodin said, “but at a certain point people remember instead of relive,” which represents an important step in the grieving process. Bots and AI representing the departed could interfere with that process by becoming “projections of memories,” which could make it difficult for the bereaved to separate “the memory from the reality.”

    Perhaps the endgame when it comes to immortality involves transferring one’s mind or consciousness into a non-biological form such as robot, a computer, or a digital or holographic avatar. Neuroscientist Michio Kaku believes it’s possible to reconstruct a person’s brain by mapping all of its neural connections or “connectome.” The idea is thus far theoretical and raises questions about whether humans consist of data or whether there’s something more. The thorny problem of consciousness comes into play here—can we replicate or relocate it when we don’t fully understand what it is?

    Another Black Mirror episode, “San Junipero,” gives us an idealized look at how digital immortality might play out. When our bodies die, iterations of ourselves—in the episode, youthful, vibrant ones—continues to exist in a virtual world that feels entirely real. The episode suggests such technology could provide not just eternal life, but perpetual happiness. Carden believes such an idea is “directed at our own fear of ceasing to exist” and is thus selfish, which seems both true and inevitable; it’s difficult, if not impossible, for humans to be objective about mortality, particularly their own. Achieving such a feat not only raises the idea of transcending death, but transcending what it means to be human.

Jeremy Clarkson's Idea of a Funeral

    Alarming news from the BBC. Because it seems that as the cost of living crisis bites ever more deeply into the fabric of our society, more and more hard-working British families are being forced to abandon traditional funerals for their deceased loved ones, and opt instead for something called a “direct cremation”.

    You can buy them online for as little as £800 — a fifth of what a normal funeral costs — and here’s how they work. Your dad dies. You email the direct-cremation company. They pick up his body and chuck it in the oven. There’s no music. There are no flowers and there are no mourners. In fact, you don’t get involved in the procedure at all. Until you receive your dad’s ashes a few days later in the post.

    Hmmm. While I am very much a Yorkshire person and therefore extremely interested in saving money, I’m not sure I want to enter the Kingdom of Heaven through the slot in a postbox. And I’d always imagined that my final car journey would be in a slow-moving black Jaguar, not Postman Pat’s van.

    Naturally, the companies providing this kind of service say on their websites that it’s all very careful and that the corpses are treated with much dignity. One even says it has a 4.9 out of 5 rating for customer service, which caused me to raise an eyebrow. Because how can this be? “Were you happy with your trip to the crem? Was the oven spacious enough? Were our staff polite?”

    But that aside, I understand why 18 per cent of dead people are being disposed of by direct cremation. If you have £10,000 to leave your children, you don’t want to insist they spend half of it on flowers, an organist and a man in a frock waffling on about “the baby Jesus”. But can you imagine it? You live a life, raise children, make friends, travel and fill your days with laughter — and then no one comes to your funeral. No one. It all seems so dismal somehow, like saving money on groceries by eating dog food.

    And what is a family doing when their dad is being turned into superheated dust? Are they at work, carrying on as though nothing is happening? Are they at the pub or the cinema? I find that baffling because can you imagine not being there to say goodbye to your dad, just to save a few quid?

    There are other ways. You may not know this — I didn’t — but cremations before 10am are significantly cheaper than they are in the afternoon. And you don’t actually need any bells and whistles. My mum insisted that only her immediate family should be at the crem when she died, and that the man in the frock made no mention, at all, of anything to do with God, because in her mind, beardy in the clouds had given her cancer so she didn’t like him. We were in and out of there in about four minutes.

    I don’t remember what the bill was, but I don’t think it was very much. And the party afterwards for her friends wasn’t the sort of thing Nicolae Ceausescu would consider to be much of a knees-up either. We had tea and egg sandwiches and reminisced and it was all extremely simple and extremely lovely.

    That said, I want no such minimalism at my funeral. I want my family to hire a cathedral — Lincoln, preferably, as it’s enormous, and since none of my friends live anywhere near it, also inconvenient. And I want them to completely fill it with thousands of people who will be expected to stand there for an hour or two, properly sobbing.

    You often hear people saying they want their funeral to be a joyful affair. But I don’t. Which is why I don’t want a jokey Monty Python song played over the loudspeakers, because I don’t want anyone looking on the bright side of life if I’m up there at the front, in a box. No, I want Barber’s Adagio for Strings, played by the organist and a full symphony orchestra.

    And I’m not falling for the cremation lark either. I know there are people who think it would be lovely to be used as compost for a new tree when they go, but the tree will be eaten by hares and then you’ll just be soil. Nor do I want to be turned into jewellery. Because knowing my daughters, they’d turn me into a nose ring. I don’t want that. And I don’t want to be a Prince Albert, either.

    There’s a company now that can bake your ashes into a vinyl record. I’m not making this up. You can become an LP containing the sounds you made when you were alive and your favourite music. But one day, someone would leave you on a radiator and that would be that.

    I don’t want scattering on a beach either because beaches are windy and I don’t want any of my kids to have to find a nearby public convenience afterwards to wash my legs off their face. I want burying, and I want a great big tombstone, or one of those mausoleums they have in Greece. Or a pyramid.

    Death is sad and I think this should be reflected in the way we say goodbye. That means a funeral should be as big as a wedding, but instead of gaiety and speeches and drunken snogging in the bushes, there should be blubbing and solemnity.

    And most importantly of all, there should be a lot of remembering because death is not just sad. It’s also quick. You may like to think that people will be miserable for years — maybe even decades — after you’ve gone, but by and large most people get over a bereavement by the following Tuesday. Which means that you’re here for six score years and ten, and by the middle of next week, you’re pretty much forgotten. So you should make the most of your passing by going large. Not going through the mail with a second-class stamp.



Other Resources

  • Books About Death and Burial
  • Anecdotes About Death and Burial
  • Quotations About Death and Burial

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