I’m up early and off to the death festival for the third day with a very light heart, and we are straight into practicalities.

Affordable funerals

A funeral, says Rosie Inman-Cook, director of the Natural Death Centre,  is the “ultimate stress purchase.” People are often stunned and wholly unprepared—and vulnerable to being fleeced. The cheapest British funeral is £2600, which can be unaffordable to many people—and the pressure is on to provide “nothing but the best” for the dead person. People do not bargain in these circumstances, and people may find themselves with huge bills. A grave in Lewisham, which is not famous for its tourists, can cost £18 000.
But it is possible to do it much more cheaply, and the Natural Death Centre will help. You can have a do-it-yourself funeral, not have a coffin, not bother with embalming, have the funeral in your front room, use your own cars and barers (strapping grandsons), dig the grave yourself, or get a friend to be the master of ceremonies. Indeed, remarkably in this age of health and safety there is nothing in English law to stop you burying the corpse in your garden. (This was news to me, and I’m now staking out a plot. I might lie beside our rabbit.)
I know a little about this because my brother, a stand up comedian, has inadvertently developed a sideline in funerals. This is not because people are poor but because they are not religious and so don’t want a vicar—and want to laugh.
If you haven’t got the money for an expensive funeral and the energy for organising it yourself, then the modern equivalent of a pauper’s grave is a “disposal service.” There is no ceremony. The body is taken away and cremated at a time convenient for the crematorium, presumably in the middle of the night when gas and electricity are cheap.
The Natural Death Society ran workshops at the festival entitled “Thinking ahead before you’re brown bread.” That’s rhyming slang for dead.

Memorial tattooing

If you can’t afford a dramatic gravestone, you might consider getting yourself a memorial tattoo—that is, to remember a dead family member or friend. Such tattoos are very common, said John Troyer, deputy director of the Centre for Death and Society at the University of Bath (the only such centre in the world, it seems). Troyer has his grandparents tattooed on his back, but only one woman in an audience of perhaps 150 had a memorial tattoo.
Some memorial tattoos are obvious—“RIP, Mum”–but many are not. Troyer showed us pictures of a woman he encountered on a beach in Hawaii with her whole back covered in Japanese looking foliage and birds; evidently, the foliage was her family tree and the birds dead members of her family. Another woman had “Do not resuscitate” tattooed on her chest, but Troyer was sceptical about is legal validity. A woman who had lost all her hair through chemotherapy for breast cancer had had her skull tattooed with all sorts of complicated designs.
Many people have portraits of the dead person or their dead pets tattooed onto some part of their anatomy, and you can see a collection on the website of Art With a Point.
The latest trend is to take a pinch of ashes from the cremated body and mix it in with the tattoo ink—so that you have some of the person’s atoms included in your tattoo.

Amortality and death on Twitter

Catherine Mayer, TIME London Bureau Chief, has written a book on amortality—the way that we live agelessly and as if death has disappeared.   (I could be a bad case myself: 60 in a month’s time, I dress like a student and think that I can do most of what I did at 20.)
Her main topic, however, was to ask whether the outpourings of grief when somebody, particularly a celebrity, dies on social media is a good or bad thing. Appropriately she Tweeted the question and received positive and negative answers. Somebody answered “We used to light a candle, now we Tweet,” while somebody else in a very Twitterish way said “death is so 20th century.”
Somebody else, however, had discovered through Facebook that her father had died, while another Tweeter thought that what was happening was nothing but “emotional vampirism.”

The female funeral director

Charles Dickens painted pictures of undertakers, all of whom were male, that live on in the modern mind. Mr Mould is described in “Martin Chuzzlewit” as having “a face in which a queer attempt at melancholy was at odds with a smirk of satisfaction.” We still expect an elderly man, all in black with a face like a bloodhound.  Rosie Inman-Cook described funeral directors earlier in the day as “arrogant, ignorant, lazy bullies.” This is clearly a stereotype, and it certainly doesn’t fit Tracey Warren, a thoroughly modern, female funeral director in scarlet high heels.
Women, she pointed out, have always been prominent in death, and midwives traditionally laid out corpses—until they were banned from doing so in 1902. But female funeral directors were very rare until the late 80s when the surge began. Warren has been a funeral director for 17 years. Pushed by the audience on whether female funeral directors were “softer” and “more sympathetic,” Warren resisted the stereotype.
What she did say, however, was that the funeral business has changed dramatically in that 15 years ago you took what you were given—a church, a vicar, an oak coffin, a black hearse—but now people come knowing what they want. “Last week,” she said, “we had a pink hearse and a Tutankhamen coffin. It was great.” We are, she concluded, “thinking outside the coffin.”

European cemeteries

The Jewish Cemetery in Prague, which has 12 000 headstones and some 100 000 bodies in 12 layers, is something you must visit when in Prague, said Ken Worpole, a prominent writer on architecture and landscape. He has spent his holidays of the past six years visiting European cemeteries with his wife, a photographer, and has had a wonderful time.
Most countries apart from Britain have cities of the dead—like Pere Lachaise in Paris—but that has never been the tradition in Britain. Unsurprisingly cemeteries reflect the values of the times and societies when they were built. The rise in cremation has destroyed innovation in British cemeteries,  but Worpole, a social democrat, is much impressed by the Stockholm Woodland Cemetery, which has a classic Swedish landscape (modelled on a famous painting) and allows only headstones of equal size.
The most innovative cemetery of recent times is the Igualada cemetery just north of Barcelona, which was designed by Enric Moralles, the architect of the Scottish Parliament who now lies in the cemetery. It is postmodern built in an old quarry on the edge of an industrial site with rusty gates and discarded railway tracks as crosses. It is, said Worpole, very beautiful and peaceful.

Researching for the Commission on Assisted Dying

Louise Bazalgette, a senior researcher from Demos, described her experiences of working on the Commission on Assisted Dying, which reported the beginning of the year, was described as independent, recommended that the law be changed, and was condemned by opponents of assisted dying as stacked with supporters of assisted dying. It was interviewing people directly affected that had the biggest impact on  Bazalgette. One woman with advanced motor neurone disease described the horrors of her condition but was wholly opposed to assisted dying, while another severely affected woman didn’t want it for herself but favoured it being available to those who did want it.
Members of parliament have not debated assisted dying for 10 years as they see supporting it as “electoral suicide.” Why” asked a member of the audience, “when most people favour assisted suicide?” Because, answered Bazalgette, those who support it don’t say much but those against it make a lot of noise.
Nevertheless, there will be a debate in the House of Commons in March, and people are urged to let their views be known to their MPs.

Hindu views on death

Ushma Williams, a Sanskrit scholar, tried hard to explain the Hindu view of death, but she was up against it because the Hindu religion has 493 words for death and 290 for “immortality,” even though Hindus don’t believe in immortality but in a “state of deathlessness.” The difference was hard to grasp.
The essence of the Hindu attitude to death was caught in the sentences “If you fear death you will not be able to live your life well” and “You must understand death to understand life.”
But how, asked somebody in the audience, can we understand death? It seems to be beyond human capacity. “We couldn’t answer that question if we were here for 30 years,” said the chair, closing the meeting.

Suicide

There was a huge queue for the session on suicide, but we’d made only a little progress when somebody in the back row went unconscious. Perhaps because we’d been steeped in death for three days there was a tendency to think that he must have died—but he hadn’t. Nevertheless, the room was cleared and the session ended.
Before the drama Jez Lewis, a film maker, showed us a portion of a film that showed him interviewing a friend in Hebden Bridge describing how five of their friends in a street of 23 houses had killed themselves. Suicide had become “normal” in that community (which didn’t actually have statistics higher than the average), while in most communities it remains an “undiscovered subject.” Indeed, the NHS and the police boycotted a showing of his film in Hebden Bridge. He didn’t know why.
Angela Samata, chair of Survivors of Bereavement by Suicide, described how her partner had killed himself eight years ago—15 minutes after she’d spoken to him. She didn’t see it coming. A mother of two small children, for eight months she “held it together” but then needed help. She found it in the organisation she now chairs, which has 46 support groups around the country, a national help line, and a website http://www.uk-sobs.org.uk/
With Heather Barker from Samaritans much of the discussion surrounded the organisation’s policy of not intervening. Although founded to help those contemplating suicide, the Samaritans recognise a person’s right to decide what to do. What else could they do, I thought.
At this point the man collapsed, bringing a whiff of real death to the festival.

Celebrity death

Although the premise of the festival is that we don’t confront death head on, don’t plan for it, and don’t talk about it enough, there are cases where death is “commercialised” and “oversold,” said Kate Woodthorpe, from the Centre for Death and Society. There are now many accounts of dying in books—known as “pathographies”–with the best including “Tuesdays with Morrie,” John Diamond’s “C: because cowards get cancer too” and “The last lecture.”
Woodthorpe talked mostly about the death of Jade Goody in 2009, which she said was a “watershed moment.” For those who don’t know, Jade Goody was a young woman who became well known, even notorious, in 2002 after an appearance on Big Brother, a reality television show. She was very frank about her personal life and was taken up by the popular media in a big way. In 2007 she appeared on Celebrity Big Brother, having become a celebrity simply by being a celebrity, and disgraced herself with what were deemed to be racist comments about another contestant. The popular media, as they do, then demonised and dropped her.
Fighting her way back, she appeared on an Indian reality television show, and live on that show she was told that she had had an abnormal cervical smear. She then lived the last months of her life in the full media spotlight, going in and out of hospital and getting steadily sicker. She was explicit that she was doing this to raise money for her young sons.
Her death, said Woodthorpe, reaffirmed cultural value of redemption, dying with courage and dignity, and doing something extraordinary for her family.
But is this “on air dying” a good thing? Does it help people face their own deaths? Or does it desensitise people? Is it “proximity emotional engagement” or “a cheap day trip into other people’s misery”? Like a good academic, Woodthorpe gave us no answers.

A junior doctor speaks

Doctors, the “custodians of death,” were not very present in the festival, but David Seligman, a junior doctor, gave a sensitive and amusing description of how medical students and young doctors familiarise themselves with death—collapsing over the corpse in the anatomy dissecting room and climbing into the mortuary fridge to declare a corpse fit for cremation. Perhaps Seligman’s acutest observation was how his friends were starting to have babies and were very knowledgeable about pregnancy and birth and had birth plans. In contrast, the very sick and dying patients he sees in the hospital know little about death, can’t talk about it, and don’t have death plans.

Extinction and speciation

Extinction is the disappearance of a species (but comes in grades “extinct in the wild,” “regionally extinct” etc), and speciation is the appearance of new species, said fish zoologist Matt Gollock, giving us a break from human death. Fish are becoming extinct at an increasing rate, but there are Lazarus moments when species thought extinct are rediscovered. At this point a colleague produced a coelocanth, which was thought to have become extinct 65 million years ago but in 1938 was discovered off the South African coast.
I’m haunted by the prediction by some respectable scientists that there is a 50% chance of humans being extinct by the end of this century, something I find more troublesome that my own death, but perhaps there will be a Lazarus moment in millions of years and a few humans will be discovered by……..

Jews are bad at dying but great at helping the bereaved

Jews, said Rabbi Julia Neuberger, are bad at dying but great on bereavement. The Jewish religion teaches that if you allow a single soul to die without trying to do everything then you kill everybody. Jews believe that doctors are created by God and so are in some sense “divine.” If they don’t do everything to keep people alive, no matter their suffering, then they are bad people. Worse, she said, Ecclesiastes says that doctors should not tell people that they are dying. (Neuberger didn’t mention him, but I thought of Ariel Sharon, the Israeli Prime Minister, who has been in a persistent vegetative state since suffering a stroke in January 2006.)
Neuberger thought that Jews might be this way because they are “shaky on the afterlife.” In contrast, Christians are clear on there being an afterlife and on the need for a “good journey” from living to the afterlife, explaining perhaps why palliative care has its roots in Christianity.
Although bad at death, Jews are marvellous at bereavement—people will bring food to the homes of bereaved every day for seven days after the death. Neuberger thinks that it’s good to have people around immediately after a death, but you are then  very glad to get shot of them.
Neuberger’s conclusion was that Jews could learn from Christians about dying and Christians from Jews about bereavement.

The future of death

“Where is death going?” asked John Troyer, deputy director of the Centre for Death and Society. “Could it be,” he asked, “that death might be patented?” This was far out stuff, but is it possible that the transhuman movement will succeed in its aim of eliminating ageing and enhancing human capabilities—so creating posthumans who are 500 years old but have the bodies of athletic 30 year olds with bigger brains than Einstein? If so, death might be a choice and you might need to buy a patented method.

The death of Philip Gould

Philip Gould—a strategist, publicist, commentator, and one of the masterminds of New Labour—died in January this year and commissioned a short film of his dying and death that was shown for the first time at the festival.
The film was made over the last two weeks of his life by Adrian Searle, and Gould had messages he wanted to punch home:
When you are in the “death zone…Life screams at you in its intensity.”
“As long as I look death in the eye I have some freedom.”
My life has become death.
“I’m defining myself through death.”
“I have had more of happiness in the past five months than over many years.”
I have no fear at all of going.
He was, suggested Searle, running his death like a political campaign, and this was a very controlled film. Searle was, however, full of admiration for Gould, enjoying particularly his humour when he said “Death is so great I should have done it years ago.”

Conclusion

I apologise for writing some 6000 words on this death festival but it was a remarkable and unique event—and I wanted to capture it for myself and try and give those who weren’t there some flavour of what it was like. It was, concluded Jude Kelly, artistic director of the Southbank Centre, very vital and was “a great door to open.” Where now, I wonder.

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