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On defining a 'natural death'.

our images of death stay fresh in my mind. The first is that of an old friend who died at the age of sixty-one of cancer of the liver. He knew at least two months beforehand he was going to die, as did his family and friends. During that time he received a constant stream of visitors. They knew and he knew they were taking their leave. He was a model of gaiety and hospitality; it is hard to imagine how any dying person could have put people more at ease. When his time came, his family and many of those friends were at his bedside in his home, not in a hospital. Without any significant pain, he slipped into a coma some six hours before he died. Until then he was fully lucid. I arrived ten minutes after his death. I wept, as did everyone else there, but I could not feel that his death was "untimely"; one could only hope to die with equal grace, encircled by one's friends and family. That kind of image invites sentimentality. It was almost too perfect a death, and those of us prone to take a dark view of the world tend to be skeptical of such perfection, even when we witness it with our own eyes. But I did witness it, and the image is fresh and powerful. Naturally, his death was inevitably easier for me to bear-a friend-than for his family, those who lived with him day-in and day-out; their sense of loss was greater than mine. Yet, however great their sadness, I had no sense that they felt his death was wrong. I might add that he left his wife healthy and financially secure, his children grown and self-sufficient, and his business affairs in order. My second image is that of the funeral of the twenty-year-old son of another friend, a bright, attractive, promising boy who died with total unexpectedness of a coronary caused (it was learned during the autopsy) by an undetected congenital heart defect. It was an unbearable funeral. I have never been able to think of anything good to say for that death. My third image is that of the death of my own son, Thomas, at the age of six weeks in 1961. The cause of death, also unexpected, was that catch-all phrase "crib-death." Alive and well one hour, dead the next. While I certainly was devastated at the time, and even now miss Thomas, I find it hard to know what to think about his death. It seems in some sense wrong that he died, but then again, his attachment to others in the world was tenuous, he felt (so far as we know) no pain in his dying, and he had had no chance to develop hopes or goals. It was hardly a routine event in our lives that he died. But I do not know what kind of event it was in his life. My fourth image is that of the death of a very elderly patient in a chronic care facility, a death preceded by a long period of physical and mental decline, with the last few years of life marked by an almost total isolation, certainly from others but seemingly from self as well. In this particular case, the isolation did not come from staff insensitivity. The time had long passed when it was possible to do more than care for the body of the patient. I mention these images for several reasons. I believe it impossible for anyone to consider the concept of "natural death" totally free of one's personal images of death, particularly those witnessed at firsthand. Moreover, given the varied forms death can take, we are each likely to have rather different images. I have witnessed at least one death which seemed to me (intuitively at any rate) to be a "natural death," at least one that seemed wrong and "unnatural," at least one that does not easily fit into either class, and one that seems to have come much too late. That there can be so many images of death points to a problem in any attempt to define, or to characterize, the notion of a "natural death." Any socially significant definition will and must be affectively colored, evoke different private images, and take its point of departure from certain powerful cognitive-emotional exemplars.