By Karem Armstrong, the author of The Great Transformation: The World at the Time of Buddha, Socrates, Confucius and Jeremiah (THE GUARDIAN, 25/03/06):
In ancient China, the rituals of filial piety required the eldest son to participate symbolically in his parents' death; he had to withdraw from the family home and live in a hut, sleep on the ground with a clod of earth for a pillow, maintain strict silence and starve himself into a state of weakness. I was reminded of these rites during the weeks of my mother's slow dying. I did not live in a hut, but in some curious way I retreated to the periphery of my life, putting off the simplest tasks, reluctant to see friends and feeling my own vitality ebbing away - as if compelled to share her miserable suspension between life and death.
At Christmas she was still able to enjoy a conversation and follow a television programme; a fortnight later she was diagnosed with Alzheimer's disease, which progressed with a rapidity that, I was told, was very unusual. In early January, she stopped eating, was admitted to hospital with seizures, and was then assailed with one infection after another. When I visited, she often failed to recognise me; at other times, she gazed at me with dull indifference and told me repeatedly to go home. She was not trying to spare me, as some kind friends suggested. That was not her style. She had simply receded so far from ordinary life that she inhabited a place where relationships had become meaningless.
She found it increasingly difficult to speak, but the one thing she said frequently and with clarity was that she wanted to die. It was her last - indeed her only - wish. Thirteen years ago, when in good health, she had made a living will, which stated that, when the time came, she did not wish her life to be prolonged artificially. The accompanying leaflet was entitled Let Me Decide. She had always warned me that if she became seriously incapacitated, she would stop eating. I was rather sceptical about this, as she was notoriously careful of her personal health and safety. But she was as good as her word, so determined not to swallow a single mouthful that she would not even let the nurses swab her mouth, which became horribly infected.
She had done everything she could to die with as much dignity as possible. But her mental powers had so declined that the person that she was had already died. The nurses were frankly incredulous when I told them that she had been a clever, strong-minded woman. Only her ruined body, grotesquely weakened and deformed, remained; her skin had already started to decay and eventually she was no longer able to absorb food.
My poor mother was stuck: she could not go back, but she could not move forward either. She had always found it well-nigh impossible to relax, mentally or physically, and her body simply did not know how to let go. People told me that she was probably not conscious of her state and that it was worse for me than for her. I doubt that. She was clearly in distress but, because her mind had gone, her anxiety was empty and unfocused. She reminded me of the gibbering shades in Homer's world of the dead, whose humanity had obscenely disintegrated. The religions tell us that life is sacred; but my mother's plight was an affront to that holiness.
I did not expect the doctors to administer a lethal injection. All she needed was a strong sedative to give her some rest and teach her body to surrender. But for some inexplicable reason this was not allowed. We regularly use medication to help us through life's physical and psychological crises: through childbirth, menopause, bereavement and depression. Why can we not use drugs to educate the body in the alien ways of death? I am sure that I would have had no difficulty procuring antidepressants to get me through my mother's dying, but she herself could have no such help - probably because it smacked of abdication.
We have banished death, a disturbing reminder of our ultimate impotence, from modern society. Old people no longer receive the respect they enjoyed in more traditional civilisations. Instead we push them out of sight into residential care. Death happens off-stage in hospices and nursing homes. And now, it seems, death is even becoming taboo in our hospitals; when we go to hospital we are meant to get better and meet government targets; we are not supposed to die there any more.
The nurses who cared for my mother were heroines. She was not an easy patient, but they were unfailingly kind, cheerful, tender, humorous and skilful. But they were clearly baffled by her refusal to eat, because they still desperately wanted to cure her. Yet what could recovery possibly have meant for my mother but appalling years in a nursing home, incontinent, bewildered, incapable of feeding herself, and unable to recognise her visitors?
We are not good at calling a halt to our technological expertise, even when it is in our interests to do so. We have created weapons that can destroy the world, and our greed for progress has perhaps irreparably damaged the planet. If we are able to do something, we feel we should do it. Because they can cure so many diseases, our medical personnel feel obliged to do so at all times. Their passion to save life is wonderful but not always appropriate. To condemn my mother to a living death against her will would have been an act of cruelty.
Of course, there are dangers. Old people must not be pressured into premature death by overwrought relatives. Many sufferers cling desperately to life - and they must be helped to do so. But when somebody has made her wishes clear - as my mother did every time she rejected the feeding cup - this should be respected too.
The religious may argue that she should have submitted to the will of God. But even the most conservative theologians believe that God works through the natural processes and in my mother's case nature was, with the best of intentions, deflected from its course. Without drips and antibiotics, her ordeal would have been over weeks ago. She had to wait until the nurses could no longer find a vein to medicate her and she could die of an awful bowel infection.
At her funeral, I will not be able to say that she died as she had lived. Towards the end, she sometimes regarded me with weary hostility. I brought her no comfort, no pleasure; she did not even want to hold my hand. And I failed to help her achieve the dignified death she wanted. But I can at least write this article in the hope that, one day, others will be spared her fate. She would have liked that.