TRIGGERnometry - How to Die Well - Dr John Wyatt

Episode Date: September 1, 2021

John Wyatt is a doctor, author, speaker and research scientist. John's background is as a consultant neonatologist and academic researcher focussing on the mechanisms, treatment and prevention of brain damage in newborn infants. He is now engaged in addressing new ethical, philosophical and theological challenges caused by advances in medical science and technology. Get TICKETS to TRIGGERnometry Live with Andrew Doyle here: https://leicestersquaretheatre.ticketsolve.com/shows/873619472 Join our exclusive TRIGGERnometry community on Locals! https://triggernometry.locals.com/ OR Support TRIGGERnometry Here: https://www.subscribestar.com/trigger... https://www.patreon.com/triggerpod​​​ Bitcoin: bc1qm6vvhduc6s3rvy8u76sllmrfpynfv94qw8p8d5 Buy Merch Here: https://www.triggerpod.co.uk/shop/​​​ Advertise on TRIGGERnometry: [e-mail] Join the Mailing List: https://www.triggerpod.co.uk/sign-up/​​​ Find TRIGGERnometry on Social Media:  https://twitter.com/triggerpod​​​ https://www.facebook.com/triggerpod​​​ https://www.instagram.com/triggerpod​​​ About TRIGGERnometry:  Stand-up comedians Konstantin Kisin (@konstantinkisin) and Francis Foster (@francisjfoster) make sense of politics, economics, free speech, AI, drug policy and WW3 with the help of presidential advisors, renowned economists, award-winning journalists, controversial writers, leading scientists and notorious comedians. Learn more about your ad choices. Visit megaphone.fm/adchoices

When you ask people how they want to die, the commonest reaction you get is I just want to go out like a light. I want, you know, I want to go to bed one day. It's perfectly healthy and just die in the bed just like that. Wouldn't it be wonderful? Fantastic. Just, you know, bang, gone. No awareness, no warning. The fascinating thing is if you go back a few hundred years, that was universally regarded as the most terrible way to die.

Really? Everybody agreed that sudden unexpected death was the absolute catastrophe. Hello and welcome to Trigonometry. I'm Francis Foster. I'm Constantine Kishen. And this is a show for you, if you want honest conversations, with fascinating people. Our brilliant guest today is a medical ethicist and the author of Dying Well. Dr. John Wyatt, welcome to Trigonometry.

Great to be here. It's so good to have you on the show. We're going to talk about the cheery subject of death. You're already excited about it, I can tell. But before we get into that, tell everybody a little bit about your background, who are you, how are you where you are, how do you find yourself here talking to us? Yeah, my background is as a medic, I'm a baby doctor by training and profession. I worked as a pediatrician and a specialist in the care of newborn babies here in

central London, University College London, and I'm an academic researcher. I was particularly involved in brain injury and finding new treatments for preventing brain injury newborn babies. 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 as the advances in technology. 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.

But I'm very interested in dying. Not personally, I think. Well, I'm trying to keep it up bare, you know, but actually, To be honest, I'm actually quite fascinated to know what it feels like. I've cared for so many people who've been dying. I've watched people die. And one of the weird things about the modern world is that we've put dying out of sight. It isn't something we talk about. It isn't something we experience. And it's a great point. It's something that we don't talk about. It's something that is an absolute taboo subject in the West. 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. And I think we've had a little bit of a moral crisis.

Would you agree? Well, I think there's something in that. 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. And then we develop psychological mechanisms to try and...

live with that reality. And the commonest psychological mechanism is defense. We deny it. We pretend it doesn't happen. It's not going to happen. It doesn't happen to people like me. And I get on living with my life. And what's happened in the pandemic is that all of a sudden, 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. And we've realized actually it does affect us. And so I think there is a sort of epidemic of death anxiety,

particularly in those early days of the lockdown. And you know, you talk about death anxiety. What are the symptoms of death anxiety? Well, I think everybody is incredibly different, isn't it? I mean, how do people cope with this sense of a lot of it is just fear. I mean, a sense of heart racing, you know, the symptoms of fear, anxiety. 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. 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.

That kind of, so I think fear, I think depression, I think sleeplessness, inability to sleep. You know, there's been an epidemic of mental health. It comes out in many, many different ways. And tragically also, I think broken relationships, abuse, you know, a whole litany of things. One of the things is pediatricians, we're aware of it, the fact it's actually been an increase in child abuse going on during the lockdown. often not recognized because the normal mechanisms by which these things became apparent were not there. Do you think we've reacted rationally to this, the fear? Because I think you're right, when we look around and see how people react, when I see some polling numbers, for example, you know, 20% of the

British public want a permanent curfew after 10 p.m. You're going, I'm not sure you're really, you know, you're reacting rationally to this. Do you think that as a society, as Francis, I think it was alluding to earlier, we've kind of wet the bed on this one a little bit. Probably a great deal of bed wetting going on. But, you know, I think we don't know, as human beings, we find it incredibly hard to assess risk. 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. And particularly early on in my career, it was about the hooping cough action.

There were statistics that one in 300,000 children suffered permanent brain damage because of a hooping cuff vaccination. And I have spent endless hours of my life talking to parents who've been agonizing about, you know, should I have my child vaccinated? What are the risks and so on? 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? If I've got a 1 in 85 risk of dying, is that something I should worry about? Is that something I should change my life over? You know, if it's one in two and fifty, is that better than one in eighty-five? I think psychologically we just can't access those mathematical risks.

And we don't know how to translate it into living. And this is, I think, part of the problem in the pandemic is how psychologically we learn to live with risk. 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. 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 instoke fear. I mean, it was in order to get people to obey the lockdown, they deliberately stoked these images about, you know, save lives, protect the NHS. it was, and the hidden message, if you don't follow the lockdown, you might die. And kill someone else. Or kill someone else. And so there was this deliberate stoking, wasn't there, of fears?

And now when we say, hang on, it's not quite as bad as that, and we should now get it in proportion, 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. 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 skepticism about lockdown. But you actually have a very mixed view about the measures the government have taken. 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. So can you give us some input on that from kind of inside the medical profession's point of view? 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? I mean, it's just, you know, as though it's a bit like protecting shipbuilding or, you know, protecting the armament industry. Just to be clear, John, Francis and I were both very much in favour of the first lockdown and complied with it completely. It was more the later steps that we were more skeptical about, but please carry on. I think what a lot of people are not in the business don't really understand is how utterly sentimental.

health care has become to the functioning of a modern society. In that sense, it's utterly different, I think, from virtually any other of the activities of a modern society. 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. It's not simply the case that health services are there in case people are critically ill than going to die. It's the fact that normal living depends, 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. Many, many of these people would have either died or be chronic cripples and severely disabled in the past. But now, and I'm one of them, we're all of them. of us getting on with our lives with chronic conditions thanks to the fact that we've got continuous healthcare input 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. So the prospect

of happening was that if the NHS became genuinely overwhelmed that literally all those activities that stopped happening simply because it was the, 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 recognized. It would have absolutely catastrophic consequences and also for the economy, because, of course, so many of those people with chronic health conditions are also productive members of the economy and therefore, once the health system goes down, the economy goes down as well. 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.

It's very naive and simplistic to say we either back the economy or we back health, the NHS, which should we back? In a modern society, that's simple. is a meaningless kind of dichotomy, yeah. Having said that, I think of course we're now in a very different stage. 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 peak. 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. And I think we're going to be living with those kind of trade-offs for the foreseeable future. I mean, you say we're going to be living with the trade-offs with the foreseeable future and talking about death. 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. They are. And, you know, this is one of the bizarre things that struck me in the height of the pandemic.

And that is, in many ways, the kind of what was happening in London was a kind, it felt like an existential risk. You know, it felt as though, you know, the analogy with warfare was not ridiculous, you know. 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. 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. I mean, what they were going through, watching the bodies, seeing people struggling for life,

working through the night. It was a war zone, but it was for a tiny minority of people. people and the vast majority of the population was sitting on their back size, warm, well-fed, safe and watching Netflix. 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. And yet the vast majority of people, it has no impact at all. It simply passes me by.

It has no impact on my life. And so that's a really strange disconnect, which I, and I think some of the people, some of the scars which we are now trying to deal with as a country are because of that disconnect many people's experience of the pandemic was it was great i was at home i watched an awful lot of television i played some great games you know you know what was the problem and yet i have some of my friends i have friends who died as health professionals got COVID and died i have some who've been permanently damaged and i have some who carry huge emotional scars because of what they experienced And of course, many, many people were bereaved and were not even, you know, 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. 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. I think it's going to take some time. Do you think that we talk enough about the effects that COVID had on the medical professionals themselves? 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. 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.

Yeah, yeah. More than, more than one. I mean, there have been a whole number and people who are permanently traumatized. I mean, particularly actually, it's the junior doctors 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. 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. But I think, you know, what happened is there were some finally a medical students who were just sort of announced.

You thought you were going to do your finals next year. Well, we are hereby nominate you. You are now a qualified doctor and you report for duty tomorrow. And they were suddenly, you know, and watching people die and feeling utterly overwhelmed. So I think there are a lot of stories that need to come out. 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. And, you know, and yes, it was nice when everybody got around and clapped hands. But frankly, that was, you know, that was a bit trivial in terms of, you know, in war.

time, the instinct was we've got to celebrate the war heroes. We've got to put up memorials. 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. 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. And yet, are we going to have the same kind of recognition, celebration, naming? 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're at the absolute bedrock of the NHS. And yet again, I think there's been this sense that they haven't been recognized or celebrated in the way that our heroes would be from the armed forces. Do you think this whole thing 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? 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. I mean, you literally could have not noticed it if you didn't turn

the TV on. And that's the kind of disconnect. It is very weird, isn't it? Because if you think, any other existential crisis which hits an entire nation, everybody notices. It's something which is affecting my life. And yet extraordinarily, people could have a really nice time and just let a few health professionals get on with it. Do you think that the reason for this is partly because the people who die from this are primarily very old people? And so it's kind of, I mean, this sounds very crass, but since we've got... got you on to talk about this very difficult subject. I'm just going to say it like it is, right? That's very Russian of you.

Sure not. Well, you relate to me as a frontline medic, I think, who had to deal with dying children all the time. But like, it's kind of factored in in our mind. Yeah, yeah. Do you know what I mean? These are all people. They're going to die anyway. It's not really, yeah, okay, my grandmother or my great aunt died and whatever, but really, as a 30-something, Matt, like, it's not affecting my life. That's absolutely right. No, I think, I think it is. And, you know, know, this is something that's really weird about COVID, because there have been lots of lethal pandemics before. 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. But we were basing it on

previous lethal pandemics. 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, it's been true of SARS. It's true of Ebola. I mean, it's often, it's young, fit, healthy people are the ones who are particularly who get it most ability and who die like flies. And that's what we were expecting and that's part of the horror. We were imagining all these people, 18-year-olds, 21-year-olds, 25-year-olds, fit young, healthy people dying in ITU. How is society going to cope with that? The fascinating thing about COVID, and there's a scientific reason as to why this is, It's almost completely unique.

It has this very precise age relationship. The risk goes up linearly with every 10 years of age. And that's just because of something very strange about the biology and how it actually gets into the cells. 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. That's unusual. And it's certainly, when the next lethal pandemic comes, there's no reason to think it will be like that. 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. And 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. And of course, that made a huge, huge psychological impact in a way that actually this, because this has been this, largely been going on in old people's homes and elderly people and so on, has not had the

same psychological. And do you think that reaction is wrong? Or do you think it's a rational reaction? And again, a difficult question, I know, but this is something that I'm. I wrestle with, right? Should I, as a young, relatively healthy man, really be that worried about Coke? Do you see what I'm in that? No, well, I do. 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. I mean, that's just, that's the biology. Hey, KKK, do you like music? Yes, but only if it's on Balalaika and we have returned from successful day bear hunting. Okay.

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fridge magnet, stickers, guitar picks and secret bonus gift. As you know, there's a lot we don't know about COVID. And I think, again, what the medics are aware of is they're seeing a whole lot of really weird stuff. People with strokes, people with heart failure, people with weird things. Almost every bodily system can be affected by COVID. And again, that's new. I mean, influenza and SARS and these things, they're very specific about what they hit, whereas there's something very interesting and unusual about COVID.

And so there are some horror scenarios, if you want a few horror scenarios, and one is we know that it invades the central nervous system. So everybody knows that one of the symptoms about COVID is that it's, you lose your sense of smell and taste. That is proof that can only happen when the virus has actually gone into your central nervous system. So it is there. It has invaded the central nervous system. What is it doing there? Nobody knows.

Is it possible that it's actually going to have an impact, which comes apparent 10, 20 years time? There are other examples of infections of virus infections, which only showed neurological symptoms 20 years, later, 30, 40 years later. Is it possible we're going to have an epidemic of some weird neurological conditions, even dementia or motor neurone disease or multiple sclerosis, which was actually intrigued by minor infections, which people didn't even notice? I mean, I don't know. But I think so before you should be sort of too, you know, relaxed about where it's not going to affect me, I think, you know, I as a medic say, well, are you sure? I mean, both of us have already had COVID. So it's too late. 20 years from now, you're right? I'm already seeing the signs.

Yeah, exactly. I'm falling apart here. Well, thanks for cheering us up, mate. Good. That's going to help me sleep. But as a result, do you think we therefore trivialise it? Because reality is, we don't know the long-term effects of it. This is a new virus. Therefore, the people are, oh, it's fine. I just got sick for a week. Then I'm fine now. Actually, they're being a little bit blase and ignorant. I think they are. And there are very few doctors who are trivializing it because we're seeing weird stuff and which we don't understand. We're seeing, we're seeing doctors who've got long COVID and who are got neurological symptoms. They, you know, people with, they're paralyzed. They can't walk properly. They've been incontinent. And it's all because of COVID. So, you know,

our knowledge is accumulating, and in 10 years' time, we'll know much better. So I certainly think we shouldn't be blasé about this new virus. But I understand why people are. I understand. And this comes back to what I'm thinking about death, doesn't it? Because, you know, when you're 25 and your life's ahead of you and, you know, what? I mean, death are just standing to think about it. And health, well, I don't need to worry about health.

How healthy? What's the problem? And so it is possible for people to have this sort of completely unrealistic understanding of what's going on, of what life is like and of the reality of death and disease. So I think, again, coming back to death, the thing was it until the 50s, 60s, everybody saw death. It happened in your home, you watched your parents die, you watched your granny and granny die. often you watch your siblings die. I mean, child mortality was huge. It was just, that was what you did. And it was part of the human condition. It always was. It always will be. And somewhere in

the 50s and 60s with a dramatic fall in mortality because of improvements in healthcare and other things, and death is now medicalized and it just happens behind curtains. It happens. And I can tell myself, death doesn't happen. It doesn't exist. It's, yeah, theoretically, I know I'm going to die. it doesn't make any difference to me. Do you think this pandemic is going to fundamentally change our attitudes to death? Because we've spoken about it a lot. We've seen it in the news, the media death tolls, the amount of people dying. All of a sudden, it doesn't seem as abstract as it used to.

I would like to believe that it will change people's attitudes to death. I have a nasty feeling that the defence mechanism 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, you know, let's get back to normal living. 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. And what, sorry, do you want to crack on? Well, I was just going to say, it makes perfect sense to me. I once got stuck in a Bulgarian airport for 24 hours. Worst experience in my life. And the moment it was over, I'm just, I was just, I was

just like, I'm never thinking about this again. And I have a feeling that that will be very similar with COVID, to be honest with you. But, you know, I was going to ask you as a sort of counter argument, because I hear absolutely the importance of not over-trivalizing it. But on the other hand, you talk about our failure to assess risk. 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. Cancer, heart attacks, suicides, mental health,

depression, drug addiction, all of the child abuse, which you mentioned earlier. And all of these things have obviously exploded in the last 18 months. Do you think that we have got the right balance between addressing those causes of mortality? Well, I mean, you know, I have a lot of sympathy with the politicians. I mean, you know, that you're the only person in the country. You know, I mean, they're making it up as they go along. Of course they are. How much training have they had for this new, brand new pandemic? Nobody but nobody.

You know, it's that famous thing, you know, events, dear boy, events. You know, what, what everybody, but everybody was blindsided by this. And I think in a way, that's one of the main things to take away. And that is you have no idea what is coming down the line. And therefore, the ability to improvise, the ability to, understand, prioritize and work out what's most important, it is incredibly important. I think in a sense, this is a wake-up call. Arguably, despite the terrible things that have happened in the pandemic, you could say

we dodged a bullet. It could have been so much worse. It could have been catastrophically worse. And because of this weird virus, it was very much. less bad than it could have been. And we've also seen a spectacular way in which the medics and the scientists came together in order to develop the vaccine. 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. 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 all the me first and the petty concerns go on the back burner. Everybody's on the same team supporting one another. Vicious competitors are working together to try and crack this problem and collaborating and sharing information and clearing. the deck, you know, so the normal bureaucracy and all the frustrations, all of a sudden, it's gone, you know, whatever you want, you can have it, we'll do it now. You know, I'll stay up all

night and do it for you. So that's, again, and a very, very encouraging to see the way that human beings can respond when faced with that kind of existential threat. Again, sadly, the vast majority of the population had no awareness of that, you know, sitting at home, watching the television, life goes on as normal. But these extraordinary things have been going on behind the scenes. And I think we've learned a lot, but have we got our priorities right? Clearly not. I think the greatest worry is that we're just going to go back to situation normal. And the opportunity, I think, of resetting, the opportunity of saying, can we build a better society? Having now what we have learned, can we actually tap some of that?

You're making a lot of people very tense on the internet when you talk about resetting. So what do you mean by that? What do you mean a better society? What is it that's not that you're not happy with in the way things used to be? I think it's the rampant individualism, the the me first, the look after number one, you know, the focus on self. self-development, self-fulfillment, and the idea that in the end, the community is, expected in central London. I mean, you know, what does it matter that there happen to be

seven million other people here? I'm just getting on living my life. And I think that is deeply broken, deep and deeply, you know, there's some very deep pathology in our society and in our community. 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. Yes, there was. It felt like the complete strangers, you know, offering to help, you know, are you all right? You know, I've never spoken to you before, but, you know, we're facing death together. Are you all right? You're okay? And that was an extraordinary feeling, I felt. And it's gone. It feels like back to situation normal. And I think that's rather sad. Do you think as well it's because at the

knowledge of our own mortality instantly humbles us? And suddenly we realize that the things that we think are important, you know, the career, whatever it may be, they're not. Yeah. I think that's part of it. So the knowledge of our mortality humbles us, but it also tells us that we depend on others. I'm not, I'm not this solitary ego. Other people may. matter and we're in this together. And I think it's that combination of things. And of course, you don't want to sentimentalize it. There was a whole lot of increase of crime, of, you know, abuse, all sorts of terrible things happening as well. 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. And the

paradox is the only reason it came out was because we were under. immense threat. So going to the subject of death, do you think that we have a healthy attitude to death in the West? And if not, what would be a healthier way to approach this subject? Yeah, well, not surprisingly, I think. I don't think we have a healthy attitude to death. And I think the healthy way to is that we have to talk about it. And we have to talk about death and dying, about the experience of what we've watching other people die. I mean, so I would feel in theory, you know, that dying ought to be a communal experience.

You know, we need to try to recover this idea that when people are dying, we need to be part of that. We need to be there with them. We need to be learning from them. We need to be sharing it. We need to be talking about it. and we need to be talking about how we would like to die. 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. I want, you know, I want to go to bed one day, perfectly healthy, and just die in the bed just like that. Wouldn't it be wonderful? Fantastic. Just, you know, bang, gone. No awareness, no warning. The fascinating thing is, if you go back a few hundred years, that was universally regarded as the most terrible way to die. Really? Everybody agreed that sudden unexpected death was the absolute catastrophe.

And in fact, there's a prayer in the Church of England. 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, no possibility of preparing yourself or whatever comes next or, you know, preparing to meet your maker or reincarnation, whatever you believe in, but just bang, just get, what a terrible

thing to do. Whereas interestingly, now it's seen as an ideal way to go. But I think a lot of that is about our narcissism. We're not actually thinking about other people. We're not actually thinking about our loved ones. They're going to discover us cold in the bed, 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. So, you know, it's that kind of self-preoccupation again, which is part of the problem. But if I can push back on you just so slightly, but let's be honest, dying is fucking horrible, isn't it? Well, it isn't fun. But it is also, it's an immense opportunity. 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. I mean, one of the interesting things is that if you're dying, you get a kind of relational authority. 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 sense. But actually, can you tell them that I'm dying and I'd really like to talk to him? And because you're dying, you have some kind of leverage authority. And, you know, I hadn't spoke to my dad for 30 years, but, you know, could you get a message that I'm in ITU? And I'd really like to speak to him

before I die. So dying actually is an opportunity for healing, for exploring new things, for dreaming dreams. 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? And so the motto came from the palliative care movement was not only we're going to help you to die well, we're going to help you to live before you die. And that was the idea that to live before you die, that actually those final hours, days, weeks, months can't turn into something incredibly precious, incredibly wonderful. So it doesn't have to be effing awful. 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. But actually,

time and time again, I've seen it turn into something that's effing wonderful. It's a very good point. 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. And you see it in the culture everywhere, whether it's, you know, we as comedians talk about people being easily offended or whatever. 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. Yeah, absolutely right. 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. 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... Now makes sense where Lenin got his idea from. Although 18th century...

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, but it is still there. So the essence of utilitarianism is the idea that the ultimate good is pleasure and the ultimate evil is pain. And therefore, as you say, pain, all aspects of pain and discomfort are deeply immoral, evil and to be avoided at all costs. And you're right that modern culture is completely imbibed that, all except to my fascination, there's one area which it doesn't, and that's the gym, because we all know, no pain, no game, you know. So, so in the, 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.

But in the rest of our lives, utilitarianism is God. You know, avoid discomfort, avoid pain, avoid anything unpleasant, focus on pleasure. 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. 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, 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. 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. That's absolutely right. And dying, as you said, is the prime example of that. Here is this really frightening, unpleasant, terrible reality, which we're all of us in different ways called to face. And yet, astonishingly, do you have a website or do you plan to have a website? Well, if you do, then easy DNS are the company for you. EasyDNS is the perfect domain name registrar provider and web host for you.

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and use our promo code, which is of course triggered as well, and you will get 50% off the initial purchase. Sign up for their newsletter, access of Easy that tells you everything you need to know about technology, privacy and censorship. It can be a positive experience. It isn't all lost. Yes, there is genuine pain. There is not just physical pain. I mean, to be honest, physical pain is easy stuff. I mean, we are these days as medics amazingly good at controlling physical pain. The problem is there are other kinds of pain, which dying people have, particularly relational pain, psychological pain, existential pain, spiritual pain. These are much harder. They don't respond to modern medications. they involve the real nitty-gritty of relationships, of addressing reality and requiring counseling, friendship, whatever it is. But they are opportunities. They are fantastic

opportunities for growth. 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. 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. What have you learned from watching people die, John? You can't summarize it in a, you know, what have I learned from life? It's almost like that. You know, you see, I learned that you can never predict how people are going to face death. You know, sometimes the biggest, toughest guys are the biggest wimps and the little shriveled old lady turns out to have this astonishing

resilience and character yeah so so it's an adventure do you learn not to judge people I take it yeah you you don't judge people you it's a it's an enormous privilege to be there you know to be there at the bedside I just feel so many people miss out on this experience you know it's a bit like you know as a pediatrician I've been there thousands of times when babies have been born. And that is again another of those just great experiences of life. And there's an amazing

symmetry between that first breath and the last breath, you know, that these are life events. They are part of what it means to be human. And they are both terrible and wonderful. Do you think sometimes that because we don't confront the reality of our death, that actually presents us from living. Because unless you know that it's going to come to an end, you don't realize that time is precious. I think that's absolutely right. That's the problem with denial. 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. I mean, it keeps you at this kind of very childish level. 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. And I think there's something in that too. You know, that there's something about being exposed to that and seeing the next generation and seeing them die, that does something to you. And so there is an opportunity to grow. 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... We don't like ourselves either, don't worry. I'm sounding like an old grandpa. No, no. 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. So carry on unrestricted and uncensored and unfiltered. Go for it.

Well, I think there's just a sort of self-preoccupation and a narcissism. You know, the strange thing is as you get older, you hear your dad saying things. You think, actually, you know, I thought my dad was completely out to lunch and mistaken. And now I've kind of realized actually was not completely aware. My dad used to talk about the impact of the war and the experience of being in the army. 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. And of course,

you know, up until the 60s, every generation had had experienced war. In Europe, there's been continuous war for centuries. I mean, the idea that you could go without there being major armed conflict and that it wouldn't touch you is simply inconceivable. But now we have had peace and prosperity for what, 70, 80 years and and therefore we've grown up generations for whom war is simply inconceivable. It simply doesn't figure in their setting. And actually, that's the abnormality, I think. I think no other generation has been so free from war. And I think it's not a bizarre reality that the absence of war in some... Because I suspect war similar to dying, it's because it makes you think about reality. It makes you think about what really

matters, about what the ultimate meaning of existence is. 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. I just want to tell the viewers I do none of those things. Yes, sure you don't. It's that thing about good times create a weak man, isn't that? I think that's what you're talking about. It's a fascinating conversation. There is one question that I really want to ask. If you... No, no, go for it. Every time we address the subject of death, there's always one topic that always comes up.

Again, we shy away from in this country. That is now being used, the word dignitas. We can only really use it as a punchline to a joke. Where do you stand on euthanasia? Well, I understand why people think this is the obvious solution. And to that extent, I sympathise with it because, you know, unfortunately, one of the terrible paradoxes is that although actually Britain leads the world in terms of palliative care 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. They die without decent care, without expert support, without the right resources. Why?

Because it is not a priority. And you know, interestingly, why? Because the great British public doesn't think it's particularly important, because it doesn't want to think about it. So we want to talk about, we think the NHS should be spending more money on advanced cancer treatments. We think they should be solving the problem of dementia. We want to spend billions of pounds on exciting new treatments. We don't think dying is important.

We don't think we should make it a priority. A lot of the NHS doesn't even pay for it. A lot of it is paid out of people jingling boxes and saying, support your local hospice, which is mass. You know, that we don't even provide proper care for the dying. So we will spend billions and billions and billions to give someone an extra half a year of life at the age of 80. But we won't spend money to give them a death and dignity. Correct.

And we don't think it's important. And the great British public doesn't think it's because basically, politicians respond to what the public think. And the public do not put pressure. They put a huge amount of pressure on when it comes to cancer and heart disease and so on. They do very little about death and dying. So therefore, the sad reality is even in some of our major teaching hospitals, people die very badly. 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. And so it's understandable that people say, well, I've heard these horror stories. Surely the best thing to do is to have a lethal injection

or take a lethal medicine and so on. And so I understand the motivation, but I personally think it's wrong. Because I think it short circuits. There are all kinds of problems, one with making, killing part of what doctors do. But from a personal point of view, it goes back to this utilitarianism, doesn't it? I mean, euthanasia is great because I just don't have to have any of that unpleasantness. I mean, you know, as soon as I start those first twinges, I sit down, take the medicine, and it's gone. So all those opportunities for growth, for discovery, for healing, are all short-circuited. 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, et cetera, 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? I have to say that with really expert palliative care, and I've seen the very best experts doing it in the very best places, those situations are vanishingly rare, interestingly. 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. But it is actually very rare, and it's often a question of digging down to discover what is causing the suffering. And it's very rarely physical things that are causing the suffering.

People are often in agony because of broken relationships, because of loneliness, because of lack of meaning in their lives. And therefore, is the right thing to do is just to bump them off? or could there be a better way of helping people to rediscover meaning? 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. Do you know how many go to Dignitas every year? It's about 50.

So it's a tiny, tiny, tiny proportion. 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 because once you legalize it you have to give people the option I need to tell you you've got cancer you know we can we can support you we can prevent you suffering we can give you but there is always the option we could kill you now which would you like once you make that option you've really changed changed the ballpark isn't 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? You are utilitarian after all? I was thinking, and look, there's one thing that obviously we haven't talked about that underpins a lot of this. I was half expecting you to whip a Bible out halfway through this, because there is a spiritual element to all of this, I think. And, you know, Francis and I are not believers. 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? Well, it's a very complex mix, isn't it? Certainly, I think that inevitably your beliefs about, is there anything beyond the grave, you know, it makes a difference. And it makes a difference to how we respond.

I, as you implied, I'm a Christian, I'm basically a sort of mainstream Anglican Church of England Christian. But I worked with a colleague, a pediatrician, who was a card-carrying atheist. And he said to me once, we talked about caring for dying babies. 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. And when I'm caring for a dying baby, I'm sending them to the compost heap. And, you know, it was meant as a joke, but we both knew it was true. I mean, it does make a difference. 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. And instead of doing the normal thing, it somehow went very much. much very wrong and evolved and it's all utterly meaningless and, you know, and we'll just fizzle out. Well, that does change your attitude to these issues. Interestingly, before Christianity was a thing in the ancient world, suicide was regarded as the most logical, rational, noble way to die in many, in many cultures. And it was really only Christianity which opposed suicide because of its view that life was precious and that all life was precious. 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. And in fact, you know, we're 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. 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, as an irrational way to die. And so I suspect that's going to be one of the big arguments as we look into the future. You know, what does it mean to die well?

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? Or in the end, is it best to top yourself if I've decided my life is coming to an end, why not? good good no turn the interview on to be honest we haven't talked this much about dying since i was a comedian so thank you john john it's been an absolute pleasure and such a great conversation i think we've both really enjoyed it we've got one more question for you which is always what's the one thing we're not talking about but we really should be whoa i i think i think the meaning of life isn't it sad that it's become terribly uncool?

It's okay for students. It's okay for, you know, for people. But grown-ups, you don't talk about serious stuff, about the meaning of life. It's just a bit toe-cirling and cool. And I just wish we could have more honest conversations like this. So do I. It's interesting, you were talking about, the conversations people are able to have when they're dying.

And really what it made me think about is it's fundamentally about having each other's attention. It's about actually listening. And that's one of the things I really enjoy about doing the show is there's very few areas of my life, even my own life, even though I do this every day, basically, where I actually have the opportunity to talk and hear someone in this way. And so I suppose just having the conversation like this gives you a bit of an insight into what it's like when you have someone's attention in the way that you might do when you're dying. It's really interesting. Thank you so much for coming on.

It's been a pleasure. The book is called Dying Well, that people should look. And you've written other books as well, including about euthanasia, haven't you? Yeah, there's a book called Right to Die, question mark. And in fact, there's a new book coming out, I hope, next month, which on assisted dying, because the, you know, the assisted dying bill in the, you know, the assisted dying bill in there. in the UK is a big thing. And another book called The Robot, We'll See You Now, which is about artificial intelligence and the ethical issues that AI is rising. Or perhaps we can have you back to talk about that.

That sounds fascinating. If people want to find you online, John, where is the best place to do that? I've got a website, john wyatt.com, j-oh-h-n-w-a-d-t-t-t dot com. Fantastic stuff. Thank you so much for watching, guys. Please, please, please like and subscribe. And if you wanted to, you can catch us with another fabulous interview or raw show, always going out, 7pm UK time, 2pm Eastern Standard. Take care and see you soon. This episode is brought to you by Netflix's remarkably bright creatures.

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