The Commission has produced an authoritative, timely, and well-researched and referenced publication:

"The story of dying in the 21st century is a story of paradox. COVID-19 has meant people have died the ultimate medicalised deaths, often alone in hospitals with little communication with their families. But in other settings, including in some lower income countries, many people remain undertreated, dying of preventable conditions and without access to basic pain relief. The unbalanced and contradictory picture of death and dying is the basis for the Lancet Commission on the Value of Death. Drawing on multidisciplinary perspectives from around the globe, the Commissioners argue that death and life are bound together: without death there would be no life. The Commission proposes a new vision for death and dying, with greater community involvement alongside health and social care services, and increased bereavement support."

Among various recommendations, these resonate particularly strongly for Plenna:

• Death literacy—the knowledge and skills that people need to navigate death systems—must be developed for all.

• Education on death, dying, and end-of-life care for a person and their family must be integral, substantial, and mandatory in the curriculum of every health and social care student and continuing education for practicing professionals.

Commission website with full report 

Image copyright: jc_design/Getty Images

"Man is a worm and food for worms", yet "up in the stars"; "out of nature and hopelessly in it": "gods with anuses" and (after 2001) "a versatile ape".  Becker's psychoanalytical enquiry of our view of, and paradoxes around, death is a foundational text.

He explores how humans construct meaning to seek security and relief from anxiety around death, noting the irony of how this search is driven itself by being alive: "we must shrink from being fully alive"; a "nexus of unfreedom".  His analyses are revealing, for example on parallels between sin and neurosis, and of how some leaders exploit fears of death - and conversely how we may scapegoat them in turn "almost as an excuse" post facto for acts they may commit: "the more you fear death and the emptier you are, the more you people your world with omnipotent father-figures, extra-magical helpers".

And in terms of seeking meaning, Becker suggests "the most that any one of us can seem to do is to fashion something—an object or ourselves—and drop it into the confusion, make an offering of it, so to speak, to the life force."

This practical guide is divided into five main sections: Before, During, After, A New Way, and Conscious Living.  Blainey is “a speaker and activist in the growing death movement” and her multi-media platform Doing Death aims to “open up authentic conversations about death and dying to inspire people to live more fully.  In addition to volunteering at a local hospice in the UK, she is involved in a charity that records the life stories of terminally ill patients [and is] training to be a death doula and regularly runs a local Death Café”.

Blainey suggests we have forgotten how to ‘do’ death, and that it has become institutionalized and peripheralized the crucial elements of family and the community.  The book is written simply and emphasizes the importance of moving beyond fear to acceptance of death.  It provides a number of step-by-step checklists as well as being a “manual for living”.

Doing death, website of Amanda Blainey

This book provides a collection of personal stories and reflections by practitioners on dying, death and loss.  It is impossible to summarize but some of the quotes below give a flavour:

"Don’t cry because it’s over, smile because it happened"

(attributed to Dr. Seuss)

“Drop the outdated idea of death as a clean, sterilized man.  Death is a woman, green, smelling of rich soil and earth.  Death is where we came from and where we will all return.” (Caitlin Doughty)

“To begin depriving death of its greatest advantage over us … let us deprive death of its strangeness, let us frequent it, let us get used to it; let us have nothing more often in mind than death… We do not know where death awaits us, so let us wait for it everywhere.  To practice death is to practice freedom.”

(Michel de Montaigne)

“Death is a comma, not a full stop”

(Rev. Jonathan Woodhouse)

Gawande is a surgeon in the USA with Indian roots who reflects on how modern medicine has altered the end of life.  Treatments and technology have meant that the descent towards death is much less a sudden drop off a cliff but more a “hilly road down the mountain”.

He suggests that society is living “a modern tragedy”, where the modus operandi is to fight against death and prolong life at all cost.  “The fact that we may be shortening or worsening the time we have left hardly seems to register” with the paradox that “you live longer only when you stop trying to live longer”.

The importance of having information, guidance and choice is central to this, but Gawande suggests that the best doctor-patient relationship go beyond this and must be ‘interpretative’.  In other words, asking patients what is most important to them and what their worries are, and then offering realistic perspectives on options where there is often no optimal solution.

Illustrated with various case studies of some of his patients, and notably the last years of his father’s life, Gawande’s book is a passionate and beautifully argued call for us to die better: ultimately achieved through “not a good death but a good life to the very end”.

Book homepage

Hebb shares insights and stories from "more than one hundred thousand ... dinners in the past five years, where strangers, friends and coworkers gather around this seemingly awkward topic".

"It is as if a conspiracy of silence has settled upon us, like a curse on a village, and we have forgotten that we know how to have this dialogue about death."

Advocating for more open and broader discussions around death in the community and beyond, the evidence shows that "open conversation with your family, doctors, and caregivers about your end-of-life wishes results in better care, less suffering, and a longer life. Conversations about death have even proved to make us funnier and more willing to laugh."

The book presents a series of prompts used in death dinners and provides examples of responses.  Quoting Kyoto Mori, “Everything we say about death is actually about life.” 

Jenkinson's mystical, dense and poetic text draws on his long experience as a self-labelled 'death angel' who discussed dying and death with tens of thousands of people when he worked in palliative care.

It is deeply critical of mainstream approaches which promote 'More Time' and 'Quality of Life' following the creed 'If you can, you should', but which end up doing those involved and society few favours.  With no allusions that death is easy, he suggests we need to shift our perspective away from 'battling' to 'wrestling' with it, using humility and wonder.

The book is a radical tour de force that reflects broadly on many issues, including suggesting the typical Western fear and denial of mortality originates from "relentless and unreflective absolutism" of monotheistic religion that perpetuates an ancestral trauma of flight and homelessness.

See on Jenkinson's Orphan Wisdom site

Griefwalker documentary

Originally published in 1969, Kübler-Ross’ book provides detailed extracts from over 500 interviews she conducted with terminally ill patients when she “asked them to share … what it is like to be dying, what kind of needs, fears, and fantasies [they had, as this] tells what kind of things we can do, by which I mean family members and members of the helping professions, to be more helpful.”

She categorizes the ‘five stages’ of dying in terms of anger, bargaining, depression, acceptance and hope.  While the modern understanding of these has evolved and become more nuanced (particularly in recognizing they are not necessarily linear), a short annex of the book, ‘Guide for further discussion’ provides concise practical advice drawn from On Death & Dying as well as (written by Kübler-Ross and David Kessler) On Grief and Grieving and Life Lessons.

This calls, “try to embrace death and dying as natural parts of life, so that you are better able to face them for others and yourself when the time comes”, and categorizes suggestions in terms of communication as a caregiver, handling an illness or loss as a family, grief, unfinished business, and final support.

Leget recasts the medieval principles of Ars moriendi (‘the art of dying’) into the 21st century, elaborating the five elements of faith, hope, love, patience and humility.  While exploring different perspectives on death the book seeks to demystify it in a humane and spiritual way.

In terms of approaching and accepting the end of life, Leget frequently refers to ‘inner space’ as an important concept: “a metaphor … situated at the crossroads of spirituality, psychology, chaplaincy, ethics and social work”.  ‘Six roads’ making the concept more accessible and concrete are humour, the body, emotions, virtues, spiritual traditions, and silence.

Leget notes that “every life story can be told in a million different ways” and that “our own life story is part of the life stories of many other people”.  He is critical of purely medical models that emphasize control and relinquish responsibility to someone else, as well as neoliberal approaches which cast everyone as entrepreneurs and push us to ‘doing’ when not acting or performing may be a better course of action.  Instead, Leget proposes narrative interconnectedness and the need to embrace multiple and often contradictory meanings around death.

This extended thanatology (the scientific study of death and the losses brought about as a result) essay outlines key concepts associated with death and, increasingly in recent decades, the effects of its prolongation.

Despite the fact that ‘death cannot be believed, magicked nor scienced away’, the book explores the bureaucratization and secularization of death and taboo: death is “used, abused and greatly exaggerated”.

Lofland outlines a conceptual framework to demonstrate different angles to understand death: space, population, knowledge and stance.  She discusses the ‘happy death’ movement which emerged in the 1970s and aimed to “establish a new order of life” to address death differently: talking about it, rearranging it, and legislating it.  She suggests the movement has three structural components: immortality, positivity and expressivity.

Above all, the book underlines the importance of breaking the culture of silence around death, suggesting that engaging with the topic shows both a natural curiosity with the human condition as well as showing the benefits of ‘being prepared’ for ourselves and others close to us.

“If we had our way, along with driving lessons and sex education, we’d all get a course in death ed before leaving school”.  Miller and Berger’s tome, also subtitled Practical Advice for Living Life and Facing Death, is a comprehensive and user-friendly manual that provides practical and thoughtful guidance - providing a de facto death ed curriculum.

In 24 chapters and 5 sections (Planning Ahead, Dealing with Illness, Getting Help Along the Way, When Death is Close, and After) it explains in clear language what to expect and ‘how to’ approach and do it.  Many parts, such as the chapters on Symptoms and Hospital Hacks, or a section on how to interact with doctors, provide useful general knowledge at whatever stage of life you may be in.  Other sections emphasize the care and love that has gone into it, for example ‘13 constructive ways to cope’ and ‘How to talk to kids’.  There is also a well-stocked 30-page resources section at the end.

While the first chapter, Don’t Leave a Mess, points to the reality of the inherent messiness of human life, the book reminds us that only a small proportion of us (10-20%) will die without warning.  This means “we do have some choice about how we orientate ourselves towards the inevitable.  Where we’ll die, maybe.  Around whom.  And, most important, how to spend our time meanwhile.”

Nuland, a Clinical Professor of Surgery, wrote this book to "to demythologize the process of dying".  He provides unabashed details of how various conditions and diseases lead to death, from "old age because we have been worn and torn and programmed to cave in" to the devastating impacts of cancer and AIDS.

The role of the doctor as detective to find the cause of disease is well examined, but Nuland also speaks to how the conviction, even mission, of doctors to do more rather than less has increasingly pushed the "boundaries of medical futility" which may serve more "the doctor’s needs rather than the patient’s".  Put otherwise, "We live today in the era not of the art of dying, but of the art of saving life, and the dilemmas in that art are multitudinous".

In the 2010 coda of the book, Nuland reflects further that there should be less of a focus on payments and more on people, where doctors are increasingly labelled as ‘providers’ rather than ‘physicians’.

The book collates the teachings of Osho, the Indian mystic who died in 1990.

Osho states “death is the last taboo” and deconstructs the way many of us deny it and/or believe “it is always the other one who dies, so why be bothered”.  His teachings are critical of unquestioning belief compared to doubt and the much harder search for truth; suggesting heaven and hell are psychological and lived by many now, rather than be geographical or a destiny.

Rather than ask, “is there life after death?”, the question should be, “is there life after birth?”; we often see “death as the enemy of death” which is “absurd as death cannot be avoided”, and with this approach, “the whole of life becomes your enemy.”

Indeed, “the fear of death is fear of time.  And the fear of time is, deeply down, fear of unlived moments, of an unlived life.”

The Art of Living and Dying presents down-to-earth and everyday reflections on how we consider death and many aspects of life around it.  Ultimately it is an unadorned spiritual guide, wherever your faith or feelings, on how to better approach ‘now’ in an insightful and joyous way.

Ostaseski was cofounder of the first buddhist hospice in the USA, and in this book he distils lessons from serving thousands of people at the end of their lives.

The ‘five invitations’ are (1) Don’t wait; (2) Welcome everything, push away nothing; (3) Bring your whole self to the experience; (4) Find a place of rest in the middle of things; and (5) Cultivate don’t know mind.  Ostaseski elaborates these and shows how they are valuable at any stage of life, drawing upon his experience which also included recovering from childhood abuse.

The book outlines the importance of forgiveness and emphasizes how ‘serving’ is always mutually beneficial rather than trying to ‘help’ or ‘fix’ which imply weakness or things are broken.  While there may be endless suffering in the world, Ostaseski suggests there is also endless potential for love and compassion to respond.

The Five Invitations provides a humane manifesto arguing for a non-judgmental approach and simplicity, where we should humbly appreciate the silences and ‘in-between’ places in life.  Citing Nisargadatta Maharaj, “Wisdom tells me I am nothing. Love tells me I am everything. Between the two, my life flows.”

Book homepage

Dr. Quintana Arantes is a Brazilian doctor and writer trained in geriatics with a wide experience in palliative care.  She feels "a dignified death should be within the reach of everyone".

Her book, initially published in Brazil, has been translated into multiple languages.  In sharing multiple stories, interweaved with poetry, drawings, metaphor, and pragmatism, she affirms how end of life planning and care can improve life at all levels.

In 2010, Brazil was considered by The Economist to be the third worst country in the world to die (with 180 palliative care services compared to more than 4,000 in the USA), giving some idea of the challenge facing Dr Quintana Arantes and her dedication.

Psychotherapist Yalom considers how the universal fear of death - "our dark shadow from which we are never severed" - influences many peoples' fears, stresses and mental illness.

Presenting his own development and reflections, along with a number of case studies drawn from interactions with his patients, Yalom also refers to Epicurus and Shopenhauer.  He encourages us to follow Nietzche's words that "To become wise you must learn to listen to the wild dogs barking in your cellar".

Yalom's approach is humanist and emphasizes developing self-knowledge and seeking to live without regrets, wary that in shielding ourselves from death we may also shield ourselves from life.