by Sue Black
My father had been a church organist for many years and I knew what he would have liked to be said and sung at his funeral, and what he definitely wouldn’t. Yet however desperate I was to do him proud, I couldn’t escape the feeling that it was ridiculous to be still thinking about his preferences when he was the one person not going to be there that day to care one way or another.
On Saturday evenings, my father used to go to the kirk to practise before the Sunday services. Sometimes I would join him and just sit in the front pew listening to his lovely touch on the church organ. He would often choose to play Glenn Miller’s ‘In the Mood’. It was odd to hear that big-band tune blaring out in the empty kirk, but I loved it. On Sundays, as a young girl, it was my job to go to church with my father, position myself in the second pew from the front, directly opposite the organ, and keep an eye on the hymnbook during the singing. When we reached the last verse of a hymn I had to remember to put my hand on the back of the pew in front of me – the agreed signal for him to stop at the end of the verse. There were a few occasions when I forgot and Father would be happily playing another verse that didn’t exist. I usually got a row that day.
Father hated it when the congregation didn’t sing up. So it got to me that, at his own funeral, the mourners were mumbling the hymns. I couldn’t bear looking at the poor organist in the corner knowing how annoyed my father would have been. I did the unthinkable. I moved forward, threw up my hands and shouted for everyone to stop – yes, in the middle of the service. I told them how my father felt about playing the organ when people didn’t sing from their hearts, and asked if they could please give it some welly, just for him. My daughters were horrified and most of the rest of the congregation thought I had lost my mind. But I do like an occasion to be memorable.
I’d had no difficulty choosing the tune to be played as people were leaving. What else could it have been but ‘In the Mood’? Or ‘In the Nude’, as my father used to call it.
Both my father and my mother had stated very clearly that they wanted their remains to be buried, but they were not bothered whether those remains were their bodies or their ashes. Of course, there is a third option, but neither of my parents wished to leave their bodies to anatomy and I didn’t ever feel it was my place to try to persuade them otherwise.
So far, so sensible. The lunacy lay in the location of their burial sites. Mother wished to be laid to rest with Uncle Willie and Teenie at the bottom of Tomnahurich Cemetery and my father wanted to be with his parents at the top. We had suggested that maybe they would like to be buried together, but good Scottish pragmatism (or, in my father’s case, short arms and long pockets) took over. There was one empty space in the lair at the bottom of the hill and another at the top, both bought and paid for. Why waste money on a new one? They both felt that when they were dead, they were dead and they didn’t really care about where they were buried as long as it was done properly. They may have been traditionalists, but they were also practical and unsentimental. Father always promised he would wave to Mother from the top of the hill and she always retorted that she’d ignore him.
And so my father was cremated, and for about a year he sat in a lovely, well-crafted box, of which even he would have approved, on our hallway table until we could get the whole family together for his interment. I didn’t feel there was any hurry. He was dead and he wasn’t going anywhere. Even our cleaners, after the initial shock, got used to him being there and became rather fond of him. They would say good morning to him when they came in the front door and give his brass plaque a bit of a dust down. They were quite sorry when he eventually left. People don’t have to be alive to make their presence felt.
On Christmas Day we decided that Grandad should join us for lunch and so we placed his box at the end of the dining table. While that might sound weird to some, it felt somehow normal for us to have him with us, a Santa hat perched on top of his box. We raised a glass to all those absent who meant the world to us, and to him – the last member of his generation to go.
This generational shift in the family had an impact on Anna, the youngest, as she got to grips with the fact that her father and I were now the oldest generation in our family, and that she and her sisters had been promoted to second in command. So she found my father’s death difficult not only because she adored him, but because she was terrified by the thought of whose turn it might be next.
When the time was finally right for my father to be buried, we gave that honour to my sister’s son, in whose life he had been an important influence. Barry displayed great dignity as he carried Grandad from the boot of the car to the hole in the ground and, with great solemnity, carefully planted him there. Anna decided that Grandad would need a dram to help him on his way, and poured a good shot of Macallan over his box once he was installed. He would probably have considered that a waste – a view evidently shared by the ever-watchful gravedigger lurking in the background.
Whatever we believe happens to the soul, or the essence of a person, after death, the bereaved usually feel a visceral need for a specific place they can visit, or picture in their mind’s eye, where the mortal remains of their loved one reside. For some this will be a grave; for others a wider landscape where cremated ashes have been scattered, generally a location that meant something to the deceased in life. Many people choose to keep ashes with them, as we did with my father’s, for a while, sometimes permanently. Some even bring them along on days out the person might have enjoyed in life, or to places they never managed to get to see. I know of someone who took their mother’s ashes to New York for a weekend because she had always wanted to visit Central Park.
Cremation, first introduced in the UK early in the twentieth century, is now the choice of a majority of people and its popularity is evidenced by the number of imaginative things you can now do with somebody’s ashes. They can be fired into space or deposited in water to create a marine reef; you can have them incorporated into glass and made into jewellery, paperweights or vases. They can be put into shotgun cartridges, turned into fish bait or added to fireworks to ensure your send-off goes with a bang, or even compressed to create teeny little diamonds.
When there is no chosen ‘resting place’, and a proper funeral is not possible, it is hard on families – indeed, it is one of the lasting agonies suffered by the relatives of likely murder victims, or those killed in disasters, whose bodies are never found. So forgoing these rituals at the time when their loss is at its sharpest is a big sacrifice to ask of the families of those who, like Henry, the man who taught me from the dissecting table, decide to donate their bodies to anatomy or to other scientific research. I understand completely how relatives may be left feeling they have no ‘closure’. A body bequeathed to science can be retained by law for three years – a long time for a family to wait for the ashes of their loved one to be returned to them. But in the case of these donors, we hope the certainty that the firm wish of the deceased is being fulfilled brings some comfort.
The decision to leave your body to medical, dental and scientific research and education is not one to be taken lightly. The reasons why some people opt for this route are many and varied, but they are mostly altruistic, arising from a genuine desire to play a part in advances that could save lives or alleviate suffering. Some bequeathers simply believe that ‘dead is dead’, and their remains might as well be put to good use as destroyed or allowed to rot. As one sassy elderly lady once said to me, hands on hips: ‘Young lady, this is just too darn good to burn.’ For others, the reason might be starkly practical. When you consider that the average cost of a funeral and burial in London is about £7,000, and just over £4,000 across the rest of the UK, you can see the economic appeal. But we do not judge anybody’s motives. It is a personal choice and our job is just to help people to make it happen.
In our anatomy department at Dundee University we have a dedicated bequeathal manager, Viv, who takes calls every day from people inquiring about donating their bodies. An anatomy departmen
t is one place where you can be confident that a conversation about death will have no uncomfortable silences, platitudes or condescension. Some prospective donors ask to come and visit us to talk about the practicalities, or to look at our Book of Remembrance. Others just want to put arrangements in place with as little engagement as possible with the process. In these circumstances, Viv pops the necessary forms in the post to them – although I have known her get in her car and deliver the paperwork herself when she is dealing with someone too infirm to visit but who she feels needs the personal contact.
The bequeathers sign the forms in front of a witness (not Viv – that would be improper), send one back to the anatomy department and lodge the other with their will at their solicitor’s office. And that’s it. We do, though, actively encourage them to speak frankly about their wishes to their families and carers, so that when the day arrives nobody is caught by surprise and delays can be kept to a minimum.
People who choose to donate are not looking for cloying niceness or obsequiousness, they just want warmth, reassurance, trust and honesty. When they ring Viv they have come to the right person. I marvel when I hear her on the phone. A kind woman with a wicked sense of humour, her objective is to answer truthfully, directly and with humanity any questions put to her and never to placate with vague words of comfort. She has regulars who phone her up just for a chat, to let her know that they are still alive and regale her with details of their latest ailments. They view her as a friend – the person who will be there for their family when the dreaded day arrives. And she always is.
When the call finally comes from a son or daughter, husband or wife, Viv steers them gently but firmly through everything that needs to be done to get the body to our department as swiftly as possible. This can be a challenging time for families. They might not understand or agree with the decision of the person they love and often feel confused by the inherent lengthy postponement of the usual funeral ceremonies. We do the best we can to assist in the fulfilment of a donor’s bequest but, since we have no desire to cause additional pain to relatives, at times strong family objections may overrule the wishes of the deceased.
As well as consenting to their bodies being kept by us for up to three years, bequeathers can opt to give permission for some body parts to be retained for longer, for photographs to be taken for educational purposes and for their remains to be used by another department in Scotland if ours is unable to accept them. This is a lot for someone to take in when their mum has just died, which is why we advise all our donors to speak openly and honestly with their families about their decision.
Viv’s is the most important, delicate and compassionate public-relations job at the university, and she accomplishes it flawlessly at a time when family grief is at its most acute. She was recently awarded an MBE for her services to anatomy bequeathal in Scotland – not for her ‘services to dead bodies’, as some crass journalist put it. I am so proud of her and of the work she does.
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Our donors come from all walks of life. We have postmen and professors, grandads and great-great grannies, saints and sinners. The youngest age at which we can accept a donor in Scotland is twelve but the vast majority are over sixty. Our oldest to date was 105. The life lived is of little consequence to us and we accept almost everyone. There are one or two instances in which we might have to refuse a bequest but they are rare. If the coroner or procurator fiscal has required a postmortem, we cannot accept the body as it will have been disrupted by the examination. If the deceased had such extensive cancer metastases that little normal anatomy remains, we may decline and in the past we have occasionally had to turn down the morbidly obese for the simple practical reason that our equipment was not able to cope with lifting them.
About 80 per cent of our donors are local to the university region and we take great pride in the relationship we have with the Tayside community. We now have several generations of Dundee families who have ‘gone to the university’. Their names are recorded in our Book of Remembrance. This is not just a memorial to the bequeathers but a daily reminder to our students of how fortunate they are to benefit from the gift of so many people who have asked only one thing in return: that they learn. The book is displayed at the top of the stairs to the department so that every single student will see it every time they enter the dissecting room.
One donor who exemplifies our relationship with the local community is an elderly man I’ll call Arthur. He is a delight: he comes to all our university events, whether the lecture on offer is on forensic science or creative writing. He has an active mind, is hungry for experiences and remains a deep thinker who ponders on his legacy but not his mortality. He isn’t religious and he sees the merit of, in his words, ‘recycling’ his remains for the general good and not spending an unnecessary fortune on a ‘wasted funeral ceremony’.
Arthur is, however, distinctive in having planned his own exit strategy from this world. He is adamant that he does not want to be dependent on others should he become infirm or incapable in his advancing age. When he has had enough, he wishes to take responsibility for his own death and end his life by his own hand. He does not want neighbours or friends to find him undergoing the indignities of dying. He is in full charge of his mental faculties, his mind is made up and no debate has ever led to him modifying his ideas – believe me, I have tried enough times. Having researched the matter exhaustively, Arthur has now chosen the way he means to die. He tells me he has purchased equipment from the internet that will allow him to go peacefully, will not cause any disruption to his body and will leave him fully in control of his actions and his decision until the very last moment.
These are not thought processes that many of us follow in such detail through to the conclusion Arthur sees as natural, although we will probably all understand them in an abstract way, and some of us will relate to them. Assisted suicide and voluntary euthanasia remain illegal in the UK. Government bills come and go and I believe that eventually one will succeed in permitting us to make the choice, in circumstances where we wish to exercise it, as to how and when we end our lives. I think that one day we will be able to make this mature decision without pressure from the authorities, and with proper legislative controls in place, so that those of us who wish to have some control over our death are not forced to come up with the funds needed to die in a foreign country to achieve it or to take more drastic measures.
Suicide tourism is an expensive business and the decision to embark on it is often made earlier than is necessary because of fears that delaying too long may result in the person becoming too ill to undertake the journey. In making sure this doesn’t happen, they may well be depriving themselves and their families of a few more precious moments and experiences together before reaching the point where no quality of life at all is possible.
Assisted suicide (or assisted dying) is legal in Canada, the Netherlands, Luxembourg, Switzerland and parts of the USA. In Colombia, the Netherlands, Belgium and Canada, voluntary euthanasia is also within the law. The difference between the two practices lies in the degree of involvement of a second party. If a patient asks a physician to end his life, perhaps with a lethal injection, and the physician complies, this is defined as voluntary euthanasia. If the physician prescribes lethal drugs for the patient to self-administer, it is assisted suicide.
In America, assisted suicide is legal only for those diagnosed as both terminally ill and mentally competent who die in Oregon, Montana, Washington, Vermont or California. Oregon was the first US state to legalise assisted dying with its Death with Dignity Act of 1994. Medication can be prescribed by a physician and self-administered only after two doctors have confirmed that the patient is likely to have less than six months to live. Strict safeguards have ensured that there have never been any proven cases of abuse. The authorised drug is a mix of phenobarbital, chloral hydrate, morphine sulphate and ethanol and costs between $500 and $700. Approximately 64 per cent of patients who request the medication will take it
, usually in their own residence. The fact that the remaining 36 per cent, quite a high number, decide not to use the drug illustrates that people understand the nature of choice. Perhaps simply knowing that the drug is there if they want it is enough to reassure the terminally ill that control of their own life and death resides in their own hands.
In UK hospitals, the terminally ill may have little personal control over their last moments and their relatives must rely on medical staff to ensure that their dying and death is as pain-free as possible. Physicians may employ continuous morphine sedation and food and water may be withdrawn, which can result in death occurring relatively swiftly, as happened with my mother.
The British Medical Association regularly votes against assisted dying, perhaps understandably fearing that it would have a detrimental effect on society’s trust in doctors. Yet in a recent European survey, the country with the highest level of trust in doctors was the Netherlands, where assisted death is legal. It seems that being given a choice may increase trust rather than diminish it.
The arguments for and against legalising assisted death are well rehearsed. Supporters maintain that just as we have a right to life, we should have a right to a dignified, humane and pain-free death at a time of our choosing. Opponents express concerns about the dangers of any legislation being abused, about potential societal pressures on the elderly or infirm not to ‘become a burden’, about illness or disability being perceived as a justification for ending a life. Some disagree for religious reasons, believing that only the Creator has the right to decide when we die. The voices of detractors often drown out the views of the unfortunate people suffering agonies they consider intolerable and inhumane who are desperate to have the option of assisted dying available to them. It is not illegal for them to end their lives, but to comply with the law it must be done without assistance, which means that often the only options at their disposal are traumatic or violent.