Interview
Culture
Death & life
S&U interviews
8 min read

Rediscovering 'ordinary dying'

On the eve of her Theos annual lecture on 'Death for Beginners', Robert Wright speaks to former palliative care consultant Kathryn Mannix about the need for everyone to re-engage with the process of dying. Part of the Seen & Unseen How to Die Well series.

Robert is a journalist at the Financial Times.

 

A woman stands in an autumnal-looking park, with her hands in her pockets
Katherine Mannix.

Shortly after the late Queen Elizabeth died, in September last year, Kathryn Mannix, a former palliative care doctor, decided to point out something that had been going unremarked. Mannix, who spent 30 years in various palliative care roles in the North of England until retiring in 2016, wrote on the social media platform then called Twitter that the world had watched the late monarch live through a process that she called “ordinary” dying. But, she added, the dying had gone “unspoken, un-named”. 

Mannix’s 12-post thread pointing out what the world had been watching was to prove one of the most successful steps yet in her long-running campaign to refamiliarise the world with how people die, the signs that someone is dying and how the process works. The thread has been viewed several million times. Among the replies to her post, according to Mannix, were several from people saying they recognised from it that relatives were going through the process and they should prepare. 

Mannix hopes that her efforts will ensure people learn to cope better with their own and others’ inevitable deaths in ways that work better both medically and emotionally. 

“The queen’s death was no surprise to those of us who have been watching that process that we recognise as ordinary dying,” Mannix says, in an interview over lunch in Newcastle, near her Northumbria home. 

“The person got into hospital to have treatment to stop them from dying. When they died, that was a medical failure. That was an embarrassment.” 

Mannix will take another substantial step in her campaign on November 1 when she delivers the annual lecture for the religious think-tank Theos on Dying for Beginners. The lecture will revisit the lessons of her thread about the queen and two successful books about dying: With the End in Mind, recounting the lessons of her career in palliative care, and Listen, about finding the words for end-of-life conversations. All of her work has stressed the unhelpful aspects of medical practitioners’ increasing involvement in deaths. Doctors’ increasing power to prevent death in many circumstances and delay it in others has made it, in her view, damagingly unfamiliar. 

However, Mannix insists that, while the November 1 lecture has been organised by a faith-based think-tank, her principles are applicable whether people understand their lives through a spiritual prism or via something else like family, politics or art. 

“There are a number of constructs that give people meaning,” Mannix says. 

At the heart of Mannix’s message is the idea that death was once a familiar process that people knew how to manage. She argues that the last century’s medical advances changed that. 

“I think we’ve forgotten because over the course of the twentieth century life expectancies nearly doubled,” Mannix says. 

She points to a range of factors behind the shift, from improved sanitation and vaccination programmes to the founding in the UK of the National Health Service and the introduction of antibiotics. 

She dates the shift of dying from home to hospital to the second half of the twentieth century. 

“It was almost like dying was kidnapped inside hospitals then,” she says. “The process itself got slightly distorted by the medical interventions like intensive care units, so the process became less recognisable.” 

The key change, according to Mannix, was that death became “the enemy”. 

“The person got into hospital to have treatment to stop them from dying,” she says. “When they died, that was a medical failure. That was an embarrassment.” 

“It’s hard to have a conversation with a person who has no pegs to hang that conversation on. The current population has no idea about dying.”

Doctors started to keep in hospital people who would prefer to be at home with their grandchildren, in case there was one more thing they might try that would save their lives, Mannix says. 

“We need to celebrate that medicine can do so much more than it used to be able to do,” Mannix says. “But we need to remember that those achievements are only postponing dying. We’ve not cured death.” 

Clinicians need to recognise the point in illnesses where death becomes inevitable and speak to patients about their priorities for their remaining time, she adds. 

“Survival at all costs might not be what is most important to them,” Mannix says. “There may be things that they wish to fulfil.” 

Mannix is clear that the UK at least remains a long way from learning the lessons that she is trying to teach. She was prompted to write her thread about Queen Elizabeth’s death partly by the ending to a news bulletin announcing that the monarch’s family were rushing to her bedside at Balmoral. Mannix says the newsreader finished the segment, hours before the death was announced, by saying “Get well soon, ma’am.” She describes it as “a dreadful example of our death-denying”. 

She is giving the annual Theos lecture as the group is in the midst of releasing a suite of resources designed to provoke greater debate around death and dying. They include a video where Mannix explains the dying process. The group’s research paper Ashes to Ashes, published in March, showed that many British people had similar priorities for their own deaths and those of loved ones as set out in Mannix’s work. They wanted to be free of pain or suffering, surrounded by family, probably at home, to be reconciled to people and to be prepared. 

According to Mannix, however, even her fellow medical professionals feel poorly equipped to begin conversations with patients or their families about impending death. Many people had contacted her after reading With the End in Mind saying that they were convinced of the need for frank conversations about death but had no idea how to start them. 

“The feedback from doctors and nurses was the same as from the general public – ‘I don’t know how to talk about this bit’,” Mannix says. “’Nobody taught us about this in training’.” 

It is also a challenge for medical professionals that patients and their families are typically resistant to conversations about death, she adds. 

“The doctor doesn’t want to be the bad guy or girl and constraints in the NHS are such they can’t find time for the length of conversation that’s likely,” Mannix says, adding that many doctors are also unfamiliar with exactly how the dying process tends to unfold. 

“They’re not taught about dying,” Mannix says of trainee clinicians. “They’re not taught to see good dying as a good medical outcome and it could be.” 

Those conversations are all the harder, she adds, because society as a whole has so little conception of the process of death. 

“It’s hard to have a conversation with a person who has no pegs to hang that conversation on,” Mannix says. “The current population has no idea about dying.” 

In wider society, meanwhile, she would like to see far more communities taking the opportunity to support the dying. 

The questions fundamentally end up being spiritual or philosophical ones, Mannix says. She declines to be drawn on her own spiritual practices but describes herself as “spiritually curious”. She similarly declines to outline her position on the debate about assisted dying, saying that expressing a view on that would be a distraction from her primary purpose of promoting discussion of the ordinary dying process. 

But she says questions about how to manage death, whether to prolong life and the balance between quality and length of life inevitably raise “societal questions”. 

“We all want to think about our life being worth something and about the purpose that we think is the purpose of being alive,” Mannix says. 

Mannix hopes her campaign will prompt religious leaders to think more carefully about how they support families and dying people. In particular, she would like priests to acknowledge to those they are supporting that faith will not always banish fear and that the faithful will sometimes feel abandoned by God in the face of death. She would like to see far more thorough training for clergy throughout their careers in how to have such conversations. 

She would also like to see more clergy learn more about the process of death, so that they can reassure families about what they are witnessing – for example, that apparent gasping from the dying person does not indicate pain. She expresses optimism about the growth of civil society organisations – some based around religious organisations – seeking to encourage a more open discussion of death and dying. She speaks particularly warmly of the Death Cafe movement – where people meet for cake and coffee to discuss death issues – and the End of Life doula movement. End of Life doulas seek to shepherd people through death the same way that birth doulas assist women in labour. 

Both of those movements have a key role to play in bringing about the revolution that Mannix would like to see in society’s understanding of death and its role in life. 

Asked what a balanced approach to the issue would look like, Mannix says it would be “very helpful” if people were told at the outset when they were diagnosed with a long term, potentially life-limiting condition that it could be so. 

“Currently, people understand that cancer can kill you,” Mannix says. “But there are many people walking around the country who have long-term lung diseases, kidney diseases, who just wonder why they never feel as well as they used to do.” 

In wider society, meanwhile, she would like to see far more communities taking the opportunity to support the dying. 

“A decision for the public would be to think of an organisation or society or a community that they belong to and how could they be agents of change in that community to explore the concept or ordinary dying,” Mannix says. 

Such communities can decide how best to prepare and make available support for other community members when they are dying. 

“Their dying will come one by one,” Mannix says. “We’ll all take our own turn.” 

 

While most tickets for Kathryn Mannix’s talk on November 1 have been taken, some more may become available at theosthinktank.co.uk. For those unable to attend, the lecture will be filmed and posted afterwards on the Theos website. 

 

Review
Culture
Film & TV
Fun & play
Justice
5 min read

Boom! I love this new Superman!

Eschewing ennui, it’s a great fairy tale for the modern age
Superman talks to his dog amid the ice.
Superman and Krypto the dog.
Warner Bros.

…and that’s what makes this film so enjoyable! 

Oh, apologies for any confusion.  

No tortuously ‘relevant’ preamble from me today. I’m starting the review right in the middle of the action, because that is exactly what Superman does. No initial slog through a ‘backstory’ that everyone knows – even my wife, who has never read a comic book in her life, is familiar with who and what Superman is. The closest we get to contextualisation is a quick sequence of text: informing us that Superman landed 30 years ago (adopted by the Kent couple, and given the name Clark), began his superhero career three years ago, stopped the fictional nation of Boravia invading the equally fictional Jarhanpur three weeks ago, and three minutes ago lost a battle for the first time. 

Boom! 

Then straight into the action! 

Superman lands in the frozen tundra of the Antarctic and can barely breathe. He lets out a whistle and the next thing we know there is a tremendous snowy disturbance. Krypto the Superdog dashes into view! No explanation – just delight in the fact that there is a mischievous canine with unbelievable power. Krypto drags Superman ‘home’ to the Fortress of Solitude. There the Superman robots heal him with a concentrated dose of radiation from the Yellow Sun which gives him his power. He immediately departs to continue his bout against the nationalist supervillain ‘Hammer of Boravia’, who is secretly being controlled by the evil genius and billionaire Lex Luthor. 

The pace of this film isn’t fast…its hypersonic. It flies by at the speed of Superman himself. There isn’t any lag, any let up. Even the quieter moments, such as those meditating on Superman’s dual identities (the alien superhero Kal El/Superman and the human reporter Clark) or his burgeoning relationship with investigative journalist Lois Lane, keep the story moving. Exposition doesn’t take place through inexplicable monologues; it is always pacy conversation, which teaches us something about the characters and their relationships and their motivations. 

This is the great triumph of writer/director/producer James Gunn. After his success over at Marvel Studios, he has taken the helm of DC and started to create a universe of characters and stories that doesn’t waste time with painful ‘exploration’ and moralising. This was always the issue that held DC films (arguably featuring the more beloved and well-known characters in comic-book culture) back from matching the success of Marvel. Christopher Nolan is a genius, giving us a superb Batman trilogy, and Zac Snyder produced an underrated dark take on Superman, but neither seemed to delight in the bright, bubble-gum, kaleidoscopic colourfulness of the comic-book medium. 

Gunn refuses to make his Superman film gritty or realistic. Characters appear in all their flash and bombast and are welcomed as cheery additions. The ‘Justice Gang’ are simply there – including the always enjoyable Nathan Fillion with an arrogant smirk and an almost offensive bowl cut. Luthor’s genius allows his to create a parallel dimension…why couldn’t he!? If we can suspend our disbelief to accept a protagonist who is an alien superhero, why not a mini-universe?  

There is none of the former focus on psychological trauma and existential crisis and the sheer overwhelming ennui of being. In previous films the ethical lesson wasn’t just ‘on the nose’…it flattened your nose with a Mike Tysonesque haymaker! Here, Superman simply IS. He IS good. He IS upstanding. He IS fighting for truth and justice. He refuses to allow political and public-relations considerations to corrupt and dilute his absolute commitment to do (and to BE) what is right. One of the most dramatic scenes isn’t a grand battle, it is a quiet moment where Clark allows Lois to interview him as Superman. The more she questions the realpolitik implications of stopping an invasion, the more Clark becomes incensed. How could someone not allow themselves to save innocent life and serve justice to the oppressed against the oppressor? 

The film is such a ‘sigh of relief’ in a bloated comic-book-film market. Yes, the script is hilarious – this is Gunn’s forte. Yes, the music is sublime – both John Murphy and David Fleming’s score (with wonderful nods to the John Williams original) and Mr Gunn’s own needle-drops. The performances are excellent across the board – special mention to David Corenswet, who doesn’t quite look like Superman to me…but boy does he embody the very essence of the character, to the point where you can’t imagine anyone else having played the alien since Christopher Reeve. But its truest strength and victory is its joy in the simplicity (especially moral) of this comic-book genre. 

This is what is so refreshing about Gunn’s vision. Superman IS pure. Lex Luthor (Nicholas Hoult not missing a baldy beat) IS so prideful and vain that it has warped him into something twisted and evil and collapsing in upon his own ego. Watching the film, I was put in mind of C. S. Lewis’ writing on the nature of fairy tales: 

“For in the fairy tales, side by side with the terrible figures, we find the immemorial comforters and protectors, the radiant ones…” 

Comic-books are the great fairy tales of the modern age…why would we make them brooding deconstructions of the human condition, a la Cormac McCarthy? That isn’t their point or purpose. Lewis again: 

“Since it is so likely that they [children] will meet cruel enemies, let them at least have heard of brave knights and heroic courage. Otherwise you are making their destiny not brighter but darker.” 

Gunn has given us a film that isn’t just fun and fluffy, but important. In his sugary, childlike wonder and delight in the genre, he has given us a tale of good versus evil that is a true fairy tale: something gleaming and good, something radiant and right, something attractive and aspirational. Superman is a fairy tale where we can be comforted and emboldened by the moral (nay, ontological!) certainties of love and hope.  

5 stars

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