In December, 1989, the Panamanian dictator Manuel Noriega was expelled from power by American forces. To escape capture, he took refuge in the Papal Nunciatura in Panama City. When an American general arrived to confer with the papal nuncio, the U.S. Army blared music from loudspeakers to prevent journalists from eavesdropping. Members of a psychological-operations unit then decided that non-stop music might aggravate Noriega into surrendering. They made requests for songs on the local armed-forces radio station, and directed the din at Noriega’s window. The dictator was thought to prefer opera, and so hard rock dominated the playlist. The songs conveyed threatening, sometimes mocking messages: Alice Cooper’s “No More Mr. Nice Guy,” AC/DC’s “You Shook Me All Night Long.”
Although the media delighted in the spectacle, President George H. W. Bush and General Colin Powell, then the chairman of the Joint Chiefs of Staff, took a dim view of it. Bush called the campaign “irritating and petty,” and Powell had it stopped. Noriega, who had received psyops training at Fort Bragg in the nineteen-sixties, is said to have slept soundly through the clamor. Nonetheless, military and law-enforcement officials became convinced that they had stumbled on a valuable tactic. “Since the Noriega incident, you’ve been seeing an increased use of loudspeakers,” a psyops spokesman declared. During the siege of the Branch Davidian compound, in Waco, Texas, in 1993, the F.B.I. blasted music and noise day and night. When Palestinian militants occupied the Church of the Nativity, in Bethlehem, in 2002, Israeli forces reportedly tried to eject them with heavy metal. And during the occupation of Iraq the C.I.A. added music to the torture regime known as “enhanced interrogation.” At Guantánamo, detainees were stripped to their underwear, shackled to chairs, and blinded by strobe lights as heavy metal, rap, and children’s tunes assaulted their ears. Music has accompanied acts of war since trumpets sounded at the walls of Jericho, but in recent decades it has been weaponized as never before—outfitted for the unreal landscape of modern battle.
The intersection of music and violence has inspired a spate of academic studies. On my desk is a bleak stack of books examining torture and harassment, the playlists of Iraq War soldiers and interrogators, musical tactics in American crime-prevention efforts, sonic cruelties inflicted in the Holocaust and other genocides, the musical preferences of Al Qaeda militants and neo-Nazi skinheads. There is also a new translation, by Matthew Amos and Fredrick Rönnbäck, of Pascal Quignard’s 1996 book, “The Hatred of Music” (Yale), which explores age-old associations between music and barbarity.
When music is applied to warlike ends, we tend to believe that it has been turned against its innocent nature. To quote the standard platitudes, it has charms to soothe a savage breast; it is the food of love; it brings us together and sets us free. We resist evidence suggesting that music can cloud reason, stir rage, cause pain, even kill. Footnoted treatises on the dark side of music are unlikely to sell as well as the cheery pop-science books that tout music’s ability to make us smarter, happier, and more productive. Yet they probably bring us closer to the true function of music in the evolution of human civilization.
A striking passage in J. Martin Daughtry’s “Listening to War: Sound, Music, Trauma, and Survival in Wartime Iraq” (Oxford) evokes the sound of the battlefield in the most recent Iraq war:
The growl of the Humvee engine. The thump-thump-thump of the approaching helicopter. The drone of the generator. Human voices shouting, crying, asking questions in a foreign tongue. “Allahu akbar!”: the call to prayer. “Down on the ground!”: the shouted command. The dadadadadada of automatic weapon fire. The shhhhhhhhhhhhh of the rocket in flight. The fffft of the bullet displacing air. The sharp k-k-k-k-r-boom of the mortar. The rolling BOOM of the I.E.D.
Daughtry underscores something crucial about the nature of sound and, by extension, of music: we listen not only with our ears but also with our body. We flinch against loud sounds before the conscious brain begins to try to understand them. It is therefore a mistake to place “music” and “violence” in separate categories; as Daughtry writes, sound itself can be a form of violence. Detonating shells set off supersonic blast waves that slow down and become sound waves; such waves have been linked to traumatic brain injury, once known as shell shock. Symptoms of post-traumatic stress disorder are often triggered by sonic signals; New York residents experienced this after September 11th, when a popped tire would make everyone jump.
Sound is all the more potent because it is inescapable: it saturates a space and can pass through walls. Quignard—a novelist and essayist of an oblique, aphoristic bent—writes:
All sound is the invisible in the form of a piercer of envelopes. Whether it be bodies, rooms, apartments, castles, fortified cities. Immaterial, it breaks all barriers. . . . Hearing is not like seeing. What is seen can be abolished by the eyelids, can be stopped by partitions or curtains, can be rendered immediately inaccessible by walls. What is heard knows neither eyelids, nor partitions, neither curtains, nor walls. . . . Sound rushes in. It violates.
The fact that ears have no lids—earplugs notwithstanding—explains why reactions to undesirable sounds can be extreme. We are confronting faceless intruders; we are being touched by invisible hands.
Technological advances, especially in loudspeaker design, have increased sound’s invasive powers. Juliette Volcler, in “Extremely Loud: Sound As a Weapon” (New Press), details attempts to manufacture sonic devices that might debilitate enemy forces or disperse crowds. Long-range acoustic devices, nicknamed “sound cannons,” send out shrill, pulsating tones of up to a hundred and forty-nine decibels—enough to cause permanent hearing damage. Police units unleashed these devices at an Occupy Wall Street rally in 2011 and in Ferguson, Missouri, in 2014, among other settings. A commercial device called the Mosquito discourages young people from loitering; it emits sounds in the 17.5-to-18.5-kilohertz range, which, in general, only those under the age of twenty-five can hear. Further Army research into low- and high-frequency weapons, which developers hoped would “liquefy the bowels,” apparently failed to yield results, although conspiracy theories proliferate on the Internet.
Humans react with particular revulsion to musical signals that are not of their choice or to their liking. Many neuroscientific theories about how music acts on the brain—such as Steven Pinker’s notion that music is “auditory cheesecake,” a biologically useless pleasure—ignore how personal tastes affect our processing of musical information. A genre that enrages one person may have a placebo effect on another. A 2006 study by the psychologist Laura Mitchell, testing how music-therapy sessions can alleviate pain, found that a suffering person was better served by his or her “preferred music” than by a piece that was assumed to have innately calming qualities. In other words, music therapy for a heavy-metal fan should involve heavy metal, not Enya.
Lily Hirsch’s “Music in American Crime Prevention and Punishment” (Michigan) explores how divergences in taste can be exploited for purposes of social control. In 1985, the managers of a number of 7-Eleven stores in British Columbia began playing classical and easy-listening music in their parking lots to drive away loitering teen-agers. The idea was that young people would find such a soundtrack insufferably uncool. The 7-Eleven company then applied this practice across North America, and it soon spread to other commercial spaces. To the chagrin of many classical-music fans, especially the lonely younger ones, it seems to work. This is an inversion of the concept of Muzak, which was invented to give a pleasant sonic veneer to public settings. Here instrumental music becomes a repellent.
To Hirsch, it’s no coincidence that 7-Eleven perfected its technique of musical cleansing while American forces were experimenting with musical harassment. Both reflect a strategy of “deterrence through music,” capitalizing on rage against the unwanted. The spread of portable digital technology, from CDs to the iPod and on to smartphones, means that it is easier than ever to impose music on a space and turn the psychological screws. The logical next step might be a Spotify algorithm that can discover what combination of songs is most likely to drive a given subject insane.
When Primo Levi arrived in Auschwitz, in 1944, he struggled to make sense not only of what he saw but of what he heard. As prisoners returned to the camp from a day of hard labor, they marched to bouncy popular music: in particular, the polka “Rosamunde,” which was an international hit at the time. (In America, it was called the “Beer Barrel Polka”; the Andrews Sisters, among others, sang it.) Levi’s first reaction was to laugh. He thought that he was witnessing a “colossal farce in Teutonic taste.” He later grasped that the grotesque juxtaposition of light music and horror was designed to destroy the spirit as surely as the crematoriums destroyed the body. The merry strains of “Rosamunde,” which also emanated from loudspeakers during mass shootings of Jews at Majdanek, mocked the suffering that the camps inflicted.
The Nazis were pioneers of musical sadism, although loudspeakers were apparently deployed more to drown out the screams of victims than to torture them. Jonathan Pieslak, in his 2009 book, “Sound Targets: American Soldiers and Music in the Iraq War,” finds a telling cinematic precedent in Alfred Hitchcock’s 1940 film “Foreign Correspondent,” where Nazi spies torment a diplomat with bright lights and swing music. To some extent, sonically enhanced interrogation may have been a Hollywood fantasy that migrated into reality—just as other aspects of the American torture regime took inspiration from TV shows like “24.” Similarly, in the 2004 battle of Fallujah, speakers mounted on Humvees bombarded the Iraqis with Metallica and AC/DC, mimicking the Wagner scene in “Apocalypse Now,” in which a helicopter squadron blasts “The Ride of the Valkyries” as it lays waste to a Vietnamese village.
Jane Mayer, a staff writer at this magazine, and other journalists have shown that the idea of punishing someone with music also emerged from Cold War-era research into the concept of “no-touch torture”—leaving no marks on victims’ bodies. Researchers of the period demonstrated that sensory deprivation and manipulation, including extended bouts of noise, could bring about the disintegration of a subject’s personality. Beginning in the nineteen-fifties, programs that trained American soldiers and intelligence operatives to withstand torture had a musical component; at one point, the playlist reportedly included the industrial band Throbbing Gristle and the avant-garde vocalist Diamanda Galás. The concept spread to military and police units in other countries, where it was applied not to trainees but to prisoners. In Israel, Palestinian detainees were tied to kindergarten chairs, cuffed, hooded, and immersed in modernist classical music. In Pinochet’s Chile, interrogators employed, among other selections, the soundtrack to “A Clockwork Orange,” whose notorious aversion-therapy sequence, scored to Beethoven, may have encouraged similar real-life experiments. [cartoon id="a20055"]
In America, musical torture received authorization in a September, 2003, memo by General Ricardo Sanchez. “Yelling, Loud Music, and Light Control” could be used “to create fear, disorient detainee and prolong capture shock,” provided that volume was “controlled to prevent injury.” Such practices had already been publicly exposed in a short article in Newsweek that May. The item noted that interrogations often featured the cloying theme of “Barney & Friends,” in which a purple dinosaur sings, “I love you / You love me / We’re a happy family.” The article’s author, Adam Piore, later recalled that his editors couched the item in joking terms, adding a sardonic kicker: “In search of comment from Barney’s people, Hit Entertainment, Newsweek endured five minutes of Barney while on hold. Yes, it broke us, too.” Repeating a pattern from the Noriega and Waco incidents, the media made a game of proposing ideal torture songs.
The hilarity subsided when the public learned more of what was going on at Abu Ghraib, Bagram, Mosul, and Guantánamo. Here are some entries from the interrogation log of Mohammed al-Qahtani, the alleged “twentieth hijacker,” who was refused admittance to the United States in August, 2001:
1315: Corpsman checked vitals—O.K. Christina Aguilera music played. Interrogators ridiculed detainee by developing creative stories to fill in gaps in detainee’s cover story.
0400: Detainee was told to stand and loud music was played to keep detainee awake. Was told he can go to sleep when he tells the truth.
1115: Interrogation team entered the booth. Loud music was played that included songs in Arabic. Detainee complained that it was a violation of Islam to listen to Arabic music.
0345: Detainee offered food and water—refused. Detainee asked for music to be turned off. Detainee was asked if he can find the verse in the Koran that prohibits music.
1800: A variety of musical selections was played to agitate the detainee.
Aguilera seems to have been chosen because female singers were thought to offend Islamist detainees. Interrogation playlists also leaned on heavy-metal and rap numbers, which, as in the Noriega case, delivered messages of intimidation and destruction. Songs in regular rotation included Eminem’s “Kim” (“Sit down, bitch / If you move again I’ll beat the shit out of you”) and Drowning Pool’s “Bodies” (“Let the bodies hit the floor”).
Does such coerced listening qualify as torture? The N.Y.U.-based musicologist Suzanne Cusick, one of the first scholars to think deeply about music in the Iraq War, addressed the question in a 2008 paper for The Journal of the Society for American Music. During the Bush Administration, the U.S. government held that techniques inducing psychological rather than physical pain did not amount to torture, as international conventions have defined it. Cusick, however, makes clear that the loud-music tactic displays a chilling degree of casual sadism: the choice of songs seems designed to amuse the captors as much as to nauseate the captives. Few detainees probably understood the English lyrics aimed at them.
No official policy dictated the prison playlists; interrogators improvised them on-site, making use of whatever music they had on hand. Pieslak, who interviewed a number of Iraq veterans, observes that soldiers played many of the same songs for their own benefit, particularly when they were psyching themselves up for a dangerous mission. They, too, favored the most anarchic corners of heavy metal and gangsta rap. Thus, certain songs served both to whip soldiers into a lethal frenzy and to annihilate the spirit of “enemy combatants.” You couldn’t ask for a clearer demonstration of the non-universality of music, of its capacity to sow discord.
The soldiers told Pieslak that they used music to strip themselves of empathy. One said that he and his comrades sought out a “predator kind of music.” Another, after admitting with some embarrassment that Eminem’s “Go to Sleep” (“Die, motherfucker, die”) was a “theme song” for his unit, said, “You’ve got to become inhuman to do inhuman things.” The most unsettling choice was Slayer’s “Angel of Death,” which imagines the inner world of Josef Mengele: “Auschwitz, the meaning of pain / The way that I want you to die.” Such songs are far removed from uplifting wartime propaganda like “Over There,” the patriotic 1917 tune by George M. Cohan. The image of soldiers prepping for a mission by listening to Metallica’s “One”—“Landmine has taken my sight . . . Left me with life in hell”—suggests the degree to which they, too, felt trapped in a malevolent machine.
As Hirsch and other scholars point out, the idea of music as inherently good took hold only in the past few centuries. Philosophers of prior eras tended to view the art as an ambiguous, unreliable entity that had to be properly managed and channelled. In Plato’s Republic, Socrates scoffs at the idea that “music and poetry were only play and did no harm at all.” He distinguishes between musical modes that “suitably imitate the tone and rhythm of a courageous person who is active in battle” and those which strike him as soft, effeminate, lecherous, or melancholy. The Chinese “Book of Rites” differentiated between the joyous sound of a well-ruled state and the resentful sound of a confused one. John Calvin believed that music “has an insidious and well-nigh incredible power to move us whither it will.” He went on, “We must be all the more diligent to control music in such a way that it will serve us for good and in no way harm us.”
German thinkers in the idealist and Romantic tradition—Hegel, E.T.A. Hoffmann, and Schopenhauer, among others—sparked a drastic revaluation of music’s significance. It became the doorway to the infinitude of the soul, and expressed humanity’s collective longing for freedom and brotherhood. With the canonization of Beethoven, music became the vehicle of genius. Sublime as Beethoven is, the claim of universality blended all too easily with a German bid for supremacy. The musicologist Richard Taruskin, whose rigorously unsentimental view of Western music history anchors much recent work in the field, likes to quote a phrase ironically articulated by the historian Stanley Hoffman, who died last year: “There are universal values, and they happen to be mine.”
Despite the cultural catastrophe of Nazi Germany, the Romantic idealization of music persists. Pop music in the American tradition is now held to be the all-encompassing, world-redeeming force. Many consumers prefer to see only the positive side of pop: they cherish it as a culturally and spiritually liberating influence, somehow free of the rapacity of capitalism even as it overwhelms the marketplace. Whenever it is suggested that music might arouse or incite violence—Eminem’s graphic fantasies of abuse and murder, or, more recently, the whiff of rape culture in Robin Thicke’s “Blurred Lines”—fans suddenly devalue music’s potency, portraying it as a vehicle for harmless play that cannot propel bodies into action. When Eminem proclaims that he is “just clownin’, dogg,” he is taken at his word.
Bruce Johnson and Martin Cloonan expose this inconsistency in “Dark Side of the Tune: Popular Music and Violence” (2008). They are not reactionaries in the Tipper Gore mode, trying to whip up a moral panic. Pioneers of pop-music studies, they address their subject with deep respect. Nonetheless, if music can shape “our sense of the possible,” as they say, it must also be able to act destructively. Either music affects the world around it or it does not. Johnson and Cloonan avoid claims of direct causality, but they refuse to rule out links between violence in music—in terms both of lyrical content and of raw decibel impact—and violence in society. Furthermore, musical brutality need not involve a brutal act, for a “song of vilification is in itself an act of social violence.”
The pattern of sonic aggression that runs from the Noriega siege to the Iraq War poses these issues in the starkest terms. There was a nasty undertow of cultural triumphalism in the hard-hitting, hypermasculine music used to humiliate foreign prisoners. “The detainee’s subjectivity was to be lost in a flood of American sounds,” Johnson and Cloonan write. On a symbolic level, the rituals at Guantánamo present an extreme image of how American culture forces itself on an often unwilling world.
Although music has a tremendous ability to create communal feeling, no community can form without excluding outsiders. The sense of oneness that a song fosters in a human herd can seem either a beautiful or a repulsive thing—usually depending on whether you love or hate the song in question. Loudness heightens the tension: blaring music is a hegemonic move, a declaration of disdain for anyone who thinks differently. Whether we are marching or dancing or sitting silently in chairs, we are being molded into a single mass by sound. As Quignard notes in “The Hatred of Music,” the Latin word obaudire, to obey, contains audire, to hear. Music “hypnotizes and causes man to abandon the expressible,” he writes. “In hearing, man is held captive.”
Quignard’s slender, unnerving volume is quite different in tone from the sober academic books on the theme of music and violence. It hovers in a peculiarly French space between philosophy and fiction, and goes on mysterious lyrical flights, animating scenes from history and myth. One astonishing sequence evokes St. Peter’s denial of Jesus before the third crowing of the cock. Quignard imagines that, ever after, Peter was traumatized by any high-pitched noise, and that he soundproofed his home to escape the cacophony of the street: “The palace was shrouded in silence, the windows blinded with drapes.”
For years, Quignard was active on the French music scene, organizing concerts and working with the Catalan viol player Jordi Savall. Quignard co-wrote the screenplay for the music-drenched 1991 film “Tous les Matins du Monde.” Soon afterward, he retreated from such projects and wrote “The Hatred of Music” as a cri de cœur. Although he does not explain this change of heart, he gestures toward the meaningless ubiquity of music in contemporary life—Mozart in the 7-Eleven. Quignard gives this familiar lament a savage edge. In a chapter on the infernal Muzak of Auschwitz, he quotes Tolstoy: “Where one wants to have slaves, one must have as much music as possible.”
The book’s most disquieting passages suggest that music has always had a violent heart—that it may be rooted in the urge to dominate and kill. He speculates that some of the earliest music was made by hunters luring their prey, and devotes a chapter to the myth of the Sirens, who, in his reading, beguiled men with song just as men once beguiled animals with music. Quignard muses that some early weapons doubled as instruments: a string stretched across a bow could be resonantly plucked or it could send an arrow through the air. Music relied conspicuously on the slaughter of animals: horsehair bows drawn over catgut, horns torn from the heads of big game.
What to do with these dire ruminations? Renouncing music is not an option—not even Quignard can bring himself to do that. Rather, we can renounce the fiction of music’s innocence. To discard that illusion is not to diminish music’s importance; rather, it lets us register the uncanny power of the medium. To admit that music can become an instrument of evil is to take it seriously as a form of human expression. ♦
After a particularly gruesome news story — ISIS beheadings, a multicar pileup, a family burnt in their beds during a house fire — I usually get to wondering whether that particular tragic end would be the worst way to go. The surprise, the pain, the fear of impending darkness.
But lately, I’ve been thinking that it’s the opposite question that begs to be asked: what’s the best way to die? Given hypothetical, anything-goes permission to choose from a creepy, unlimited vending machine of endings, what would you select?
If it helps, put yourself in that mindset that comes after a few glasses of wine with friends — your pal asks something dreamy, like where in the whole world you’d love to travel, or, if you could sleep with any celebrity, who would it be? Except this answer is even more personal.
There are lots of ways to look at the query. Would I want to know when I’m going to die, or be taken by surprise? (I mean, as surprising as such an inevitable event can be.) Would I want to be cognizant, so I can really experience dying as a process? Or might it be better to drowse my way through it?
Many surveys suggest that about three-quarters of Americans want to die at home, though the reality is that most Americans, upwards of 68 percent, will die in a hospital or other medicalized environment. Many also say they want to die in bed, but consider what that actually means: just lying there while your heart ticks away, your lungs heave to a stop. Lying around for too long also gets rather uncomfortable — as anyone who’s spent a lazy weekend in bed can tell you — and this raises a further question: should we expect comfort as we exit this life?
Sometimes I think getting sniped while walking down the street is the best way to go. Short, sweet, surprising; no worries, no time for pain. Sure, it’d be traumatic as hell for the people nearby, but who knows — your death might spark a social movement, a yearlong news story that launches media, legal, and criminal justice careers. What a death! It might mean something. Does that matter to you — that your death helps or otherwise changes other people’s lives? If there’s not a point to your death, you might wonder, was there a point to your life?
These are heavy questions — ahem, vital, ones — that don’t seem to come up very often.
I got curious about how other people would answer this question, so I started asking colleagues and friends for their ideal death scenarios (yes, I’m a blast at parties). I heard a wide variety of answers. Skydiving while high on heroin for the second time (because you want to have fun the first time, according to a colleague). Drowning, because he’d heard it was fairly peaceful once the panic clears. Storming a castle and felling enemies with a sword to save a woman, who he then has appreciative sex with, just as he’s taking his dying breaths. (That poor gal!) An ex-boyfriend of mine used to say that the first time he lost bowel control, he’d drive to the Grand Canyon and jump off.
My own non-serious answer is to be tickled to death, sheerly for the punniness of it.
Anecdotally, young men were more fancy-free about their answers, while the older folks and women I spoke with gave more measured answers or sat quietly. Wait, what did you ask? I’d repeat the question. A pause. Hmm.
One old standby came up quite a lot: dying of old age in my bed, surrounded by family. The hospital nurses I asked had a twist on that trope: in bed, surrounded by family, and dying of kidney failure. Among nurses, there was consensus that this is the best way to go if you’re near death and in intensive care — you just fade out and pass, one ICU nurse told me. In the medical community, there’s debate about how calm death by kidney failure actually is, but really, who can you ask?
These answers are all interesting, but my nurse friend got me wondering about people who deal with death on the regular — what do they think about the best death? Do they think about it? Surely hospice workers, physicians, oncologists, “right-to-die” advocates, cancer-cell biologists, bioethicists, and the like have a special view on dying. What might their more-informed criteria be for my “best death” query?
I started with a concept that I think most can agree with — an ideal death should be painless.
Turns out, a painless death is a pretty American way to think about dying.
Jim Cleary, a physician in Madison, Wisconsin, specializes inpalliative care, cancer-related pain relief, and discussing difficult diagnoses with patients. “Eighty percent of the world’s population lacks access to opioids,” he tells me. That includes morphine, fentanyl, oxycodone, and many of the other drugs used to soothe patients in the United States. Cleary is director of the World Health Organization’s pain and policy studies group, which is working to get these relief drugs to other nations to help those in need — burn and trauma victims, cancer patients, and women giving birth.
In his work with American cancer patients, he’s careful not to suggest that dying will be comfortable. “I can’t promise ‘pain-free,’” he says. What he can promise is that he’ll try his best to help patients end their lives as they wish. “Listen to your patients,” he tells his colleagues, “they have the answers.”
Cleary says you can lump the different ways we die into categories. The first is the sudden death. “That’s not going to be a reality for most of us,” he’s quick to point out. The other category is the long death, which is what most of us will likely experience. “The reality is death from cancer,” says Cleary, “where you actually know it’s going to happen, and you can say goodbye.”
According to theAmerican Cancer Society, a man’s risk of dying from cancer is 1 in 4, and a woman’s 1 in 5. (It’s important to note that those numbers are just for dying from one of the many types of cancer, from bladder to brain, prostate to ovaries. The odds that a man will develop cancer are 1 in 2; for women, 1 in 3. Reality, indeed.) In long-death cases, most care does not extend life so much as extend the dying process, a fact noted by many end-of-life experts, fromsurgeon and author Atul Gawande to hospice patients.
Cleary thinks the idea of a “best” death or even a “good” death is a little misleading, as if it’s a competition or something one can fail at. He prefers the term “healthy dying,” which isn’t as oxymoronic as it sounds. To him, healthy dying means that death is “well-prepared for, it’s expected, and other people know about it.”
The idea of a “best” or even a “good” death is a bit misleading — as if it’s a competition.
Cleary prefers the term “healthy dying.”
“We as a society have to do much, much more on accepting death as a normal part of living,” he says. “So rather than even talking about what’s ‘the best way to die,’ how do we normalize dying?” In a country where funeral parlors handle our dead and corpses no longer rest for days in our own parlors at home, we’re rather removed from the whole ordeal.
Still, I press Dr. Cleary to answer the question at hand: How would he choose to die? “Would it be sudden death walking along a beach in Florida?” he ventures, then quickly reconsiders. “But if your family doesn’t know you’re dead — dad goes for a walk or run and doesn’t come back — is that good for them? It may be good for me, but it may not be good for them.”
In many American hospitals, you’ll find representatives from No One Dies Alone (NODA), a nonprofit volunteer organization formed in 2002 by a nurse named Sandra Clark. NODA’s founding principle is that no one is born alone, and no one should die alone, either.
NODA volunteers work in groups of nine. Each carries a pager 24 hours a day during their assigned shifts, so that one of them is always available to attend a death. Usually, a nurse makes the phone call summoning NODA volunteers. The vast majority of people who NODA visits are comatose. But that makes no difference, the principle abides; comatose or not, it’s still important for someone — anyone — to be present.
Anne Gordon, NODA’s current program director, has helped hospitals around the country start the program in their facilities. She has a worldly perspective similar to Cleary’s, and different from the expectations that most Americans have on the topic of death.
“Dying is a process, not [just] the last breath,” says Gordon. If you’re a hospital patient in the process of dying, there’s a specific protocol to qualify for NODA services. You need to be actively dying — estimated to pass in the next day or so. (“Seasoned nurses can tell,” Gordon says, which is why they’re often the ones to page the NODA volunteers.) You must have reached a point where you will not receive any further interventions — that means comfort care only, with a required “do not resuscitate” order. And you must be without family or friends who can keep you company as you pass away.
Nobody? How does it happen that a person has nobody to visit when they die?
“Sometimes a person’s outlived everyone, or they’re estranged,” Gordon explains. Maybe they do have family, but for whatever reason, the loved ones needed to leave, or live far away, or just cannot bear to be present. Some of the patients are homeless and, just as in their healthier days, have no one to comfort them. Whatever the reason, NODA will be there.
“Dying is a process, not [just] the last breath,” says Gordon.
As Gordon sees it, death is an act of meaning, and the process — what she calls “the human family coming together” — is an act of intentionality and love. “I find the whole process to be so compelling,” she says. “It’s our shared experience — a key transition we all share.”
Gordon, a Baby Boomer, sees her work and the recent public interest in end-of-life issues as a byproduct of her generation aging — an extension of the consciousness-raising of the 1960s and “one of the good echoes” from that era, she quips. “As we get closer to death, we like to talk about these things.”
There are “death cafes,” informal coffee hours where friends and strangers get together, eat cake, and talk about dying. There are high-demand conferences where people share their personal experiences of loss and grief. There are bestselling books about coming to terms with your own mortality and how to prepare for death — spiritually, familially, and financially. Even Costco, the bulk-retail giant, sells coffins alongside its low-price tire changes and discount cruises. It’s mostly just static noise, though. Death is never fully discussed, only hinted at from the margins.
Gordon believes that now — with Baby Boomers entering retirement, many losing their parents, and many more coming to grips with their own mortality — is the moment to talk through these issues as a culture, to discuss the process of death in specific terms, beyond the anecdotal and platitudinal. “When death is a daily concept,” as it might be in Bhutan, she offers, “it’s not as terrifying. What matters is quality of life.”
When I ask Gordon how she’d like to die, she demurs. “I have no answer. I figure it’ll be what’s appropriate for me.”
Pamela Edgar is an end-of-life doula and drama therapist in Brooklyn, New York. Similar to how birth doulas help pregnant women bring new life to the world, end-of-life doulas help people on their way out.
Edgar grew up with a mom who worked in nursing homes, and young Pamela sometimes tagged along, visiting people at different stages in their lives, including the final ones. As she grew older, Edgar got especially interested in those last months: “What is the kind of relationship that you can have with someone when it might be one of their last new relationships? What can that be like?” she wondered.
Edgar has worked in nursing home dementia units and other late-life facilities for the past eight years. After working in a Veterans Administration hospital during an internship as a creative arts therapist, she requested to go to the hospice unit. (“Nobody ever asks to do that!” she remembers her supervisor replying.) For the past three years, she’s been an end-of-life counselor with Compassion & Choices. The organization is primarily known for advocating right-to-die legislation at the state level, but it also helps anybody seeking assistance to “plan for and achieve a good death.”
“As a drama therapist,” Edgar says softly, “I look a lot at roles that people play in their life, and one of the things that I really see — and this is a little bit related to a good way to die — I see that for a lot of us, a lot of our lives are spent doing. What can we do for other people, how we define ourselves by these roles that are really about what we can do, or what we have. And as people get older, of course, that role system gets smaller, and often people can’t do all the things they used to do. I think it’s really an interesting moment for people then: What is their identity, and who are they now?”
For many, dying becomes about control and autonomy, she says. “Here are the things I still can do and what I can still control are really important for some people.”
Others get spiritual. Edgar shares the example of a patient in his 70s who’d been diagnosed with ALS and lost the ability to do many of the things he loved. “He decided that he was ready, and he and his wife kind of describe it that ‘his spirit had outgrown his body.’ He was on hospice care and he chose to stop eating and drinking, and the wife had a lot of support, and hospice was really excellent and supportive of them. It was a very peaceful passing for him.”
Peaceful. Especially given the circumstances of a degenerative illness, “peaceful” seems like an indispensable criterion for the “best” death.
“Peaceful” seems like an indispensable criterion for the “best” death.
Edgar has been particularly affected by seeing choice taken away from patients. Many of the people she worked with early in her career wanted to go home but, because of what she calls the country’s “medical model” of dying, never were able to. After helping hundreds of people with their deaths — filing wills, deciding on final treatments, aiding loved ones with the transition — she’s developed an idea of a good death that’s based on her background in psychology. You’ve heard it before: letting go.
“Ultimately, we are going into an unknown,” Edgar says. “Even when people think or have ideas about what’s next, truth is, we don’t have proof. So there is that sense of going into an unknown and do people feel ready — body, mind, and spirit? Are they really ready to go?”
Sometimes, Edgar says, the body and mind are ready, but the person isn’t emotionally there yet. Or vice versa — the person feels spiritually ready, but their body’s still holding on.
“My personal answer for the best way to die is being ready, like being physically, emotionally, spiritually ready to go.”
Before we end our conversation, she stresses a point to me: “Life and death are not opposites,” she says. “We haven’t figured out how to stop either. They’re partners.”
In the autumn of 2014, the story of Brittany Maynard incited conversations on this topic in average American living rooms. Maynard, a 29-year-old newlywed, was diagnosed with an incurable brain cancer that gave her seizures, double vision, headaches, and other terrible symptoms that inevitably would intensify until her almost surely agonizing death.
As she looked at that future, Maynard decided that she wanted to end her life on her own terms with the help of legal medication. Unfortunately, she lived in California, which didn’t allow doctors to write life-ending prescriptions. So Maynard, her husband, and her mother packed up and moved to Oregon, where the right to die is legally recognized.
Through the ordeal, Maynard partnered with Compassion & Choices to spread the word about her journey for a good death. Her story appeared on the cover of People magazine, was featured on CNN, the Meredith Vieira Show, in USA Today, in the op-ed pages of theNew York Times — you name it. Such a young woman facing such a terrible fate: it’s compelling, even wrenching, and hard to turn away from.
Disregard your personal beliefs on the morality of this situation for a moment, and think about what you would do in the face of an agonizing terminal diagnosis. Would you seek medical care until the very last breath, demanding chemo from your deathbed? Or would you prefer to go without, letting the disease take its natural course? Which path do you fear the most?
David Grube is an Oregon family doctor who, in his own words, has “delivered babies and sung at people’s funerals.” He wants to die “feeling perfectly well, and just not wake up.” Over his 35-year career, he has prescribed life-ending drugs to about 30 patients (though “aid in dying,” as it’s often called, only became legal in Oregon — and for the first in time the United States — in 1994). He did not prescribe Maynard’s medication, but he did talk to me about the process of aiding in a patient’s death.
Grube, who is the medical director for Compassion & Choices, says that though many people ask for the drugs, few end up using them. The prescriptions require a psychological evaluation, sign-off from two different physicians, and a 15-day waiting period before they’re available. The fatal dose will be a barbiturate like pentobarbital, a sedative that’s also used in animal euthanasia — it’s the same drug as the “sleeping pill” that killed Marilyn Monroe, Grube notes — or secobarbital, a bitter anesthetic and sleep aid. Someone like Brittany Maynard would likely stir the drug into a glass of juice, drink it, then await its effects.
In her final message to the public, Maynard wrote, “The world is a beautiful place, travel has been my greatest teacher, my close friends and folks are the greatest givers. I even have a ring of support around my bed as I type. … Goodbye world. Spread good energy. Pay it forward!” Her husband, Dan Diaz, said that as she took the medication, “The mood in the house was very peaceful, very loving.” Within five minutes, she fell asleep. Then she died.
Grube says that’s usually how it goes with these cases: within an hour or two, the person stops breathing and experiences “a peaceful, simple death.” On the rare occasion when the patient takes the medication with a glass of milk or with a large dose of anticonstipation medication (vanity doesn’t automatically disappear with terminal illness), they will sometimes wake up. But when taken as prescribed, most people who choose to end their life this way will, like Maynard, pass with tranquility. It is, in a word, peaceful.
Another term for Maynard’s act is “physician-assisted suicide,” but Grube rejects that concept wholeheartedly. “They don’t want to die!” he says. “‘Suicide’ is such a harmful word ... and words are scalpels; they can be healing, kind, or destructive.” Some of Grube’s allies prefer the term “physician-assisted dying,” while others talk about the “right to die.” Compassion & Choices has settled on its own values-based language to discuss cases like Brittany Maynard: “death with dignity.” Partly due to Maynard’s activism, the California legislature and Governor Jerry Brown passed the “End of Life Option Act” this October, just before the one-year anniversary of her death.
Grube says most people who ask for these prescriptions are educated, motivated, and confident. What they want, he explains, is to determine the timing of their imminent death.
Control. When a disease is controlling your body and mind, when you’ve lost pleasure in the things you once loved, when you’re in pain, when you’re suffering and you fear burdening those around you, when there’s nothing more to do but wait for death, having the power to take — or not take — life-ending drugs can be a supreme comfort. But it’s a fine line of morality.
As a philosopher and bioethicist at Vanderbilt University, John Lachs considers these situations all the time. His mother, Magda, lived to 103, but given her ever-increasing collection of age-related illnesses, he wrote in Contemporary Debates in Bioethics, “living longer seemed to her utterly pointless: the pain, the indignity and the growing communicative isolation overshadowed her native optimism and the joy she had always taken in being alive. She decided that she had had enough and she was ready to die.”
Magda stockpiled prescriptions, ready to overdose on them, but lost them in a move, according to her son. She tried to die by abstaining from food and drink, but, as Lachs put it, “there was enough love of life left in her to make this a regimen she could not sustain.”
Is it okay to help someone else die? Lachs argues that “doctors should help us through every stage of life,” including the final one. Furthermore, exercising freedom — in this case, the freedom of choice to end one’s life — is not the same as following moral rules. “We have the right to terminate our lives even if it is wrong to do so,” Lachs says — with an important caveat. “Healthy young adults who propose to kill themselves cannot demand aid from others. … The situation is altogether different with suicide that is justifiable.”
To Lachs, context is of the utmost importance. “We don’t want people to choose death over life,” he tells me. But when the end is near anyway, and the person is suffering, what’s the argument against it?
The philosopher has developed a set of five standards for the ideal death:
1. It must be after a person has exhausted his purpose; there’s got to be nothing more for him to truly do.
2. Corresponding to the loss of purpose is a lessening of energy — mental and physical.
3. The person’s affairs should be in order — paperwork, wills, goodbyes, all of it.
4. The person should feel he’s leaving something good behind — “I didn’t live for naught.”
5. The death should be quick and painless.
Lachs has seen and heard of people who are near death but linger on. “It’s so much better when the other conditions are met and they just pass on,” Lachs says. “Ideally, life is such that it gives you a chance to get ready for death.
“Nobody has ever survived life. The bet is going to be lost. All of life is uncertain. We think it’s not, and contingency is the name of the game. But ultimately, we’re going to have to come to terms with the end of it.”
Magda, Lachs’ mother, finally did pass in the “subterfuge” way that hospice workers sometimes quietly administer: a nurse offered a morphine solution that depressed Magda’s lung function and finally accelerated her death.
What’s the best way to die? It’s a question that Lachs has spent time considering. His favorite answer comes from a medical colleague of his, but it’s an old yarn: being shot to death at 90 years old by an irate husband while biking away from sleeping with the gun-toting man’s wife.
Barring that, Lachs says, he’d like to die having met his own criteria — quickly, of a heart attack.
One of the last people I posed my question to was Doris Benbrook, director of research in gynecologic oncology at the University of Oklahoma. Her specialty is much different from the health care staff I’d spoken to previously — she studies cancer on the cellular level, particularly apoptosis, or programmed cell death. Does the microscopic level of dying give us any other ways to think about the best way to go?
In its most basic sense, a cancer cell over-multiplies and begins causing bodily trouble. “At the organ and tissue level, it eats away at vital organs. It grows, duplicates, divides.” That clogs up organs, cascades into other systems, and makes its body croak. How utterly unfair of something so tiny. Some cancers you barely feel, like the notoriously silent ovarian cancer, while others, like bone cancer, cause immense, deep pain.
Benbrook’s work with apoptosis aims to switch off that growth, to figure out how to flip the cell’s existing kill-switch so it can’t wreak such havoc. Years from now, she hopes, doctors could even use this mechanism as a cancer-prevention method.
Interestingly enough, CPR and other familiar cardiovascular attempts to keep people alive take the opposite tack: “They want to prevent cell death,” Benbrook notes. So there are many different ways to think about what the end of a cell means for the end of the human. But cells die constantly, and a few cells dying here and there don’t kill a person. Even though our cells die with us, she stressed that the microscopic level isn’t the right place to look when considering dying.
Her personal answer to the best way to die, however, was my favorite, if only for its imagery.
“I would like to die by freezing to death,” she says. “Because from what I understand of the process, it’s that you eventually just go numb and don’t feel anything. I have experienced extreme pain. I don’t ever want to do it again. I would like to go peacefully.”
Interesting. But it’s where she’d like to freeze to death that moved me.
“I would think that if I were to just sit on an iceberg floating up in the Arctic Ocean, that it would be a peaceful death. I could look up at the stars, I could think about life, and it could be a good experience.”
The frozen night air blowing over your body. The dead quiet of nature interrupted only by laps of the ocean and the occasional fish flopping out of the water. The icy sensation of your tears freezing as you look up at the Great Bear constellation for the last time. That really doesn’t seem like such a bad way to go.
Floating on an iceberg in the Arctic Ocean, the frigid air sweeping over your body as you look at the nighttime sky.
It doesn’t seem like a bad way to go.
But Benbrook and I come quickly back to land. “Of course I would like to have my family surrounding me, and the chances that I’m going to go sit up on an iceberg in the Arctic Ocean to die — that is not likely.” She laughs. “I’d probably be laying in a bed surrounded by loved ones. My goal would be to go peacefully.” Back to the beginning.
So I turn to you, brave and patient reader: from the absurd to the probable, how would you like to die? Allow yourself to think about it, in as far as you’re ready to do so. Do you want a breathing tube snaked down your throat if it becomes necessary? Do you want to be fed if you can’t do it yourself? Would you mind dying in a hospital? You can even get down to ambient details — do you want punk music blasting, a warm room, someone rubbing your swollen feet?
Whatever you wish, however deeply you’re willing to think about it, the key is to share your ideas about a good death. Talk to your family, write down what you want, and keep it somewhere they know about. Ask people about it at parties. As anyone who’s made a “pull the plug” decision can tell you, any guidance you leave will be helpful if you can’t speak for yourself on your last day.
This is your last possible decision, after all — better make it a good one.
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Robyn K. Coggins is a writer and editor who lives in Pittsburgh. In grad school, she worked as an editorial assistant on Creative Nonfiction’s essay anthology,At the End of Life: True Stories About How We Die, which furthered her interest in death, dying, and green burials.
Her mother and husband still won’t answer the big question yet — if you see them, please ask them about dying. Tweet her your answer to the question on@RoJoOhNo. Furthermore, she apologizes if this story made you sad.
Cover image courtesy of the Van Gogh Museum