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What's wrong with dying, anyway?

05 October 2012

Robert Thompson enjoys In the Midst of Life by Jennifer Worth

The rhythm of life and death: the author (and
musician) Jennifer Worth

The rhythm of life and death: the author (and
musician) Jennifer Worth

Jennifer Worth is best known for her first memoir, Call the Midwife, which was made into a successful television series (Features, 20 January). That book formed part of a trilogy which recounted her experiences of midwifery in east London in the 1950s. In the Midst of Life is the thought-provoking fourth volume of Worth's memoirs. It focuses on her reflections on nursing those with terminal illness, and her thoughts on how we die in our contemporary society.

Over the summer, I was at a discussion group on assisted dying at a parish holiday. The main issues were well outlined and debated for most of the session. Then a participant told us about her mother's terminal care in a hospice. Her mother's pain was not adequately controlled, and she had been in distress. In tears, the daughter told us how, for much of the last few weeks of her mother's life, she felt like taking the pillow, covering her head, and aiding a quicker death.

As I read In the Midst of Life, I thought of that woman. I think she would find its tone reassuring in the face of the guilt that she openly expressed. It is a book that should appeal to anyone who wishes to reflect on how advances in medical care affect the quality of both our lives and our deaths. It is a book that we should all read, as these issues will have an impact on all of us, at some point in our lives.

In the Midst of Life is an important contribution not only to thinking through these issues, but also to feeling them, too. Worth's writing is thoroughly grounded in her practical nursing experience. This makes is both accessible and engaging. But it also renders it refreshingly free from the moral over-generalisations that come from some Christian ethicists.

The book also offers a mixture of styles of writing. The bulk of it comprises stories of nursing care that Worth was involved in. These are told with a compassionate and critical voice. Narrating the stories offers her the opportunity to raise questions about what constitutes good medical and nursing care.

There are also biographical chapters on the work and influence of Elisabeth Kübler-Ross and Cicely Saunders. Others are essays that focus on the social taboos of death, the separation of nursing and caring, resuscitation, and assisted dying.

Worth invites us to reflect on how we think and feel about death. In her preface, she says: "This book assumes that death is sacred," and that it can be experienced as a friend rather than an enemy. She tells us the stories of what she describes as the "natural death" of her grandfather, and the "unnatural death" of Mrs Ratski. The former died of "old age", while, in the case of the latter, medical interventions are depicted as causing further suffering.

In Mrs Ratksi's case, the medical profession is seen as treating diseases rather than people, and of making decisions without reference to the patient or the family. This story is doubly tragic, in that the burden of care on the family leads to the break-up of Mrs Ratski's son's marriage. In a conversation with a Matron about this patient's care, Worth says: "What's wrong with dying, anyway? We're all going to die."

Worth focuses on the denial of death in modern medicine. For me, this also raised questions about similar denials that may come from Christians when healing and miracles are over-emphasised, at the expense of the life-cycle.

Later in the book, a chapter on dementia expands her insights about the aims of medicine. Because of its focus on prolonging life, modern medicine is ill-equipped to assess the qualitative outcomes of its own interventions. This is exacerbated when medicine and care become business. Worth notes that residents in care homes are often fed by tube simply because it is more cost-effective. It is also expedient to keep residents alive, as they are the main revenue stream. As the rate of privatisation of health care increases, these trends will become more prevalent.

Worth also reflects on hope. In the face of illness, hope is not only or necessarily about cure, but can mean something different to each person. "Hope, directed towards an achievement, is the driving spirit that makes the future endurable."

On the questions surrounding assisted dying, Worth comes to a tentative, ambiguous, and honest conclusion:

I am a Christian; with every breath of my body, every beat of my heart, I trust and love God. Christian teaching guides my thoughts and my life. But, when it comes to euthanasia, I flounder in a sea of uncertainty. It is horrifying, and contrary to the Ten Commandments, to think of killing the weak and helpless. Yet I also believe in evolution, and it may be that the necessity to decide the time of death for ourselves and others is part of God's purpose for the evolutionary development of mankind towards responsible maturity, to which we will have to adapt mentally, spiritually, and emotionally. Yet still it shivers me, and I don't know the answer.

Her comments brought me back to the parish discussion group. Worth helped me to feel the issues.

The Revd Robert Thompson is Lead Chaplain at the Royal Brompton Hospital in London.

In the Midst of Life by Jennifer Worth is published by Phoenix/Orion at £7.99 (CT Bookshop £7.20 -Use code CT941 ); 978-0-7538-2752-9.


  • Did reading this book make you think about anything in particular relating to your own mortality?
  • "This book assumes death is sacred." How does Jennifer Worth show this in her writing?
  • Whose was the first death you experienced? How did it affect you?
  • What have Dr Elisabeth Kübler-Ross and Dame Cicely Saunders contributed to the field of death and dying, in Worth's view?
  • Worth is opposed to euthanasia, as she makes clear in her writing. What is your view?
  • How would Worth sum up good care for the dying?
  • Has your view of resuscitation changed after reading the chapter "999"?
  • Were you able to discern how Worth's faith affects her views about the care of dying people?
  • "It is well nigh impossible to talk to anyone about death, I find." Do you agree?


IN OUR next reading-groups page, on 2 November, we will print extra information about the next book. This is Death Comes to Pemberley by P. D. James. It is published by Faber at £7.99 (CT Bookshop £7.20 - Use code CT941  ); 978-0-571-28817-5.

Author notes
P. D. James was born in Oxford in August 1920, and educated in Cambridge from the age of 11. Her career began in the National Health Service in 1949, before she moved to the Home Office as a civil servant, where she worked for both the police and criminal policy departments until retirement in 1979. Her first book, Cover Her Face, was published in 1962, although she had had a desire to be a novelist since childhood.

Since then, she has written 20 books, including an autobiography which was published to coincide with her 80th birthday. She was made a life peer in 1991, and has received numerous awards. In addition, she has been a member of the C of E's Liturgical Commission, and served as a magistrate.

Book notes
Death Comes to Pemberley is a form of sequel to Pride and Prejudice. Mr Darcy and Elizabeth Bennet have been married for six years. They are planning their annual ball when Elizabeth's younger sister Lydia turns up, claiming that her husband has been murdered in the woods on the estate. It turns out, in fact, that it is not he but his friend who is dead, and words that he utters are taken by some to be a confession of murder. As the story unravels, however, the truth about what happened in the woods becomes clear.

Books for the next two months:
December: Effie Briest by Theodor Fontane
January: The Paris Wife by Paula McLain

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