Perspectives on Life and Death
Three Principles for Managing Living and Dying to Live out as Summer Flowers and Decease as Autumn Leaves

With the advent of an era of aged and super-aged society, everyone, whether married or not, with or without children, must prepare themselves for solitary death. We should manage our living and dying by thinking through the relations between hospice/elder care and community. Although we must travel alone on our way to the afterlife, we will not be bothered by loneliness.



Original Chinese text by Ven. Hui Min (惠敏法師, Former President of Dharma Drum Institute of Liberal Arts and Emeritus Professor of Taipei National University of the Arts)

When the aged and super-aged society becomes the norm in the near future, everyone, no matter married or unmarried, with or without children, needs to prepare themselves for the scenario of "dying alone" or "solitary death." In fact, from the perspective of "the state of incessant change of all things," we must be aware of the fact that "life is between breaths" and that "one must travel alone on the road to the afterlife." In response to the issue of "dying alone" or "solitary death," here are three tips, based on my limited knowledge, that I would like to share, and I keep open to suggestions from experts from all walks of life.
 

I. Learning Life-saving Skills such as CPR and Getting Prepared for Death by Signing ACP and AD
 
According to the statistics of the Ministry of Health and Welfare of Taiwan, "heart disease" ranks second among the ten leading causes of death in Taiwan, with sudden cardiac arrest being the most common. For every minute without life-saving treatment, the survival rate diminishes by 7-10%. Therefore, since life is unpredictable and could be lost in a blink of an eye, it is worthwhile to encourage everyone to learn life-saving skills such as performing CPR, using AED, and various first-aid procedures such as the Heimlich Manoeuvre. Acquiring life-saving skills not only allows us to save others, but its prevalence also enables more people to save themselves or their family and friends, which is beneficial to both others and self.

In addition, with the establishment of the Hospice Palliative Care Act (implemented in 2000, amended in 2002) and the Patient Right to Autonomy Act (implemented in 2019) in Taiwan, people here can sign up for Advanced Care Planning (ACP) and an Advanced Decision (AD), and have it registered on their health insurance card. By expressing their "refusal of CPR at the end of life" in advance, people can avoid going through the pain of "futile medical treatment" if they happen to be terminally ill or brain dead with "out-of-hospital cardiac arrest." For example, avoiding CPR or "life-sustaining measures" (extracorporeal membrane oxygenation, vasopressors, intravenous therapy, nasogastric tube feeding, etc.) reduces the waste of medical resources. Making an Advanced Decision can deeply affect an individual's quality of death and end-of-life care, so it is worth promoting for the benefit of ourselves and others. (See note.)


II. More Good Interpersonal Relationships and Fewer Possessions

The second advice is to develop the habit of building good interpersonal connections with individuals and communities, as well as reducing excess possessions and avoiding hoarding.

According to an article titled "Not Immune to Solitary Death despite Being Rich and Having Kids? An interview with Lu Lala (盧拉拉), a Cleaning Artist at Scenes of Death, Suggesting to Hoard Less Possessions and Build More Relationships" (有錢有孩子，仍可能孤獨死？命案現場清潔師盧拉拉：少囤物品，多積緣分) published on 50+ (Fifty Plus) community on January 3, 2021, the reporter Chen Wan-shin (陳莞欣) mentioned that: Lu Lala, after working as a liturgist for years, realized that the cases of solitary deaths have been increasing year by year, but there were not many companies specialized in providing relevant services. Around 2018, Lu and his friends co-founded Yue-ming Special Cleaning (玥明特殊清潔), which is the first cleaning company in Taiwan that specializes in dealing with the death scene of unnatural causes. The uncommon nature of their work allows them to have first-hand observations of the issue of solitary death.

According to the common stereotype, "solitary death only happens to the poor and childless elderly." However, Lu points out that a high percentage of solitary death cases are middle-aged men between the ages of 35 and 65. Most of them were married, had children, and had enough money to make ends meet. Sometimes, they may even find large sums of money properly stored among the garbage left by the deceased. However, having money does not necessarily mean living a life of dignity.

Why do solitary deaths happen? On the surface level, the immediate cause of their death is mostly cardiovascular disease that leads to sudden death. Since no one finds the victims after they fall due to cardiac shock, the opportunity to resuscitate them was missed. However, Lu believes that there are three real causes of solitary death: changes in family structure, weakening of kinship, and interpersonal alienation.

The definition of solitary death used to be: "A person who lives alone passes away with no one around." However, in recent years, Lu and his team have found that more and more cases of solitary death are individuals who were not living alone. It's just that the family members who lived with them didn't notice their death. Often, when the cleanup team arrives at the scene, they find the living room of their clients clean and tidy, and their family's life goes on as usual. However, when they open the door of the decedent's room, they will face a room filled with food remnants, trash, and an overwhelming stench. The space between heaven and hell is just one door away.

It is worthwhile for us to reflect on such phenomena caused by interpersonal relationships and personal living habits. In addition, in the Chinese edition of the book The room where time stands still: A story of solitary death told through miniatures by an estate cleaner who sorts out the belongings of the deceased (時が止まった部屋：遺品整理人がミニチュアで伝える孤独死のはなし, translated into Chinese by Chen Bo-yao), written by Japanese cleaning artist Miyu Kojima (小島 美羽), she has transformed the harrowing scenes of solitary death into eight exquisite and lifelike miniature models of rooms. They encapsulate the shared features of hundreds of death scenes and untold stories, which is thought-provoking.


III. Be Aware of Moment-to-moment Impermanence in a 100-year Life

We need to live with an attitude of "impermanence at any moment" towards life– treating every day as the last day and every breath as the last breath. At the same time, we need to prepare ourselves for a "100-year life" to avoid a prolonged life of poor quality due to advances in life-sustaining treatment. We should develop habits that prolong the life span of our organs and mental functions as much as possible. For example, we can try to delay the onset of cataracts by wearing sunglasses to protect our eyes from ultraviolet rays; we can also try to delay the onset of mental deterioration by keeping a diary and taking notes.

In 2016, some professors at the London Business School published The 100-Year Life: Living and Working in an Age of Longevity, a book that maps out the challenges and opportunities of the future for individuals, enterprises and governments. According to this book, children born after 2007 have a 50% probability of living to age 100. Some experts in Japan, taking into account the experience of Scandinavian countries such as Finland, have suggested that a social system based on Universal Basic Income (UBI) could be the solution.

From my perspective, in the face of the challenges of the Double A era (AI + Aging), the "Double B approach" (UBI + Basic [Healthy] Lifestyle) will have a more long-term effect. For example, maintaining basic life styles to support physical and intelligent health by implementing the "Five Precepts for Physical and Mental Health: Smile, Brush Teeth, Exercise, Eat Properly, and Sleep Well" and the "Five Precepts for Lifelong Learning: Read, Record, Study, Share, and Practice." In this way, we can reduce the economic burden on individuals and society, enhance the physical and intellectual abilities of all people, and improve the quality of life and civic literacy of every citizen. This may serve as the fundamental principle for the "management of living and dying" and "building a pure land on earth."


Note: Please refer to my article "Taking 'Advance Care Planning' (ACP) as a Meeting of Life and 'Advanced Decision' (AD) as the Final Examination of Life" on Issue 428 of Humanity Magazine (April 2019)


 


Resource: Issue 452 of Humanity Magazine (April 2021), Dharma Drum Publishing Corporation
Translation: Li Siang-ling
Editing: Keith Brown, James