Death: "the Distinguished Thing"‪.‬

Faced with his imminent death, Henry James is reported to have said, "So it has come at last, the distinguished thing." Distinguished? That seems an odd term to use, but James was a master at choosing the right word, and he may have seen better than most of us what death is all about. My dictionary defines "distinguished" as "having an air of distinction, dignity, or eminence." Yet there is dissent from that judgment. The late theologian Paul Ramsey contended that there could be no death with dignity. Death is too profound a blow to our selfhood, to everything good about our existence. James or Ramsey? For at least forty years now--Ramsey notwithstanding--a massive effort has been under way to bring about death with dignity. The leading techniques have been the use of advance directives, hospice and palliative care, and improved end of life education for physicians, nurses, and other health care workers. As the Hastings Center Report 1995 special supplement on the SUPPORT study indicated, that effort achieved only a mixed success; a decade later, this report describes progress since then, but points to the long road for creating real and lasting improvement.