TRIGGERnometry - How to Die Well - Dr John Wyatt

00:00:00.000 When you ask people how they want to die, the commonest reaction you get is,

00:00:03.700 I just want to go out like a light. 0.62

00:00:05.980 I want to go to bed one day, perfectly healthy, and just die in the bed just like that.

00:00:10.940 Wouldn't it be wonderful? Fantastic. Just, you know, bang, gone. 0.72

00:00:14.180 No awareness, no warnings.

00:00:16.120 The fascinating thing is, if you go back a few hundred years,

00:00:19.820 that was universally regarded as the most terrible way to die.

00:00:23.880 Really?

00:00:24.220 Everybody agreed that sudden, unexpected death was the absolute catastrophe.

00:00:30.000 Hello and welcome to Trigonometry. I'm Francis Foster.

00:00:39.480 I'm Constantine Kishin.

00:00:40.620 And this is a show for you if you want honest conversations with fascinating people.

00:00:46.700 Our brilliant guest today is a medical ethicist and the author of Dying Well.

00:00:51.080 Dr. John Wyatt, welcome to Trigonometry.

00:00:52.840 Great to be here.

00:00:53.380 It's so good to have you on the show.

00:00:55.340 We're going to talk about the cheery subject of death.

00:00:57.960 You're already excited about it, I can tell.

00:01:00.000 But before we get into that, tell everybody a little bit about your background.

00:01:03.940 Who are you? How are you? Where you are?

00:01:05.980 How do you find yourself here talking to us?

00:01:08.440 Yeah, my background is as a medic.

00:01:10.440 I'm a baby doctor by training and profession.

00:01:13.780 I worked as a paediatrician and a specialist in the care of newborn babies

00:01:17.120 here in central London, University College London.

00:01:20.860 And I'm an academic researcher.

00:01:22.360 I was particularly involved in brain injury and finding new treatments for preventing brain injury in newborn babies.

00:01:30.500 And then from my work, I got more and more interested in some of the fascinating and challenging ethical debates that are going on to do with medicine and the advances in technology.

00:01:41.340 And so I've now retired from the clinical front line, but I'm still very much involved and engaged in medical ethics and in technology issues related to technology, including artificial intelligence and the new challenges which are coming up down the road.

00:01:56.700 But I'm very interested in dying.

00:01:59.420 Not personally, I tell you.

00:02:00.860 Well, I'm trying to keep it up there, you know, but actually, to be honest, I'm actually quite fascinated to know what it feels like.

00:02:07.160 I've cared for so many people who've been dying.

00:02:10.200 I've watched people die.

00:02:11.960 And, you know, one of the weird things about the modern world is that we've put dying out of sight.

00:02:18.000 It isn't something we talk about.

00:02:19.940 It isn't something we experience.

00:02:21.280 And it's a great point.

00:02:23.520 It's something that we don't talk about.

00:02:25.260 It's something that is an absolute taboo subject in the West.

00:02:29.360 And it seems to me that over the past 18 months, as a pandemic has encroached in all our lives, we've suddenly become a little bit more aware of our own mortality.

00:02:40.100 And I think we've had a little bit of a moral crisis.

00:02:42.520 Would you agree?

00:02:43.760 Well, I think there's something in that.

00:02:44.680 I think the interesting thing is that particularly what psychoanalysts and psychologists say is that all of us suffer fundamentally from death anxiety, from this outrageous discovery that our lives are going to end.

00:02:59.420 And then we develop psychological mechanisms to try and live with that reality.

00:03:04.700 And the commonest psychological mechanism is defense.

00:03:08.300 We deny it.

00:03:09.180 We pretend it doesn't happen.

00:03:10.760 It's not going to happen.

00:03:11.660 It doesn't happen to people like me.

00:03:12.980 And I get on living with my life.

00:03:15.680 And what's happened in the pandemic is that all of a sudden that those defense mechanisms have turned out to be not very good because we've just been bombarded with these horrific images, haven't we, of mass graves and intensive care units and weeping relatives and watching those statistics.

00:03:33.300 And we've realized, actually, it does affect us.

00:03:36.620 And so I think there is a sort of epidemic of death anxiety, particularly in those early days of the lockdown.

00:03:42.100 And, you know, you talk about death anxiety.

00:03:45.180 What are the symptoms of death anxiety?

00:03:49.320 Well, I think everybody is incredibly different, isn't it?

00:03:52.820 I mean, how do people cope with this sense of a lot of it is just fear?

00:03:59.640 I mean, a sense of heart racing, you know, the symptoms of fear, anxiety.

00:04:07.140 You know, one of the things we all got used to is you're walking along the street and someone's coming the other way and you suddenly, you almost bump into them.

00:04:15.780 And I remember people cowering back and with great sort of terror on their faces that, you know, you were going to be the angel of death to them.

00:04:23.400 That kind of of so.

00:04:26.080 So I think fear.

00:04:27.580 I think depression.

00:04:29.500 I think sleeplessness, inability to sleep.

00:04:33.580 You know, there's been an epidemic of mental health.

00:04:35.860 It comes out in many, many different ways.

00:04:38.200 And tragically also, I think broken relationships, abuse, you know, a whole litany of things.

00:04:44.600 One of the things as pediatricians, we're aware of it.

00:04:47.680 The fact there's actually been an increase in child abuse going on during the lockdown, but often not recognized because the normal mechanisms by which these things became apparent were not there.

00:04:58.660 Do you think we've reacted rationally to this, the fear?

00:05:03.540 Because I think you're right when we look around and see how people react.

00:05:07.480 When I see some polling numbers, for example, you know, 20% of the British public want a permanent curfew after 10 p.m.

00:05:14.840 You're going, I'm not sure you really, you know, you're reacting rationally to this.

00:05:19.620 Do you think that as a society, as Francis, I think I was alluding to earlier, we've kind of wet the bed on this one a little bit?

00:05:26.840 Probably a great deal of bedwetting going on.

00:05:30.420 But, you know, I think we don't know.

00:05:35.280 As human beings, we find it incredibly hard to assess risk.

00:05:39.520 You know, so in my previous work as a pediatrician, one of the things I often had to do was to discuss with parents whether they were going to have their children vaccinated.

00:05:48.680 And particularly early on in my career, it was about the whooping cough vaccine.

00:05:52.280 There were statistics that one in 300,000 children suffered permanent brain damage because of a whooping cough vaccination.

00:06:01.000 And I've spent endless hours of my life talking to parents who've been agonizing about, you know, should I have my child vaccinated?

00:06:08.760 What are the risks and so on?

00:06:10.220 And the problem is, of course, if you say if your risk is one in 100,000 or one in 85 or what does that mean?

00:06:16.720 You know, if I've got a one in 85 risk of dying, is that something I should worry about?

00:06:21.260 Is that something I should change my life over?

00:06:23.720 You know, if it's one in two in 50, is that better than one in 85?

00:06:27.440 You know, I think psychologically we just can't access those mathematical risks.

00:06:34.640 And we don't know how to translate it into living.

00:06:37.560 And this is, I think, part of the problem in the pandemic is how psychologically we learn to live with risk.

00:06:44.640 And I think that a lot of people got the risk completely out of kilter so that they felt that by going to the local shop, you know, they were putting their life at mortal risk.

00:06:57.520 And therefore, and interestingly, you know, I mean, politically, you can see that Boris and the government in those early days of the lockdown, their intention was to stoke fear.

00:07:09.960 I mean, it was in order to get people to obey the lockdown.

00:07:13.260 They deliberately stoked these images about, you know, save lives, protect the NHS.

00:07:20.400 It was and the hidden message, if you don't follow the lockdown, you might die. 0.98

00:07:25.300 So and kill someone else or kill someone else.

00:07:27.280 And so there was this deliberate stoking, wasn't there, of fears.

00:07:31.220 And now when we say, hang on, it's not quite as bad as that, and we should now get it in proportion.

00:07:37.580 I think what's interesting is there's a whole population of people who once these fears are turned on, particularly older people, they're just not at all sure they ever want to come out of their houses ever again.

00:07:48.160 It's interesting because I think some people who watch our show regularly might at this point be thinking, well, they've got this guy on who agrees with their scepticism about lockdown.

00:07:56.060 But you actually have a very mixed view about the measures the government have taken.

00:08:00.060 For example, one of the things I know you talked about is the fact that the NHS being overwhelmed would be just a catastrophic thing to happen, given the number of people with chronic conditions.

00:08:11.760 So can you give us some input on that from kind of inside the medical profession's point of view?

00:08:17.500 Yeah, I have to say I was very frustrated about some of the conversation that was going on early on where people were saying, well, why do we need to protect the NHS?

00:08:25.040 I mean, it's just, you know, as though it's a bit like protecting shipbuilding or protecting the on-the-send.

00:08:31.460 Just to be clear, John, Francis and I were both very much in favour of the first lockdown and complied with it completely.

00:08:36.580 It was more the later steps that we were more sceptical about.

00:08:39.300 But please carry on.

00:08:40.640 I think what a lot of people who are not in the business don't really understand is how utterly central healthcare has become to the functioning of a modern society.

00:08:51.900 In that sense, it's utterly different, I think, from virtually any other of the activities of a modern society.

00:08:59.540 And that's because so many of us have got chronic conditions, which for our normal everyday functioning, we depend on the continual existence and input of health services.

00:09:14.240 It's not simply the case that health services are there in case people are critically ill and going to die.

00:09:19.100 It's the fact that normal living depends.

00:09:22.560 You know, there are so many people with diabetes, with kidney problems, with hypertension, blood pressure, with cardiac problems, with respiratory problems, with asthma and so on.

00:09:34.020 And many, many of these people would have either died or be chronic cripples and severely disabled in the past. 0.94

00:09:41.780 But now, and I'm one of them, we're all of us getting on with our lives with chronic conditions, thanks to the fact that we've got continuous healthcare input.

00:09:51.960 And if we become particularly sick and we know that there are people there who are going to look after us and bail us through some acute episode and so on.

00:09:59.800 So the prospect of happening was that if the NHS became genuinely overwhelmed, that literally all those activities stopped happening simply because it was the NHS was overwhelmed with COVID patients, then the knock-on effects on the whole functioning of society was far greater, I think, than people recognised.

00:10:24.140 It would have absolutely catastrophic consequences and also for the economy because, of course, you know, so many of those people with chronic health conditions are also productive members of the economy.

00:10:36.120 And therefore, if once the health system goes down, the economy goes down as well.

00:10:40.660 I think that awareness, I think that was something that was appreciated in the Department of Health and in the Cabinet, but it was something that was often not appreciated in the kind of debates that were going on.

00:10:55.180 You know, it's very naive and simplistic to say we either back the economy or we back health, the NHS, you know, which should we back?

00:11:02.880 In a modern society, that simply is a meaningless kind of comparison, I think, dichotomy.

00:11:12.460 Having said that, I think, of course, we're now in a very different stage.

00:11:16.100 So my own feeling as a medic, and I think the vast majority of people with experience of frontline medicine, that we really didn't have any alternative but to try to protect the NHS at that, at the time, at the peak.

00:11:32.880 I think now, of course, we're in a very different situation and these very difficult questions of lockdowns versus economic and growth and freedom and liberty and so on and that trade-off.

00:11:47.180 And I think we're going to be living with those kind of trade-offs for the foreseeable future.

00:11:51.200 I mean, you say we're going to be living with the trade-offs for the foreseeable future and talking about death.

00:11:58.840 The excess deaths caused by the lockdown and the shutting down of the NHS, I mean, those are very, very difficult subjects and topics to address.

00:12:07.900 They are. And, you know, this is one of the bizarre things that struck me in the height of the pandemic.

00:12:14.920 And that is, in many ways, the kind of what was happening in London was a kind of, it felt like an existential risk.

00:12:22.500 You know, it felt as though, you know, the analogy with warfare was not ridiculous, you know.

00:12:28.140 But the difference was, you know, and I was thinking back to what it would have been like, you know, in these very streets in the Second World War or in the Blitz and, you know, when the whole nation is at war.

00:12:38.420 The bizarre thing that was going on in the pandemic is that a small number of people, many of whom are my friends and who I was closely related to, health professionals working in ITUs and A&E departments, it was a war zone.

00:12:52.340 I mean, what they were going through, watching the bodies, seeing people struggling for life, working through the night, it was a war zone.

00:13:00.760 But it was for a tiny minority of people.

00:13:03.540 And the vast majority of the population was sitting on their backsides, warm, well-fed, safe, and watching Netflix.

00:13:12.300 And there's this sort of strange disconnect that I know that just down the street, there is absolute carnage going on in the ITU.

00:13:20.600 And yet the vast majority of people, it has no impact at all.

00:13:24.320 It just simply passes me by.

00:13:25.900 It has no impact on my life.

00:13:28.280 And so that's a really strange disconnect.

00:13:30.800 And I think some of the scars which we are now trying to deal with as a country are because of that disconnect.

00:13:39.480 Many people's experience of the pandemic was it was great.

00:13:42.180 I was at home.

00:13:43.400 I watched an awful lot of television.

00:13:44.880 I played some great games.

00:13:46.740 You know, what was the problem?

00:13:49.180 And yet I have some of my friends.

00:13:51.060 I have friends who died as health professionals, got COVID and died.

00:13:54.620 I have some who've been permanently damaged, and I have some who carry huge emotional scars because of what they experienced.

00:14:02.440 And of course, many, many people were bereaved.

00:14:05.240 And their last words with their loved ones was over an iPad or a phone, you know, not even able to be there to hold a hand.

00:14:12.420 So there are some deep, deep scars there and trying to come to terms with what actually happened and how we can heal those wounds.

00:14:23.340 I think it's going to take some time.

00:14:25.240 Do you think that we talk enough about the effects that COVID had on the medical professionals themselves?

00:14:31.060 I mean, I've received some messages from doctors who said that the front line was carnage, that a lot of doctors have got PTSD as a result.

00:14:40.940 Yeah.

00:14:41.180 And there was one, and I don't know if it's true, saying that one of them actually committed suicide as a result of what they'd seen on the front line.

00:14:48.480 Yeah.

00:14:48.740 More than more than one.

00:14:49.720 I mean, there have been a whole number and people who are permanently traumatized.

00:14:54.640 I mean, particularly, actually, it's the junior doctors who I feel most for, because I know, you know, as a junior, you get catapulted into horrific situations where you feel completely out of your depth.

00:15:07.520 You know, at least when you're an experienced consultant, you've been here before and you've got some way of understanding what's going on and how to cope.

00:15:14.600 But I think, you know, what happened is there were some final year medical students who were just sort of announced, you know, you thought you were going to do your finals next year.

00:15:21.200 Well, we are hereby nominate you.

00:15:23.580 You are now a qualified doctor and you report for duty tomorrow.

00:15:27.380 And they were suddenly, you know, and watching people die and feeling utterly overwhelmed.

00:15:33.760 So I think there are a lot of stories that need to come out.

00:15:38.880 And it is interesting that, and I think a lot of health professionals feel that the rest of the country has just done very well, thank you.

00:15:47.920 And, you know, and yes, it was nice when everybody got around and clapped hands.

00:15:52.760 But frankly, that was, you know, that was a bit trivial in terms of, you know, in wartime, the instinct was we've got to celebrate the war heroes.

00:16:03.240 We've got to put up memorials.

00:16:04.440 We've got to, you know, you think of everything that goes on into the lost soldiers and Poppy Day and celebrating the people who gave their lives for this country.

00:16:13.440 There are far more people who have given their lives and suffered damage because of COVID than in some of the military conflicts, certainly since the Second World War.

00:16:26.200 So, and yet, are we going to have the same kind of recognition, celebration, naming?

00:16:32.740 One of the fascinating things, of course, is that many of the health professionals who died came from ethnic minorities and were not, you know, they are at the absolute bedrock of the NHS.

00:16:46.180 And yet, again, I think there's been this sense that they haven't been recognised or celebrated in the way that our heroes would be from the armed forces.

00:16:56.360 Do you think this whole thing is, relates very much to what you were talking about earlier, which is, there's kind of this meme going around on the internet, like, what kind of pandemic is this that you wouldn't know it, it's happening unless you watch the news.

00:17:10.520 And that is kind of speaks to the disconnect between the fact that the medical professionals were on the front line facing it, everybody else.

00:17:18.540 I mean, you literally could have not noticed it if you didn't turn the TV on.

00:17:22.060 And that's the kind of disconnect.

00:17:23.720 It is very weird, isn't it? Because if you think any other existential crisis which hits an entire nation, everybody notices.

00:17:34.360 It's something which is affecting my life.

00:17:36.840 And yet, extraordinarily, people could have a really nice time and just let a few health professionals get on with it.

00:17:44.440 Do you think that the reason for this is partly because the people who died from this are primarily very old people?

00:17:51.320 And so, it's kind of, I mean, this sounds very crass, but since we've got you on to talk about this very difficult subject, I'm just going to say it like it is, right?

00:18:00.300 That's very Russian of you.

00:18:02.480 Surely not.

00:18:03.240 Well, you'll relate to me as a front line medic, I think, who had to deal with dying children all the time.

00:18:08.300 But, like, it's kind of factored in, in our minds.

00:18:11.540 Yeah, yeah.

00:18:12.180 Do you know what I mean?

00:18:12.680 These are old people. 1.00

00:18:13.400 They're going to die anyway.

00:18:14.520 It's not really, yeah, okay, my grandmother or my great aunt died and whatever.

00:18:18.300 But really, as a 30-something old man, like, it's not affecting my life.

00:18:23.220 That's absolutely right.

00:18:24.360 No, I think it is.

00:18:25.700 And, you know, this is something that's really weird about COVID because there have been lots of lethal pandemics before.

00:18:33.040 And, in fact, I was, you know, 10 years ago, I was part of an ethics group that was discussing how the NHS would cope with a lethal pandemic.

00:18:40.640 But we were basing it on previous lethal pandemics.

00:18:43.820 The interesting thing about previous lethal pandemics is they actually target young people, and it's young, fit people who particularly – so that was true of the Spanish flu.

00:18:55.220 It's been true of SARS.

00:18:57.120 It's true of Ebola.

00:18:58.500 I mean, it's often – it's young, fit, healthy people are the ones who are particularly – who get it most severely and who die like flies.

00:19:05.780 And that's what we were expecting, and that's part of the horror we were, you know, imagining all these people, 18-year-olds, 21-year-olds, 25-year-olds, fit, young, healthy people, dying in ITU.

00:19:16.920 How is society going to cope with that?

00:19:19.420 The fascinating thing about COVID, and there are – there's a scientific reason as to why this is – it's almost completely unique.

00:19:25.460 It has this very precise age relationship.

00:19:28.680 It goes – the risk goes up linearly with every 10 years of age.

00:19:32.480 And that's just because of something very strange about the biology and how it actually gets into the cells.

00:19:39.000 And so that meant this very unusual age profile, that it was almost entirely older people, and particularly once you got into your 70s and 80s, you were at very high risk, whereas the people in their 20s, as you said, felt immune.

00:19:53.420 That's unusual.

00:19:54.620 And it's certainly – when the next lethal pandemic comes, there's no reason to think it will be like that.

00:20:00.180 But I do think the psychological response, the way that people responded, would have been very different if all your mates – if you knew that all these young, fit, healthy people were going down and dying.

00:20:14.420 And you – much more like the AIDS – you know, when I was around, when the AIDS epidemic first hit, and what was so awful was it was young, healthy, fit people who were dying like flies. 0.60

00:20:28.240 And, of course, that made a huge, huge psychological impact in a way that actually this – because this has been this – it's largely been going on in old people's homes and elderly people and so on, has not had the same psychological –

00:20:42.980 And do you think that reaction is wrong, or do you think it's a rational reaction?

00:20:49.400 And, again, a difficult question, I know, but this is something that I wrestle with, right?

00:20:54.920 Should I, as a young, relatively healthy man, really be that worried about COVID?

00:20:59.680 Do you see what I'm saying now?

00:21:00.880 No, well, I do.

00:21:02.020 And I think, clearly, because now knowing what we know, you are in a very different category from me in terms of the risks if we got infected.

00:21:12.360 I mean, that's just – that's the biology.

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00:22:09.480 As you know, there's a lot we don't know about COVID.

00:22:13.860 And I think, again, what the medics are aware of is they're seeing a whole lot of really weird stuff.

00:22:19.540 People with strokes, people with heart failure, people with weird things.

00:22:24.940 Almost every bodily system can be affected by COVID.

00:22:28.200 And again, that's new.

00:22:29.120 I mean, influenza and SARS and these things, they're very specific about what they hit.

00:22:36.080 Whereas there's something very interesting and unusual about COVID.

00:22:40.240 And so there are some horror scenarios, if you want a few horror scenarios.

00:22:44.440 And one is we know that it invades the central nervous system.

00:22:48.540 So everybody knows that one of the symptoms about COVID is that you lose your sense of smell and taste.

00:22:55.940 That is proof that can only happen when the virus has actually gone into your central nervous system.

00:23:01.540 So it is there.

00:23:03.140 It has invaded the central nervous system.

00:23:04.980 What is it doing there?

00:23:06.080 Nobody knows.

00:23:07.000 Is it possible that it's actually going to have an impact, which comes apparent 10, 20 years now?

00:23:12.660 There are other examples of infections, of virus infections, which only showed neurological symptoms 20 years later, 30, 40 years later.

00:23:21.960 Is it possible we're going to have an epidemic of some weird neurological conditions, even dementia or motor neuron disease or multiple sclerosis,

00:23:30.660 which was actually triggered by minor infections, which people didn't even notice?

00:23:36.020 I mean, I don't know.

00:23:37.760 But I think so before you should be sort of too, you know, relaxed about where it's not going to affect me.

00:23:44.420 I think, you know, I as a medic say, well, are you sure?

00:23:47.160 I mean, both of us have already had COVID.

00:23:48.980 So it's too late.

00:23:50.040 20 years from now.

00:23:51.300 Well, I'm already seeing the signs.

00:23:53.100 I'm falling apart here.

00:23:56.640 Well, thanks for cheering us up, mate.

00:23:59.540 Good.

00:24:00.120 That's going to help me sleep.

00:24:02.020 But as a result, do you think we therefore trivialize it?

00:24:04.960 Because reality is we don't know the long-term effects of it.

00:24:08.300 This is a new virus.

00:24:10.320 Therefore, the people are like, oh, it's fine.

00:24:12.040 I just got sick for a week.

00:24:13.220 Then I'm fine now. 0.99

00:24:14.480 Actually, they're being a little bit blasé and ignorant. 0.99

00:24:17.300 I think they are. 0.90

00:24:18.100 And there are very few doctors who are trivializing it because we're seeing weird stuff and which we don't understand.

00:24:23.420 We're seeing doctors who've got long COVID and who have got neurological symptoms.

00:24:30.560 They, you know, people with, they're paralyzed.

00:24:33.260 They can't walk properly.

00:24:34.520 They've been incontinent.

00:24:36.180 And it's all because of COVID.

00:24:38.300 So, you know, our knowledge is accumulating.

00:24:41.640 And in 10 years' time, we'll know much better.

00:24:45.520 But, so I certainly think we shouldn't be blasé about this new virus.

00:24:51.320 But I understand why people are.

00:24:52.920 I understand.

00:24:54.520 And this comes back to, well, thinking about death, doesn't it?

00:24:56.740 Because, you know, when you're 25 and your life's ahead of you and, you know, what, you know, I mean, death, I just don't need to think about it.

00:25:04.640 And health, well, I don't need to worry about health.

00:25:06.740 What's that healthy?

00:25:07.280 What's the problem?

00:25:08.900 You know, and so it is possible for people to have this sort of completely unrealistic understanding of what's going on and what life is like and of the reality of death and disease.

00:25:26.060 So I think, again, coming back to death, the thing was, until the 50s, 60s, everybody saw death.

00:25:34.120 It happened in your home.

00:25:35.500 You watched your parents die.

00:25:37.060 You watched your granny and granny die.

00:25:38.740 Often you watched your siblings die.

00:25:40.520 I mean, child mortality was huge.

00:25:43.920 It was just, that was what you did.

00:25:46.060 And it was part of the human condition.

00:25:47.680 It always was.

00:25:48.300 It always will be.

00:25:49.280 And somewhere in the 50s and 60s, with a dramatic fall in mortality because of improvements in health care and other things, and death is now medicalized and it just happens behind curtains.

00:26:00.300 It happens and I can tell myself death doesn't happen.

00:26:04.300 It doesn't exist.

00:26:05.240 It's, yeah, theoretically, I know I'm going to die.

00:26:07.660 It doesn't make any difference to me.

00:26:10.140 Do you think this pandemic is going to fundamentally change our attitudes to death?

00:26:14.260 Because we've spoken about it a lot.

00:26:17.440 We've seen it in the news, the media, death tolls, the amount of people dying.

00:26:21.380 All of a sudden, it doesn't seem as abstract as it used to.

00:26:26.140 I would like to believe that it will change people's attitudes to death.

00:26:32.780 I have a nasty feeling that the defense mechanisms are so incredibly powerful and that as life goes back to normal and we just say, well, you know, well, that wasn't that weird.

00:26:43.980 You know, let's get back to normal living.

00:26:46.400 I think people's attitudes to death need to change, but I'm not convinced the pandemic has actually, is going to cause that kind of sea change.

00:26:56.780 And what, sorry, do you want to crack on?

00:26:58.180 Well, I was just going to say, it makes perfect sense to me.

00:27:00.120 I once got stuck in a Bulgarian airport for 24 hours.

00:27:04.080 Worst experience of my life.

00:27:05.320 And the moment it was over, I'm just, I was just like, I'm never thinking about this again.

00:27:09.900 And I have a feeling that that will be very similar with COVID, to be honest with you.

00:27:14.200 But, you know, I was going to ask you as a sort of counter argument, because I hear absolutely the importance of not over-trivializing it.

00:27:22.800 But on the other hand, you talk about our failure to assess risk.

00:27:26.520 And one of the big concerns for me has been that while we threw the kitchen, everything but the kitchen sink at COVID, we do seem to have forgotten that there's other things that cause death as well.

00:27:39.000 Cancer, heart attacks, suicides, mental health, depression, drug addiction, all of the child abuse, which you mentioned earlier.

00:27:47.140 And all of these things have obviously exploded in the last 18 months.

00:27:51.660 Do you think that we have got the right balance between addressing those causes of mortality?

00:27:58.040 Well, I mean, you know, I have a lot of sympathy with the politicians.

00:28:03.380 I mean, you know.

00:28:04.040 You're the only person in the country.

00:28:07.140 You know, I mean, they're making it up as they go along.

00:28:09.120 Of course they are.

00:28:09.880 How much training have they had for this new, brand new pandemic?

00:28:13.600 Nobody, but nobody.

00:28:14.980 You know, it's that famous thing, you know, events, dear boy, events.

00:28:18.280 You know, what, what, everybody, but everybody was blindsided by this.

00:28:23.240 And I think in a way, that's one of the main things to take away.

00:28:28.120 And that is, you have no idea what is coming down the line.

00:28:32.160 And therefore, the ability to improvise, the ability to understand, prioritize, and work out what's most important is incredibly important.

00:28:43.920 I think in a sense, this is a wake-up call.

00:28:46.720 Well, arguably, despite the terrible things that have happened in the pandemic, you could say we dodged a bullet.

00:28:53.200 It could have been so much worse.

00:28:55.320 It could have been catastrophically worse.

00:28:58.540 And because of this weird virus, it was very much less bad than it could have been.

00:29:07.080 And we've also seen a spectacular way in which the medics and the scientists came together in order to develop the vaccine.

00:29:16.940 I mean, I think that, again, is a story which, if you're not actually in the business, you don't realize quite how utterly extraordinary that was.

00:29:24.880 And actually, very, very impressive, very encouraging that when the chips are down and when we're facing this kind of existential crisis and wondering whether the human race can survive, you know, or whether UK PLC is going to go bust, that all of a sudden, all the traditional rivalries, all the me first and the petty concerns go on the back burner.

00:29:48.980 Everybody is on the same team, supporting one another.

00:29:53.140 You know, vicious competitors are working together to try and crack this problem and collaborating and sharing information and clearing the deck, you know, so that the normal bureaucracy and all the frustrations, all of a sudden, it's gone.

00:30:10.840 You know, whatever you want, you can have it.

00:30:12.320 We'll do it now.

00:30:13.420 You know, I'll stay up all night and do it for you.

00:30:15.120 So that's, again, very, very encouraging to see the way that human beings can respond when faced with that kind of existential threat.

00:30:26.240 Again, sadly, the vast majority of the population had no awareness of that.

00:30:30.220 You know, sitting at home, watching the television, life goes on as normal.

00:30:34.220 But these extraordinary things have been going on behind the scenes.

00:30:38.220 And I think we've learned a lot, but have we got our priorities right?

00:30:44.440 Clearly not.

00:30:46.020 I think the greatest worry is that we're just going to go back to situation normal.

00:30:50.840 And the opportunity, I think, of resetting, the opportunity of saying, can we build a better society?

00:30:59.220 Having now what we have learned, can we actually tap some of that?

00:31:05.140 You're making a lot of people very tense on the internet when you talk about resetting.

00:31:09.100 So what do you mean by that?

00:31:10.860 What do you mean a better society?

00:31:12.360 What is it that you're not happy with in the way things used to be?

00:31:18.900 I think it's the rampant individualism, the me first, the look after number one,

00:31:26.120 you know, the focus on self-development, self-fulfillment, and the idea that in the end,

00:31:38.540 the community, you know, is especially in central London.

00:31:42.720 I mean, you know, what does it matter that there happened to be 7 million other people here?

00:31:46.380 I'm just getting on living my life.

00:31:47.680 And I think that is deeply broken and deeply, you know, there's some very deep pathology in our society and in our community.

00:31:58.240 And there was just a period at the height of the pandemic when all of a sudden it felt like people were looking out for one another.

00:32:07.020 Yes, there was.

00:32:07.500 It felt like the complete strangers, you know, offering to help, you know, are you all right?

00:32:13.480 You know, I've never spoken to you before, but, you know, we're facing death together.

00:32:17.600 Are you all right?

00:32:18.200 Are you okay?

00:32:18.640 And that was an extraordinary feeling, I felt.

00:32:23.220 And it's gone.

00:32:24.520 It feels like back to situation normal.

00:32:27.880 And I think that's rather sad.

00:32:31.180 Do you think as well it's because the knowledge of our own mortality instantly humbles us?

00:32:37.960 And suddenly we realise that the things that we think are important, you know, the career, whatever it may be, they're not.

00:32:45.120 Yeah.

00:32:46.100 I think that's part of it.

00:32:48.560 So the knowledge of our mortality humbles us, but it also tells us that we depend on others.

00:32:52.740 I'm not this solitary ego.

00:32:56.240 Other people matter.

00:32:58.080 And we're in this together.

00:33:00.420 And I think it's that combination of things, you know.

00:33:04.280 And of course you don't want to sentimentalise it.

00:33:06.340 There was a whole lot of increase of crime, of, you know, abuse, all sorts of terrible things happening as well.

00:33:12.140 But nonetheless, I think many of us got a glimpse of a better way of living, a better kind of society, what it might look like.

00:33:22.280 And the paradox is the only reason it came out was because we were under immense threat.

00:33:27.540 So going to the subject of death, do you think that we have a healthy attitude to death in the West?

00:33:34.540 And if not, what would be a healthier way to approach this subject?

00:33:39.200 Yeah, well, not surprisingly, I think.

00:33:41.240 I don't think we have a healthy attitude to death.

00:33:43.800 And I think the healthy way is that we have to talk about it.

00:33:47.800 And we have to talk about death and dying, about the experience of what we've watching other people die.

00:33:56.260 I mean, so I feel in theory, you know, that dying ought to be a communal experience.

00:34:04.140 It's, you know, we need to try to recover this idea that when people are dying, we need to be part of that.

00:34:13.500 We need to be there with them.

00:34:14.780 We need to be learning from them.

00:34:16.140 We need to be sharing it.

00:34:17.240 We need to be talking about it.

00:34:18.860 And we need to be talking about how we would like to die.

00:34:21.480 You know, it's interesting that when you ask people how they want to die, the commonest reaction you get is, I just want to go out like a light.

00:34:32.180 I want, you know, I want to go to bed one day, perfectly healthy, and just die in the bed just like that.

00:34:37.060 Wouldn't it be wonderful?

00:34:38.180 Fantastic.

00:34:38.800 Just, you know, bang, gone.

00:34:40.320 No awareness, no warnings.

00:34:42.460 The fascinating thing is, if you go back a few hundred years, that was universally regarded as the most terrible way to die.

00:34:50.020 Really?

00:34:50.340 Everybody agreed that sudden, unexpected death was the absolute catastrophe.

00:34:55.800 And, in fact, there's a prayer in the Church of England.

00:34:59.580 One of the main prayers is to pray against sudden death because, you know, because the idea of just being snuffed out with no warning, no possibility of saying goodbye, no possibility of preparing your next generation, no possibility of asking forgiveness for all the people you've hurt and wounded,

00:35:16.480 no possibility of asking for all the people you've hurt and wounded, no possibility of preparing to meet your maker or reincarnation or whatever you believe in, but just bang, just go.

00:35:25.400 What a terrible thing to do.

00:35:27.760 Whereas, interestingly, now it's seen as an ideal way to go.

00:35:31.460 But I think a lot of that is about our narcissism.

00:35:33.680 We're not actually thinking about other people.

00:35:35.260 We're not actually thinking about our loved ones who are going to discover us cold in the bed.

00:35:39.840 You know, our children are, you know, all we're thinking about is our precious own little experiences that we shouldn't have anything at all nasty or threatening or anxiety making.

00:35:49.440 So, you know, it's that kind of self-preoccupation again, which is part of the problem. 0.98

00:35:54.860 But if I can push back on you just so slightly, but let's be honest, dying is fucking horrible, isn't it? 0.82

00:36:00.140 Well, it isn't fun, but it is also, it's an immense opportunity.

00:36:07.440 I mean, I have seen people die and I have seen people how it turns out that dying has been an opportunity for restoring relationships, for fulfilling dreams, for having the most amazing conversations they've never had before, but all kinds of positive things that can happen when people are dying.

00:36:27.160 I mean, one of the interesting things is that if you're dying, you get a kind of relational authority.

00:36:32.760 So, when you're dying, you can say, I haven't spoken to my mate, we had this terrible argument 10 years ago, and I haven't spoken to them since, but actually, can you tell them that I'm dying and I'd really like to talk to them?

00:36:48.100 And because you're dying, you have some kind of leverage, authority.

00:36:53.600 And, you know, I haven't spoke to my dad for 30 years, but, you know, could you get a message that I'm in the ITU and I'd really like to speak to him before I die?

00:37:01.700 So, dying actually is an opportunity for healing, for exploring new things, for dreaming dreams.

00:37:10.060 So, that was the whole vision behind palliative care, was this idea that instead of just being snuffed out, couldn't there be something precious about those last few hours and days?

00:37:23.640 And so, the motto came from the palliative care movement was, not only are we going to help you to die well, we're going to help you to live before you die.

00:37:32.360 And that was the idea, that to live before you die, that actually those final hours, days, weeks, months can turn into something incredibly precious, incredibly wonderful.

00:37:43.200 So, it doesn't have to be effing awful.

00:37:46.980 I mean, it's effing awful if there's nobody there, if you're abandoned, if there's no care, there's nobody love you.

00:37:53.360 But actually, time and time again, I've seen it turn into something that's effing wonderful.

00:37:58.540 It's a very good point.

00:37:59.480 And do you think that the reason you talk about making it a communal experience, the reason that often we don't do that is that we've become these pleasure-optimizing machines almost, where the thing that we most want is to have pleasure, and the thing that we most want to avoid is discomfort.

00:38:20.240 And you see it in the culture everywhere, whether it's, you know, we as comedians talk about people being easily offended or whatever.

00:38:27.540 Like, we think that the highest value is not to experience discomfort of any kind, whereas we really know that discomfort is often the prelude to the biggest transformations, the biggest growth opportunities, the most positive events in our lives have often been preceded by experiencing something deeply uncomfortable.

00:38:48.640 Yeah, absolutely right.

00:38:49.460 Now, this is very close to home for me, because, I mean, what you're describing is the philosophy of utilitarianism, and that was invented by Jeremy Bentham, who was actually seated on a chair at the entrance to University College London, my university, because he was an out-and-out atheist, and he insisted, he didn't believe in any of this eternal life rubbish, but he wanted his body to be preserved so that he should continue to play a role in the university.

00:39:19.060 In fact, it's laid down in the university that his body, his embalmed body should be present at every meetings of the university council, and it still is, although...

00:39:29.060 Now it makes sense where Lennon got his idea from.

00:39:32.700 Although, 19th century embalming techniques were not very good, and after a while the body became so disgusting, they now use a sort of plastic replica.

00:39:41.060 It's a replica, but it is still there.

00:39:44.120 So, the essence of utilitarianism is the idea that the ultimate good is pleasure, and the ultimate evil is pain.

00:39:52.500 And therefore, as you say, pain, all aspects of pain and discomfort are deeply immoral, evil, and to be avoided at all costs.

00:40:02.260 And you're right that modern culture has completely imbibed that, all except, to my fascination, there's one area which it doesn't, and that's the gym.

00:40:10.840 Because we all know, no pain, no gain, you know.

00:40:14.740 So, on the sports field and in the gym, we all get the idea that actually there is a benefit to agony, that real sweat and pain and struggle can actually be beneficial.

00:40:31.640 But in the rest of our lives, utilitarianism is God.

00:40:36.500 You know, avoid discomfort, avoid pain, avoid anything unpleasant, focus on pleasure.

00:40:42.340 But I think people are waking up to this, John, because I don't know how familiar you are with Jordan Peterson, and we've had him on the show a couple of times.

00:40:49.460 And I think he became a huge star precisely by giving people this message, actually, that if you want to have a meaningful life, if you don't, if this existential dread that you experience on a daily basis by pursuing momentary pleasures and, you know, the newest coffees and then this and then that,

00:41:08.360 actually, by binding yourself to other people, by standing up in the face of adversity, by dealing with the discomforts that come with the fact that you are responsible for things.

00:41:21.260 And that message has actually seemed to have really resonated with a lot of people, because I think we've just gone so far down this utilitarian path that a lot of people are starting to realize it doesn't lead anywhere.

00:41:33.340 Yeah, that's absolutely right. And dying, as you said, is the prime example of that.

00:41:40.160 Here is this really frightening, unpleasant, terrible reality, which we're all of us in different ways called to face.

00:41:50.480 And yet, astonishingly...

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00:42:56.080 It can be a positive experience.

00:42:58.340 It isn't all loss.

00:42:59.300 Yes, there is.

00:43:00.640 There is genuine pain.

00:43:02.140 There is.

00:43:02.580 They're not just physical pain.

00:43:03.940 I mean, to be honest, physical pain is the easy stuff.

00:43:07.000 I mean, we are, these days, as medics, amazingly good at controlling physical pain.

00:43:13.060 The problem is there are other kinds of pain, which dying people have, particularly relational pain, psychological pain, existential pain, spiritual pain.

00:43:22.760 These are much harder.

00:43:25.160 They don't respond to modern medications.

00:43:28.020 You know, they involve the real nitty gritty of relationships, of addressing reality, of requiring counseling, friendship, whatever it is.

00:43:39.200 But they are opportunities.

00:43:40.740 They are fantastic opportunities for growth.

00:43:43.780 And that's why I'm not looking forward to dying, but actually, I recognize that going through that experience myself could be even a strange kind of adventure.

00:43:54.800 You know, I've got more things to learn, more things to experience, more things to say to other people, more things for them to say to me.

00:44:03.300 What have you learned from watching people die, John?

00:44:05.460 You can't summarize it in a, you know, what have I learned from life?

00:44:10.700 It's almost like that.

00:44:12.380 You know, you see, I learned that you can never predict how people are going to face death.

00:44:17.860 You know, sometimes the biggest, toughest guys are the biggest wimps.

00:44:21.780 And the little shriveled old lady turns out to have this astonishing resilience and character. 1.00

00:44:32.020 Yeah, so it's an adventure.

00:44:36.260 You learn not to judge people, I take it.

00:44:37.960 Yeah, you don't judge people.

00:44:40.760 It's an enormous privilege to be there, you know, to be there at the bedside.

00:44:45.380 I just feel so many people miss out on this experience, you know.

00:44:49.000 It's a bit like, you know, as a pediatrician, I've been there thousands of times when babies have been born.

00:44:53.980 And that is, again, another of those just great experiences of life.

00:45:00.500 And there's an amazing symmetry between that first breath and the last breath, you know, that these are life events.

00:45:09.620 They are part of what it means to be human.

00:45:12.220 And they are both terrible and wonderful.

00:45:15.260 Do you think sometimes that because we don't confront the reality of our death, that actually prevents us from living?

00:45:22.560 Because unless you know that it's going to come to an end, you don't realize that time is precious.

00:45:27.440 I think that's absolutely right.

00:45:28.900 That's the problem with denial.

00:45:30.300 You know, the mechanism of denial that just says it doesn't exist, I'm not going to think about it, change the subject, actually is very limiting.

00:45:39.960 I mean, it keeps you at this kind of very childish level.

00:45:47.120 And there's a sense in which, you know, it's often said you don't grow up until you've watched your parents die.

00:45:51.860 And I think there's something in that, too.

00:45:53.360 You know, there's something about being exposed to that and seeing the next generation and seeing them die.

00:46:00.480 That does something to you.

00:46:02.560 And so there is an opportunity to grow.

00:46:05.160 And I think, you know, there is a huge amount of infantilism in our modern society, particularly, if I might say it, you know, with a sort of millennial generation who...

00:46:16.680 We don't like ourselves either.

00:46:17.840 Don't worry.

00:46:19.280 Anyway, I'm sounding like an old grandpa.

00:46:22.260 No, no.

00:46:22.780 We are just on the edge of the millennial generation and that we have a lot of bad things to say about millennials as well.

00:46:28.720 So carry on.

00:46:30.260 Unrestricted and uncensored and unfiltered.

00:46:32.160 Go for it.

00:46:32.640 Well, I think there's just a sort of self-preoccupation and a narcissism.

00:46:36.600 You know, again, the strange thing is, as you get older, you hear your dad saying things.

00:46:44.440 You think, actually, you know, I thought my dad was completely out to lunch and mistaken.

00:46:49.700 And now I've kind of realised, actually, he was not completely in my...

00:46:52.180 My dad used to talk about the impact of the war and the experience of being in the army.

00:46:58.440 He was in the army during the Second World War and how it had changed him and how his life would have been different if he hadn't gone through that experience.

00:47:08.980 And, of course, you know, up until the 60s, every generation had experienced war.

00:47:15.780 In Europe, there's been continuous war for centuries.

00:47:18.860 I mean, the idea that you could go without there being major armed conflict and that it wouldn't touch you is simply inconceivable.

00:47:27.380 But now we have had peace and prosperity for, what, 70, 80 years?

00:47:34.260 And, therefore, we've grown up generations for whom war is simply inconceivable.

00:47:40.300 It simply doesn't figure in their setting.

00:47:44.560 And, actually, that's the abnormality, I think.

00:47:48.680 I think no other generation has been so free from war.

00:47:53.760 And I think it's not a bizarre reality that the absence of war in some...

00:48:02.760 Because I suspect war, similar to dying, it's because it makes you think about reality.

00:48:10.220 It makes you think about what really matters, about what the ultimate meaning of existence is.

00:48:14.360 And it's possible, in this period of peace and prosperity, to be sitting on your backside, playing computer games, watching the world go by, in a kind of infantilized existence.

00:48:29.440 I just want to tell the viewers I do none of those things.

00:48:31.840 Yeah, sure you don't.

00:48:33.760 No, it's that thing about good times create weak men, isn't it?

00:48:37.880 I think that's what you're talking about.

00:48:40.480 It's a fascinating conversation.

00:48:41.860 There is one question that I really want to ask if you...

00:48:46.400 No, no, go for it.

00:48:48.540 There's...

00:48:49.380 Every time we address a subject of death, there's always one topic that always comes up.

00:48:55.420 Again, we shy away from in this country.

00:48:57.780 That is now being used, the word dignitas, we can only really use it as a punchline to a joke.

00:49:05.320 Where do you stand on euthanasia?

00:49:07.120 Well, I understand why people think this is the obvious solution.

00:49:17.800 And to that extent, I sympathize with it because, you know, unfortunately, one of the terrible paradoxes is that although actually Britain leads the world in terms of palliative care,

00:49:29.600 and in terms of all the resources we commit to it, and in terms of the expertise we have, the terrible reality is an awful lot of people in this country die very badly.

00:49:39.020 They die without decent care, without expert support, without the right resources.

00:49:45.060 Why?

00:49:45.380 Because it is not a priority.

00:49:47.800 And do you know, interestingly, why?

00:49:49.640 Because the great British public doesn't think it's particularly important, because it doesn't want to think about it.

00:49:55.540 So we want to talk about...

00:49:56.980 We think the NHS should be spending more money on advanced cancer treatments.

00:50:00.620 We think they should be solving the problem of dementia.

00:50:03.640 We want to spend billions of pounds on exciting new treatments.

00:50:08.880 We don't think dying is important.

00:50:11.420 We don't think we should make it a priority.

00:50:13.400 A lot of the NHS doesn't even pay for it.

00:50:17.180 A lot of it is paid out of people jingling boxes and saying, support your local hospice, which is, you know, that we don't even provide proper care for the dying.

00:50:29.000 So we will spend billions and billions and billions to give someone an extra half a year of life at the age of 80.

00:50:36.960 But we won't spend money to give them a death and dignity.

00:50:42.100 Correct. And we don't think it's important.

00:50:44.480 And the great British public doesn't think it's because basically politicians respond to what the public think.

00:50:50.960 And the public do not put pressure.

00:50:52.780 They put a huge amount of pressure on when it comes to cancer and heart disease and so on.

00:50:56.020 They do very little about death and dying.

00:50:58.980 So therefore, the sad reality is even in some of our major teaching hospitals, people die very badly.

00:51:06.540 They die because doctors are poorly trained, because they're not having the resources, there's not the emphasis on it and all the rest.

00:51:12.980 And so it's understandable that people say, well, I've heard these horror stories.

00:51:17.020 Surely the best thing to do is to have a lethal injection or take a lethal medicine and so on.

00:51:23.960 And so I understand the motivation, but I personally think it's wrong.

00:51:28.180 Because I think it short circuits that there are all kinds of problems with making killing part of what doctors do.

00:51:38.560 But from a personal point of view, it goes back to this utilitarianism, doesn't it?

00:51:44.340 I mean, euthanasia is great because I just don't have to have any of that unpleasantness.

00:51:49.940 I mean, you know, as soon as I start those first twinges, I sit down, take the medicine and it's gone.

00:51:56.280 So all those opportunities for growth, for discovery, for healing, are all short circuitous.

00:52:07.340 Do you not think there are some cases, though, where someone can't talk, can't eat, you know, they're in pain that cannot be treated medically, etc.,

00:52:15.880 where they're not really living and those opportunities aren't there, where it's the humane thing to do to give them that option?

00:52:23.980 I have to say that with really expert palliative care, and I've seen, you know, the very best experts doing it in the very best places,

00:52:34.020 those situations are vanishingly rare, interestingly.

00:52:36.560 I mean, there are certainly rare situations where it seems that people are in such distress that nothing can be done for them apart from just putting them to sleep.

00:52:47.520 But it is actually very rare, and it's often a question of digging down to discover what is causing the suffering.

00:52:56.100 And it's very rarely physical things that are causing the suffering.

00:52:59.100 People are often in agony because of broken relationships, because of loneliness, because of lack of meaning in their lives.

00:53:05.700 And therefore, is the right thing to do is just to bump them off?

00:53:10.140 Or could there be a better way of helping people to rediscover meaning?

00:53:16.160 So I personally think that if you legalize it, you know, there are 500,000 people a year in the UK who die every year.

00:53:29.040 Do you know how many go to Dignitas every year?

00:53:32.080 It's about 50.

00:53:32.980 So it's a tiny, tiny, tiny proportion.

00:53:37.980 The question is, do we change the entire law of the country and therefore mean that every dying person has to consider, do I want to be?

00:53:46.060 Because once you legalize it, you have to give people the option. 0.97

00:53:48.740 I need to tell you, you've got cancer, you know, we can support you, we can prevent you suffering, we can give you da-da-da-da-da-da, but there is always the option, we could kill you. 0.99

00:54:01.360 Now, which would you like? 0.99

00:54:02.920 Once you make that option, you've really changed the ballpark, isn't it?

00:54:09.180 And so the question is, for the sake of a small number of people, do we take 500,000 people and offer them the prospect of killing themselves?

00:54:18.720 You are a utilitarian after all.

00:54:22.420 I was thinking, and look, there's one thing that obviously we haven't talked about that underpins a lot of this.

00:54:27.600 I was half expecting you to whip a Bible out halfway through this.

00:54:31.880 Because there is a spiritual element to all of this, I think.

00:54:35.400 And, you know, Francis and I are not believers.

00:54:38.720 But do you think, as we've become a more secular society, some of the downstream consequences that you've talked about are a product of that?

00:54:49.300 Well, it's a very complex mix, isn't it?

00:54:51.540 Certainly, I think that inevitably your beliefs about is there anything beyond the grave, you know, makes a difference.

00:55:02.220 And it makes a difference to how we respond.

00:55:04.260 Well, I, as you implied, I'm a Christian.

00:55:10.280 I'm basically a sort of mainstream Anglican Church of England Christian.

00:55:15.880 But I worked with a colleague, a pediatrician, who was a card-carrying atheist.

00:55:21.640 And he said to me once, we talked about caring for dying babies.

00:55:25.440 And he said, you know, it is different for you and me, John, because, you know, when you're caring for a dying baby, you're sending them to heaven.

00:55:32.600 And when I'm caring for a dying baby, I'm sending them to the compost heap.

00:55:37.360 And, you know, it was meant as a joke, but we both knew it was true. 0.98

00:55:41.380 I mean, it does make a difference.

00:55:43.240 And therefore, if you do genuinely believe that all there is is the compost heap and that human beings are some bizarre, you know, existential freak of the universe, which somehow got its knickers in a twist.

00:55:59.560 And instead of doing the normal thing, it somehow went very much very wrong and we evolved and it's all utterly meaningless and, you know, and we just fizzle out.

00:56:09.020 Well, that does change your attitude to these issues.

00:56:14.520 Interestingly, before Christianity was a thing in the ancient world, suicide was regarded as the most logical, rational, noble way to die in many cultures.

00:56:30.220 And it was really only Christianity which opposed suicide because of its view that life was precious and that all life was precious.

00:56:43.180 And therefore, you know, for 20 centuries, there's been a sort of idea that suicide is not a good way to end your life.

00:56:53.300 And in fact, you know, we still in a very secular NHS put enormous amount of work into suicide prevention, you know, and the Samaritans and a huge amount of emphasis saying killing yourself is not a good way to die.

00:57:06.480 But arguably, if you follow the logic and you say it's all, there isn't any ultimate significance to life, there isn't anything beyond the grave, then perhaps suicide becomes rehabilitated as a rational way to die.

00:57:29.160 And so I suspect that's going to be one of the big arguments as we look into the future.

00:57:34.120 You know, what does it mean to die well?

00:57:37.160 Does it mean this traditional view that dying is part of life and that there are things to learn and that it's an opportunity for growth and so on and for care and support?

00:57:50.420 Or in the end, is it best to top yourself?

00:57:53.020 If I've decided my life is coming to an end, why not?

00:57:58.120 Good, good enough to end the interview on.

00:57:59.880 To be honest with you, I haven't talked this much about dying since I was a comedian.

00:58:03.100 So thank you, John.

00:58:04.020 John, it's been an absolute pleasure and such a great conversation.

00:58:08.320 I think we've both really enjoyed it.

00:58:09.820 We've got one more question for you.

00:58:11.040 Which is always, what's the one thing we're not talking about, but we really should be?

00:58:14.380 Whoa, I think, I think the meaning of life.

00:58:23.620 Isn't it sad that it's become terribly uncool?

00:58:29.240 It's okay for students.

00:58:32.880 It's okay for, you know, for people.

00:58:37.560 But grown-ups, you don't talk about serious stuff, about the meaning of life.

00:58:41.440 It's just a bit toe-curling and cool.

00:58:44.680 And I just wish we could have more honest conversations like this.

00:58:48.540 So do I.

00:58:50.280 It's interesting, you were talking about the conversations people are able to have when

00:58:54.540 they're dying.

00:58:55.260 And really, what it made me think about is, it's fundamentally about having each other's

00:58:59.720 attention.

00:59:00.580 It's about actually listening.

00:59:03.140 Yeah.

00:59:03.340 And that's one of the things I really enjoy about doing the show, is there's very few

00:59:10.060 areas of my life, even my own life, even though I do this every day, basically, where I actually

00:59:15.380 have the opportunity to talk and hear someone in this way.

00:59:20.520 And so I suppose just having the conversation like this gives you a bit of an insight into

00:59:24.800 what it's like when you have someone's attention in the way that you might do when you're dying.

00:59:30.000 It's really interesting.

00:59:31.320 Thank you so much for coming on.

00:59:32.640 It's been a pleasure.

00:59:33.960 The book is called Dying Well, that people should look at.

00:59:36.420 And you've written other books as well, including about euthanasia, haven't you?

00:59:39.240 Yes, there's a book called Right to Die, question mark.

00:59:41.560 And in fact, there's a new book coming out, I hope, next month, which on assisted dying,

00:59:47.860 because the assisted dying bill in the UK is a big thing.

00:59:51.280 And another book called The Robot Will See You Now, which is about artificial intelligence

00:59:55.260 and the ethical issues that AI is rising.

00:59:58.720 Well, perhaps we can have you back to talk about that.

01:00:00.860 That sounds fascinating.

01:00:01.820 If people want to find you online, John, where is the best place to do that?

01:00:04.600 I've got a website, johnwyatt.com, J-O-H-N-W-Y-A-T-T.com.

01:00:10.180 Fantastic stuff.

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TRIGGERnometry - September 01, 2021

How to Die Well - Dr John Wyatt

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