Have you thought about your death? About how and where you want to die? These are the questions Australian science journalist Bianca Nogrady asks us to consider in her recent book, The end: the human experience of death. I’m not a morbid person, but when Nogrady contacted me to ask whether I’d consider reviewing her book, The end, it didn’t take me long to say yes. Like Nogrady I did witness, a couple of years ago, something I would call “a (pretty) good death”. That I felt it was so, intrigued me. I was therefore interested to read what Nogrady had to say.

And what she had to say was fascinating from beginning to end. In her introduction, she says:

This book could just as easily have been Everything you wanted to know about death but were afraid to ask. Death is fascinating, compelling, and it consists of much more than simply the end of a biological life-form. In seeking to understand death, we are seeking to understand life.

The rest of the book is structured logically according to the sorts of topics we are likely to ask about, starting with why we die, and then moving on to issues like defining death, where, when and how we die, spiritual and out-of-body experiences, and religion. Nogrady looks at these issues from all the likely points of view –  medical, sociological, psychological, philosophical, legal and ethical. She organises her information well, and the chapters (and subchapters) flow very naturally from each other.

So far, I have probably made it sound like a well-organised rather dry read – but that’s not how it is. Not only did Nogrady do a lot of secondary research (as the Notes at the end attest) but she also interviewed a lot of people. As a result, the formal information garnered from her research is supported by people’s stories, which also add colour and life to the facts. Many are of course sad – we are talking death after all – but this is not a sad book.

The most complicated section of the book is the second chapter on “Defining Death”. Nogrady takes us carefully through the different “definitions” – specifically, cardiac death and brain death (which, I learnt, can be further subdivided into “whole brain death” and “brain stem death”). She shows how the definition issue has been complicated by medical advances enabling us to keep the body alive and, of course, by the organ transplant process. Royal North Shore Hospital’s Intensive Care Specialist Dr Ray Raper suggests that death is:

a continuum; a graded box with one end as ‘being alive’ and the other end as ‘being dead’ … If you look at the domains of the transition between life and death, they’re spiritual, functional and structural and they’re biological, and the most important ones are the functional ones.

Death, in other words, is a process. If your fingernails are still growing when you are in the coffin, then, says Arizona State University Professor of Philosophy Joan McGregor, the questions needing answers relate to what are we preserving and why do we value it. I’ll leave this discussion here because there is no single solution – or not at present anyhow. This is murky ground indeed, but Nogrady manages to traverse it with clarity. I will probably have to read the book a few times though for the concepts to stick!

She also discusses euthanasia, teasing out misconceptions. She explains the differences between physician-assisted suicide, voluntary euthanasia and terminal sedation. She also explores the rise in palliative care as a profession, covering related issues like death doulas and volunteer workers in palliative care hospitals (or hospices). And of course she talks about near-death experiences, and those death-time phenomena that science can’t explain such as clocks stopping, machines behaving erratically, and deathbed visions.  The final chapter discusses faith and belief. Death is cultural, but, as she discovered, there is as much similarity as there are differences in end-of-life rituals.

It’s a funny thing to say, I suppose, but this is an enjoyable book. It’s neither superficial nor so detailed that you get bogged down. There is a lovely balance between expert opinions and anecdotes. I can imagine reading it again – or parts of it. It’s a shame, though, that there isn’t an index, which seems to be common in non-fiction books aimed at a general market. I guess it’s all about cost.

In her epilogue, Nogrady returns to her own experience, to how the death of her grandmother had caused her to want to better understand death. Writing the book, she says, made her think about “the value of planning, or at least thinking about how we want to die”. Death is, after all, a “one-way journey”. We do it alone, and it may well be, she argues, our best chance “find out who we are at the core”. One man who spent a long time thinking about his death, because he had a degenerative, terminal disease, was Australian public intellectual Donald Horne whose last book, written with his wife Myfanwy, was Dying: A memoir. He wrote:

My final drifting away, via a morphine dose, I would want to be among my memories, with Myfanwy whom I love holding my hand.

Think about your death, plan for it, is Nogrady’s final message to us. If you’re ready to take up her challenge, The end would be a good place to start.

Bianca Nogrady
The end: The human experience of death
North Sydney: Vintage Books, 2013
260pp
ISBN: 9781742752051

(Review copy supplied by the author)