The second day of the festival began with Jude Kelly, the artistic director of the Southbank Centre, explaining that the festival is about “reshaping our ability to look death in the eye, and to have a relaxed way of talking about death.” In a secular age, she says, we don’t have ways of congregating to talk about important things like death.

She explains as well how the idea for the festival has grown directly out of her own experience. Two couples she knows have had children who killed themselves and both couples were driven apart by the experience. Perhaps if there was more conversation about death those splits could have been avoided.

Kelly tells as well about the death of her middle child from a cot death—while she was abroad and away from her husband, Shortly before the death she had seen a television programme about a campaign in Australia to put stillborn children in a freezer so that families could have the child for a while and get to know him or her. When the doctor asked Kelly if they could have her son’s corneas, Kelly said: “You can have the corneas if you’ll put Johnny in the freezer.” It was practical knowledge that allowed her “to achieve some degree of ownership” in the dreadful circumstances, and the festival is about practical knowledge as well as much more.

Another inspiration for the festival was the way that the people of Wootton Bassett (now Royal Wootton Bassett) spontaneously created a ceremony for soldiers being returned dead from overseas wars. “If we are not going to return to Christian rituals what are we going to do instead?” asked Kelly.

Kelly was followed by the poet, Lemn Sissay, reading poems, and I liked the line “Life is not worth living if there is nobody that you would die for.”

Death rituals around the world

There is enormous variety of death rituals around the world—with some putting the emphasis on sadness and others celebrating the spirit rising to heaven—but is there something they all have in common, asked Noo Saro-Wiwa, daughter of the Nigerian author and activist Ken Saro-Wiwa who was murdered by the Nigerian state. The rituals all have points in time when certain things must be done, “providing hooks on which to hang grief,” answered Sarah Murray, a journalist who has toured the world observing death rituals to write her book “Making an exit.”

Murray told the story of her father to illustrate that rituals seem to be important even to the most rational. Her father, a popular man who loved life, wanted no gathering and no speeches when he died (he hated long speeches), but rather to be taken to crematorium in a plastic bag. But after he died the family discovered in his final note that he wanted his ashes to be scattered in the local churchyard in Dorset “because it was the most beautiful place he knew and two of his friends were there.”

Ghana seems to be leading the world with imaginative funerals (see my first blog on Ghanaian coffins), but one snag is that Ghanaians fast before a funeral and so must be fed after the funeral. Many people scan the list of funerals each day and turn up for a free meal, so food at a funeral may cost £5000.

One of the rituals that most attracted me was the tradition—from Tibet, Iran, and India—of “sky burials,” where bodies are placed on “towers of silence” for the birds to eat—so avoiding pollution of either the ground, water, or the air through burning. I’d like to see a tower of silence on Clapham Common and am suggesting it to Lambeth Council.

Standing room only at the death festival

As I arrive 15 minutes early for the next session I see a huge queue. The session downstairs was full and Jude Kelly said that 500 tickets had been sold, but it’s becoming clear that this is a very popular event. It’s standing room only in the next session, and the audience is splendidly mixed—old and young, smart and scruffy (that’s me), male and female, different ethnic groups. Kelly has hit on something.

London cemeteries

London has 130 cemeteries, and one of the best ways to understand the city is to visit them, said Brian Parsons, editor of the Funeral Service Journal,” the “unsung hero of the funeral industry,” and coauthor of “London Cemeteries: An Illustrated Guide and Gazetteer.” In a tour lasting less than 15 minutes Parsons showed us how the cemeteries had evolved from the “magnificent seven” (Kensal Green, West Norwood, Highgate, Abney Park, Nunhead, Brompton, Tower Hamlets) built early in the 19th century with their beautiful chapels and extravagant sepulchres through “the world’s first and foremost crematorium” at Golder’s Green built in the early 20th century to the “golf courses” and burial parks of today. He particularly recommended  Wood Green Cemetery, which has a “ Mediterranean air.”

Digital death

Increasingly our digital selves are bigger than our physical selves, said Stacey Pitaillides who is doing a PhD on digital death, and we need to think about digital death. You can now have your funeral streamed on the internet, but the central question with digital death is how to ensure handing on what may be thousands of photographs and (in my case) millions of words in blogs, Tweets, and entries to Facebook. If you don’t make arrangements to share your passwords then you will discover that the data of the dead person are owned by Facebook, Twitter, Linked-in, and the other popular sites, almost all of which are owned by corporations.

This was the practical advice Kelly was saying was central to the festival. We need digital wills, and—most important—you should think about sharing your passwords right now.

Post-modern obituaries

Obituaries are always good for a laugh, and Tim Bullamore, a professional obituary writer, reminded us that they are written in code so that “a tireless raconteur” is really a deadly bore and someone who is “convivial” is a habitual drunk. But Bullamore’s main interest is in the “post-modern obituary,” which began in 1986 when the new newspaper the Independent began and rejected the hagiographic obituary and The Times published an obituary critical of somebody’s life. Since then the way obituaries are written has changed as has who gets an obituary. An analysis of obituaries in British newspapers still shows, however, that 80% of obituaries are about men and that there is an Oxbridge connection with 40%.

In passing, Bullamore noted that soldiers have very boring obituaries—because they write their own obituaries. When editor of the BMJ, obituaries were the bane of my life, and I hated the way that most obituaries of doctors are wholly uncritical—and like the worst writing have no light and shade. Why, I wondered, should doctors and soldiers, two professions intimately associated with death, be so squeamish with their obituaries?

Bullamore ended with a useful tip: if you want a full obituary die in the summer, when there are fewer deaths and less news.

Death in video games

Many video games (something about which I know nothing) feature mass killing, said Tom Armitage, a game designer. You too, the gameplayer and protagonist, may die many times. So this is a world where death is of little consequence. But one game designer has given your death in a video game real consequences in that it leads to a deletion of a file on your hard disk—perhaps a favoured photograph or even a system file, so crashing your computer.

“What game would you recommend for your mother? asked a motherly woman in the audience. Galatea was the answer: it’s available almost everywhere and involves you interrogating a statue. It’s suitable for lovers of fiction. As video games are now an accepted art form, I ought to try the game.

An actor takes his ex-wife to Dignitas

Perhaps the best thing that I experienced at this very wonderful festival (regular readers, if there are any, will know I usually go easy on my superlatives) was Chris Larner’s one man show in which he described his ex-wife Alison’s journey to Dignitas, the Swiss clinic where people go to be helped to die. I’ve known about Dignitas for a long time, and I saw a strong television programme about a woman who went to the clinic. But this performance, which was both poignant and funny, gave me new insights, particularly into the messy detail of getting to the clinic and achieving death.

There is huge bureaucracy involved in achieving death at Dignitas. One small example is the need to obtain an “affidavit of domicile,” something I’d never heard of. You have to get this from a notary, and Leeds, where Alison lived, had only two. Both asked what the affidavit was for, and when they were told refused to provide one: their professional body had advised refusal to avoid the notary being charged with assisting suicide, an offence that potentially carries a 40 year sentence.

The play was not an appeal for assisted suicide, and there were scenes where Chris wondered whether he was doing the right thing or being “a monster of arrogance” and where Alison’s son begged her not to kill herself.

I recommend anybody who gets a chance to see this play to go, and I wondered if the BMJ shouldn’t sponsor it to be performed for doctors around Britain.

Standing room only at the debate on assisted suicide

I rushed straight from play to the debate on assisted suicide, but I wasn’t in time to get a seat. Some 600 people with perhaps 150 standing paid very close attention to a discussion that was intense but which never overheated. The newscaster Jon Snow did an excellent job of chairing the discussion.

Although there were the usual deep divisions, there was some kind of a agreement that it wasn’t easy to draft a law that would ensure the “safety” of people who might feel pressure to end their lives. Helena Kennedy, baroness and QC, said how she and criminal lawyers had not been happy with the laws that had been presented to parliament so far—simply on grounds of poor drafting.

Peter Saunders (who took some criticism for not declaring upfront that he is the chief executive of the Christian Medical Fellowship) said the argument against assisted suicide was both moral and legal but that he was concerned today with the legal. Pressure would inevitably be put on vulnerable people, and the “right to die would become the duty to die.”

Philip Graham, acting chair of Dignity and Dying, made clear that his organisation was in favour only of assisted dying only when people were terminally ill. It is not in favour of euthanasia or people having the right to take their lives when not terminally ill—when, for example, they become demented. His argument was that most people, including most disabled people, want a change in the law and that there was no evidence from Oregon and Washington, which already have assisted dying, that people were pressured to accept assisted dying.

Debbie Purdy, who famously brought the case that forced the Director of Public Prosecutions to clarify when people would and would not be prosecuted for taking relatives or friends to Dignitas, argued that there was a safety problem now because people were not able to discuss assisted dying with doctors and because some people were killing themselves prematurely to avoid the possibility of not being able to do so later. She got the loudest round of applause.

Kevin Fitpatrick of Not Dead Yet also put the argument against changing the law but made something of a fool of himself by describing how his daughter was heartbroken and “wanted to die.” People didn’t exactly boo but made very clear that they could see at once that this was a wholly irrelevant anecdote.

At the end of the discussion about 90% of the audience voted for a change in the law and a similar proportion voted for a Royal Commission to consider the issue, something that Kennedy had pushed hard.

The Sandy Toksvig Memorial Lecture

A long and fascinating day ended appropriately with jokes, song, and dance. After the Southbank Centre’s Voicelab, a 50 person choir, sang “Ode to Joy,”  and Sandy Toksvig, the well known comedian, gave us a “lecture” on death. She began by pointing out that the canard that “half of the people who have ever lived are alive today” is completely wrong as there are 7 billion people alive today but about 107 billion that have ever lived. She discussed causes of death in the 18th century and got the biggest laugh not from the three who died of “wind” but the one who died of “lethargy.” She herself was vastly amused by the 513 people in a recent year who suffered “biscuit related injuries.”

Some of the old jokes got the biggest laugh. She told us the one about the energetic young tax collector who asked a local rabbi what he did with the drippings from the candles.

“We collect them, send them to the candle factory, and then get sent a new candle.”
“What about cake crumbs?”
“We collect them, send them to the cake factory, and get a new cake.”
“What about the foreskins discarded after circumcision?”
“We send them to the tax office, and they send us a new prick.”

This wasn’t much to do with death, but after Toksvig flashed up a portrait of skeletons copulating I remembered a joke from my dead father. It’s about a man whose parents die at the same time. He takes them to a taxidermist to be stuffed.

“Do you want them mounted?” asks the taxideremist.
“No, holding hands will be enough.”

My brother, a comedian, tells me that all shows should end with a song, and we ended with all 600 of us singing “You’ll never walk alone.”

Many people, including me, Tweeted during the festival, and if you search #deathfest on Twitter you can see them all.

RS was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.