by PJ Moon

A phrase in Dr. Dieter’s recent Pallimed piece, “Facing the Abyss: Planning for Death,” usefully resurfaced a notion I’ve had for 12 years now. It started when a professor I was working under remarked how the “death denial thesis” may not really be valid anymore in geriatric/end of life publications and discourse.

Combing through the literature, my professor’s hunch rang true, but only faintly so. To be clear, it wasn’t that issues of human mortality were given special spotlight by journal editors and varying authors, but rather the matter was generally portrayed in ways that did not neatly fit the category of denial, cloaking, or marginalization. Instead of the so-called death denial thesis being eliminated, I perceived another thematic rhetoric rising.

Given the commerce of innovation in medicine and cognate arenas, emerging tools have enabled us to ‘manage’ death, hence rendering death-denial less marketable. I call this the death-management thesis.

Let me clarify the usage of the term ‘management’ in this context. Here, it does not mean an approach to our inevitable end where it is bravely confronted with solemn sincerity, strategy and resolve. No. Rather, death-management denotes a semi-deceptive scheme of managing-from-the-top what it sees as a nagging, irritating and pesky problem of existential impermanence, namely death. Colloquially, I’m using death-management as a reference to how we clamor to gain control over our end so we can manage it by manipulating related dynamics (e.g., pace of decline, labeling processes and conditions (as giving things a name can make us feel as having ‘mastery’ over it, etc.) and, basically, calling the shots so it is not as wild and scary anymore. And so, it is a management project of taming death. It is a management mission to make death submit to us via our innovative tools and techno-rational prowess. Death-management so declares: “Death, we own you and you are under our management!”

But wait, there is more. This line of thinking (manipulatively managing death) conjures a subsequent idea. Once you and I buy this death-management thesis, then it is no huge leap to land on the square of a “death-defiance” thesis. Ok, here’s the sequence: After we can manipulate death so to manage it any way we like, then we are liable to think we can defy it altogether. Shout it with me now, “We not only manage you, death, but we defy you too!”

What a claim.

Before we get carried away, a distinction is made between Hippocratic and Baconian paradigms.¹The former is a view that human nature is to be “worked with” out of inherent respect. The latter is a view that human nature is a thing to be figured out towards overcoming and controlling it, to have victory over it, according to our will and whim. So, which appeals to you, dear reader: the Hippocratic or Baconian enterprise?

Whether death-denial, -management or –defiance, mortality rate for the human race is still running on full steam at 100%. Given this persisting fact, it is to our loss when death is denied. You see, when you and I deny death, we lose track of our constituent nature, or our inherent mortal state. When death is denied then we actually give death the upper hand. It just may be that death wants mortals to vigorously exercise the skill of denying its reality so it can eventually strike with greater insult and offense.

My humble encouragement to us all is threefold:
(a) please deny the denial of death, lest the impact of its promised arrival be felt much more pungently than necessary
(b) please rethink if it’s death that’s being managed or merely its common forerunners of certain kinds of pain, angst, slumber, etc.
(c) please take caution in defying death because wisdom tends to be about facing reality (including seeing through illusions)² and not turning away from it.

In sum, I find it more worthwhile to live in light of intractable death by actively preparing for it in various ways today, tomorrow, and the next day, and thereafter until it comes.

1. Jecker, N. S. (1991). Knowing when to stop: The limits of medicine. Hastings Center Report 21,(3), 5-8.

2. McKee, P., & Barber, C. (1999). On defining wisdom. The International Journal of Aging and Human Development, 49(2), 149-164.

Paul J. Moon, PhD, is Bereavement Coordinator at Alacare Home Health & Hospice in Birmingham, Alabama, USA. Even apart from his professional role, he ponders much on his mortality, the afterlife, and how best to get ready. He cares to plead for you to consider doing likewise.