Death becomes us

According to www.deathclock.com I will die on Tuesday 14 March 2051. At the time of writing that translates to 1 504 875 429 seconds left of living. But when my time comes will I die the death I want?

Perhaps the best way to die is to do so in a way that leaves the possibility of living again. Arrangements can be made at the Alcor Life Preservation Foundation (www.alcor.org) to cryopreserve your body—that is, to freeze it in liquid nitrogen for future resurrection. Once medical technology catches up, proponents of cryonics claim, it may be possible to have your suspended body revived, the cause of your death cured, and your aged and damaged cells repaired. Cryonics is touted as an extended form of artificial resuscitation: you wouldn't deny a paramedic resuscitating your heart after it stops beating, would you?

For those curious about death and the funeral industry, www.msprozac.zoovy.com (which is run by a webmaster battling advanced stage breast cancer) gives information on the dying process and how to plan for death. Death, after all, is a part of life, the site says, but this is mostly a commercial endeavour, and its embalming details and autopsy memorabilia may leave some people feeling queasy.

Advice on living wills (also known as advance directives) has proliferated on the web, much of it linked to the thriving funeral and insurance industries. From a healthcare perspective, the American Medical Association's online booklet (www.ama-assn.org/public/booklets/livgwill.htm) provides useful instruction to people wanting to document in advance their dying wishes and to designate an agent to execute treatment decisions if necessary. You can register your living will in the United States at www.uslivingwillregistry.com and in Canada at www.sentex.net/~lwr/index.html

Detail from a Day of the Dead costume, Mexico

Credit: KEN WELSH/BAL

The international site www.partingwishes.com has clever page wizards to help you securely document your preferences for burial or cremation, write a will, and design a future web based memorial. Online advice on creating your own funeral is hard to come by, but at www.allen-nichols.com/products.cfm you can buy a popular workbook. Any memorial service is unlikely to come cheap for your family (http://observer.guardian.co.uk/Print/0,3858,4681030,00.html). For the bereaved who are planning funerals and juggling the various financial, legal, and practical decisions that accompany the death of a loved one, the Vancouver based www.funeralswithlove.com is a gentle, compassionate resource.

The death websites at www.selfgrowth.com/archive/death-websites.html range from the bizarre to the sublime. Of these, death-dying.com offers perhaps the broadest range of content on death, dying, bereavement, and caregiving, mostly geared towards non-professionals. Unlike other sites, it includes sections on dealing with sudden deaths such as suicide and murder. Self assessment tools, chat rooms, book reviews, question and answer forums with experts, and a personalised email service of grief support are offered, and its content appears to be updated regularly. A series of provocative personal views—some touching, others ranting—might provide comfort to those experiencing the rollercoaster of grief.

A good death is emphasised at Growth House (www.growthhouse.org), an educational site for healthcare professionals and consumers on life threatening illness and care at the end of life. Special sections on the death of infants and children and on pregnancy loss have comprehensive advice that will probably help people. But its professional content is thin. The section on quality improvement, for example, lists a series of organisations rather than examples of best practices or clinical guidance. Perhaps its best feature is its hosting of the inter-institutional collaborating network on end of life care, an online international group of palliative care organisations.

Palliative Care Matters (www.pallmed.net), founded by a consultant in Wales, provides news, scientific articles, drug advisories, job postings, conference announcements, and regular updates on governmental happenings for healthcare professionals working in palliative care in the United Kingdom. Forums are also hosted. The site is detailed and user friendly, with a "quick update" link that lists content posted within the previous seven days.

The National Library of Medicine site (www.nlm.nih.gov/hmd/hmd.html) has an outstanding history of medicine collection including Physician Struggling with Death For Life. Photogravure by Ivo Saliger

Credit: NLM

Celebrating the dearly departed, www.mexconnect.com/mex_/feature/daydeadindex.html provides a fascinating, if frenetic, series of photo and journalistic accounts of Mexico's Día de los Muertos, or Day of the Dead. The festivities involve such customs as macabre adornments and lively reunions at family burial plots, chocolate skulls and skeletons, fireworks, and seasonal flowers such as cempazuchiles (marigolds) and barro de obispo (cockscomb) that serve as offerings to the dead. www.darwinawards.com slyly commemorates individuals who eliminate themselves "in an extraordinarily idiotic way" from the gene pool.

If you wish to seek solace in the words expressed in the moments before death, choose from the last words of famous people (www.geocities.com/Athens/Acropolis/6537/index.htm) or the rather sprightly Japanese jisei (death poems) at www.samurai-archives.com/deathq.html

Jocalyn Clark, editorial registrar

BMJ jclark@bmj.com

http://www.bmj.com/cgi/content/full/327/7408/231