Ready for a deep dive? You can’t get much deeper than asking: What is the purpose of death? This episode is about Medical Assistance in Dying, yes, but that is only the avenue in for a next-level discussion. What are the psycho-spiritual dynamics around death? What does it mean that the ego dissolves? How does consciousness expand at the end of life?

As a Chaplain, cancer survivor, and someone who has worked in palliative care for over 25 years, David Maginley has much to say. And I am – and hopefully you will be – an eager listener.

For more information on Best Life Best Death please visit our website at ⁠⁠www.bestlifebestdeath.com⁠⁠
Follow us on our social channels to receive pertinent and helpful resources on death, grieving, and more at:
Facebook: ⁠⁠www.facebook.com/bestlifebestdeath⁠⁠
Instagram: ⁠⁠www.instagram.com/bestlifebestdeath⁠⁠

Transcript:

Diane Hullet: [00:00:00] Hi, I am Diane Hullett, and you’re listening to the Best Life Best Death podcast. Today I’ve got a fantastic guest, David McGinley, author of Early Exits, spirituality, mortality and Medical as Early it’s a long

David Maginley: one.

Diane Hullet: It’s a, it’s a long subtitle. Early exits, spirituality, mortality and meaning in an age of medical assistance and dying.

So welcome David.

David Maginley: Thank you Diane. Thanks for having me on, Michelle.

Diane Hullet: This is, I mean, the book is really just a launching pad for us to have a bigger conversation about what you found in your experience. And, you know, I, I found the book just an incredibly rich read. It’s one of those books that I wanna recommend.

Everybody I know and at the same time I know it’s a dense book and a research book and a thoughtful book, and it’s really gonna take some grappling for someone to get into it. So you and I are kind of trying to have a couple [00:01:00] of short conversations, a double episode here of 30 minutes each and try to capture some of what’s in this really meaningful book.

So I, you know, I first came across you through one of the When You Die project. Movies in which you were just an incredibly articulate participant and researcher, and give us a little introduction about, you know, how you came into the work you do, your personal experience, and you know why you wrote this book.

David Maginley: It’s been a wild ride and I’m, I’m blessed and blown away by where it’s landed me and what, what it landed me doing. It began with cancer. I’ve had cancer four times a life-threatening type that doesn’t respond to chemo or radiation. You have to go in surgically and remove it, and it’s been incredibly dangerous every time.

But that propelled me onto a journey of trying to understand like what’s life about. So I ended up, you know, I was 17 years old when I first had it, [00:02:00] and I ended up studying philosophy and comparative religion and learning to ask better questions, and it just kept on going. And then, you know, I went to seminary.

Not that I was very religious, I just wanted to go and ask better, bigger, deeper questions. And then I got into ministry at a church, a Lutheran church for 10 years. It didn’t feel perfect for me, it didn’t feel right. I was drawn to suffering. Now, by this time I’d had cancer three times and I was pulled into hospital chaplaincy.

So I worked in cancer, palliative and intensive care for 27 years. And it was a landscape I was surprisingly comfortable in. Well, I guess because I know it from both sides of the bed. And this embedded me in the suffering of others. And in the way that, that is a transformative process. How it can’t help but change who and what we are in our relationship to the very texture of [00:03:00] life.

And this, this awakened me along with several mystical experiences during my career. To this fundamental question around life and death and consciousness and whatever mystery awaits us on the other side. So that led to one book called Beyond Surviving Cancer and Your Spiritual Journey, exploring how to not only go through cancer, but but grow through cancer.

And then in 2016, medical assistance in dying. Or euthanasia was legalized in Canada and it fundamentally changed the nature of palliative care and end of life care. And I participated in about a dozen procedures and made, kept coming up weekly in palliative care rounds. And I. I was increasingly [00:04:00] feeling some moral distress and I couldn’t articulate exactly why, which led to me wrestling with meaning suffering at the end of life.

And this seemingly compassionate procedure that rescues people from the suffering and the descent that they imagine is, is just ahead of them. And, six years after writing that first sentence. I hit the punch, the publish button, and it’s out there in the world.

Diane Hullet: It, it is out there in the world. I, I think your book is just extraordinary because it’s grappling with a, i i, I said to a couple of people like, it’s grappling with the gray area of made and you, you talk really clearly.

You know, there are people who absolutely are in the camp of this, this is a right, this is a choice. This is the right to choose at the end of life. And then there are people solidly in the camp of, this is morally wrong, this is against our religion or our beliefs. [00:05:00] And, and, and there they sit these two camps, right?

But you dive into this big gray area of what is the purpose of death? What does it mean to be dying and. Undergo the transformation that happens at a spiritual soul level as we die. And I just think it’s an incredible kind of gray area dive that I haven’t seen anybody else dive into those waters. So say a little more about you know, for listeners who maybe aren’t super familiar with MAID or those two kind of entrenched encampments around Maid.

Tell us a little about that.

David Maginley: Sure. Well let, let’s start that with a question for your listeners, how would you like to die? It’s the biggest and for most of the scariest event in life now, most people would say, I’d like to die in my sleep. Let me fall asleep here and wake up on the other side. Or they may say, let me die quickly, so I don’t even know what’s [00:06:00] happening.

But mostly let me be comfortable.

Diane Hullet: Yes,

David Maginley: let it feel, let it feel safe. I wanna acknowledge that there are people who are experiencing unimaginable suffering and distress. But we must emphasize that the vast majority of requests for physician-assisted death, which is what it’s called in the United States, are driven not by physical suffering.

They’re driven by existential distress. Now, what does that mean? It means fundamentally people are scared, of course but deeper than that they are anticipating increased physical deterioration and pain ahead. But that is their imagination of what that pain will look like. And it is infused with a desire to take care of their family and not [00:07:00] have them witness or prolong to death.

It’s infused with a desire fundamentally to feel safe and a loss of meaning and purpose that they experience at the end of life. Yeah. And I dive into that in great detail. Who and what we are. Is being eroded away by our illness and then the dying process and we don’t like it. Now, as we resist that inevitable outcome of the dying process, we’re actually gonna increase our existential distress, but surprisingly, as we allow it to move wisely with it, what is increased is a sense of grace, compassion.

And a surrendering to a process that calls on the community to provide the best of [00:08:00] care when you are reaching your seemingly worst state. But in that dependency, you become our teacher, right? And so the book explores that and much more in great detail. I understand people wanna feel safe, and I understand that it’s a relief to many to have their death, but in the hands of a professional who through an injection, will put you to sleep and then you, you’re, you’re gone.

Of course that feels safer. But I I, I propose that it is a profoundly inappropriate intervention, existential distress is the same as spiritual distress, the loss of meaning, purpose, or identity and functioning in the world, and the loss of something, connection to something greater. You don’t need to be religious, but that means that a medical procedure is [00:09:00] being used to treat what is a spiritual condition.

Diane Hullet: And that’s really your key. Like if there were one line in the book, that’s the key. That the number of people who choose medical aid and dying medical assistance and dying are choosing it for existential distress and it’s a physical solution. And I, I think that’s absolutely fabulous. You know, to name that you have.

Some statistics on it, and it’s, it’s a big number of people who are choosing it out of fear. And I also think of this word burden, right? That we have such a, such a bias at this time that I, I don’t completely understand, that says I shouldn’t be a burden to my family, that this will be terrible for them to witness my disintegration.

David Maginley: Yeah. I had one fellow, he was a very successful businessman and he, he asked me. To convince him why maid was not a good idea. And I told him, that’s not my job. [00:10:00] My job is to support him in his choices as best I can. But he, he was relentless. And after I checked with our ethicist at the hospital and the doctor I was given the go ahead.

So I said to him, well, can you imagine that in your dying and your dependency, you’re teaching your family about the fundamentals of mortality? You are teaching them how not to abandon any aspect of suffering. You are awakening them to the gift of an ordinary day. You’re helping them to say the foremost important words that Mark A.

Good death. Thank you. Love you. Forgive me, goodbye. Can you allow your daughters and sons and your wife to anoint your body with their tears? Can you teach them? How to be embedded in ambiguity. How to simply be fully present and not understand or know, but to love all the way through. [00:11:00] And can you give yourself to the final transformation and mystery that it’s awaiting all of us without your ego getting in the way and saying, I don’t like it.

I don’t want it, and just shut me off.

Diane Hullet: Yes. And you talk about, so you talk about the, I’m gonna say it kinda superficially here, but like the benefit to family members if someone is dying and has that experience. And, and you also talk in the book about the benefit, again, that’s not quite the right word, but like the, the true outcome of the grappling of that descent of the soul at the end of life.

What’s, what’s the benefit to the dying person of sticking around for a natural death?

David Maginley: Right. The benefit is profound. Now, in, in exploring this, I’m not making any statement about the effect of made upon you in the afterlife. That’s beyond my scope of practice. Right. And I actually trust that the [00:12:00] grace that receives us is infinitely more than the grace that seemed to send us however.

The vast majority of people as they’re dying, move into expansive or more nuanced states of consciousness. Even though they are descending, they are expanding. There is an equanimity that’s quite perplexing. There is a sense of simply being not doing, of resting in awareness of moving to a state that is not of the rational mind.

So it’s not something the mind or ego can understand. It is a state of being which is punctuated in the vast majority of cases of dying with mystical phenomena, right? You see your welcoming party you you feel this infusion of peace and a connection to everything. There’s a sense of gratitude that is beyond the poverty of words.

There’s a stillness that [00:13:00] cannot be described. It is sublime, it is universal, but it, these moments are infuriatingly transitory, they’re impermanent. They’re up and down in the flow and the negotiations with mortality. I’ve seen this in many, many cases in my 27 years in palliative care. Let us acknowledge that some people die.

What can be termed as a, an awful death because their pain is not properly controlled. There’s no excuse for that.

Diane Hullet: Yeah, I think that’s a big thing. I hear people fear, and yet my understanding from the medical profession is that really should not be the case in this day and age. No one should die in pain and that dying in and of itself is not painful.

Disease process can be painful,

David Maginley: right. Dying itself. The process is, is what could even be called graceful. [00:14:00] We know how to come into this world. We know how to leave this world, and this is an age where medicine can mitigate the turbulence better than at any other period in history. But there are two factors that compromise that.

I don’t know how many patients have said to me, well, I just wanna be careful about the, the pain medication. I don’t wanna get addicted. And it’s hilarious because I say, you’re dying. Why don’t you get, have a bit of fun.

Diane Hullet: I take the edge off. It’s okay. The opiate, your friends at this point,

David Maginley: right? We’ll make sure you don’t get addicted ’cause you, you gotta increase the pain medication to meet the higher level of physical pain that’s being injured.

So you could be on morphine that’ll drop an elephant. Because of your pain level, you’ll be able to manage it. Yeah. But they’re so deeper than that though. They’re worried about being sedated and not being able to communicate with their family. So that’s about the grief, the preparatory [00:15:00] grief, the saying goodbye, which you must do in nuanced in various ways.

I really understand this anxiety around heavier pain meds. I really do understand the anxiety around death itself, which is why the option for physician-assisted death is an existential analgesic. It calms the fear of death because now your back in control. You determine how and when and where, and who you’re gonna be with.

So. Made seems on that level to make sense.

Diane Hullet: And a lot of people would argue, that’s great. I, I wanna be in control. I should have choice. And how, how do you respond to that?

David Maginley: That becomes the ultimate act of ego, self preservation in the face of the process that naturally deconstructs it for your transformation.[00:16:00]

That’s a heavy statement. What does it mean? Well. Can we talk a bit about the ego,

Diane Hullet: please?

David Maginley: What is it? It’s the perceived separate self. It’s the me that I identify through my thoughts, my feelings, my body, my story, my perceptions, my hopes, my expectations, right? But the ego in spiritual traditions becomes a handicap and then becomes a saboteur.

To spiritual growth because all spiritual development deconstructs or erodes the ego to result in an identity that is based in connection to the mystery, to the all where you are not center stage. Where ego becomes this is rather thick, a functional process through which consciousness has [00:17:00] experience.

Instead of a dysfunctional construct that attaches its identity to the experience. Hope that makes sense.

Diane Hullet: That’s mouthful, but I think it makes good sense. Keep going.

David Maginley: So this is, we’re getting thick here. Pretty complex psychospiritual dynamic.

Diane Hullet: Well, it is, this is what your book is about, is the psychospiritual dynamic of death and what is the purpose and the meaning.

And I think one of the key things here, just to pop out to this level and then back in, is that, that we have lost touch with that. I think in, in current modern society, we’ve lost touch with death, having purpose and death, having meaning, and so we fear it and we don’t like it, and we want it to happen quickly and in our control.

David Maginley: Right. We’ve lost our vocabulary around death and dying. We’re unfamiliar [00:18:00] with the texture and reality of it because it happens predominantly behind closed doors, hospitals, nursing homes. We do not see it in the streets around us, as happens in other countries, and we don’t treat it as a community building event that deepens the cultural intelligence and wisdom.

Yeah. We treat it as a medical failure

Diane Hullet: and an individual choice, and it, we, we treat it as something that happens to the individual and a medical failure,

David Maginley: right? But birth and death are not as much as they may appear. Individual events, they’re cultural events and they are as natural as your next breath, right?

Nature knows the way, and medicine can make that way smoother. Doesn’t need to make it shorter.

Diane Hullet: And yet again, go back to this idea of control. That, that I, I think it has to do with our [00:19:00] individualistic society that says, I, the individual get to be in control. And one of the things I love in your book is that you talk about the ground of being and you talk about sort of, you know, universal oneness in, in a lot of different phrases that I think can resonate with people, whether they have a religious.

Angle and belief or not. So I don’t know if you wanna elaborate on, you know, this, what is the ground of being and why does it matter for the end of life and understanding what can happen at the end of life,

David Maginley: right? So this is connecting to the essence of what you truly are. We’re trying to strip away anything that’s temporary, that’s not perennial.

So your thoughts, your feelings, they flow every few seconds. They’re not, they’re not robust enough. They’re not permanent. They’re so fleeting. So that’s not who and what you are. And your body, well, your body changes and it’s that brutal reminder in the mirror [00:20:00] every morning. So your body is not permanent to who and what you are, but yet we un naturally, understandably, are identifying.

Our body and thoughts and feelings and our story, right? This is who I am. This is what I do, right? This is how I am a human in the world.

Diane Hullet: Even this is even, this is what the world is.

David Maginley: Yeah, but it’s not because even that is a changing, passing story. What is permanent and perennial? It is awareness. It is you as a being, a human being, not a human doing, not a human thinking feeling, but a human being.

So what does that mean? It’s easy to access. Even as your viewers are listening or watching us, they can step back from their thoughts and just watch the thoughts. Don’t stop them. Watch the feelings, and. Watch the [00:21:00] experience now. Describe the nature of the one that’s watching. It’s always there. This is a fundamental, universal, unchanging foundation of spirituality, nature and animals have no problem being what they truly are.

But humans, oh my goodness. We pile on the perceptions and thoughts and roles and attachments and hopes and aspirations. Until you can, you, you lose touch with what you fundamentally are. So when you reconnect to that awareness, there is a surprising, neutral peace. Equanimity, relaxation, harmony, connection, awareness, openness.

All these things our restless hearts are longing for, but do not know how to [00:22:00] find a way home to yet it, it’s right here. It’s always been there and dying. Erodes those illusionary aspects of the self away to land you in a place that is surprisingly safe. Especially if you’re well medicated.

Diane Hullet: Beautiful. You have a wonderful chapter about meditation, and I love it because it begins with you.

You see this poster on a, on a board, you know, on a street corner, and it says, learn meditation, find inner peace free sessions. And you, you, you comment, oh boy, there’s trouble because what meditation is, as you say. It is raw engagement with the monkey mind. The cacophony of thoughts and distractions stirred up by naked awareness.

Right? Meditation is not exactly peaceful when you start it, but it develops that ability to step back and see the thoughts as this. [00:23:00] Chatter that doesn’t stop. And I love that you, this is kind of jumping a little, but you know, each chapter in the book ends with a practice that is very deliberate. And some of them are guided meditations and some of them are exercises to go out and do an experience.

And you’re really trying to take the reader into an experience of what you’re talking about in the chapter. And so the chapter on meditation says. You know, essentially practicing meditation is practicing being ready to die.

David Maginley: Yeah. We spend a great deal of energy avoiding ourselves. We fill our thoughts with so many distractions, right?

This thing becomes an adult pacifier for our anxiety,

Diane Hullet: big time,

David Maginley: while it even creates the anxiety even more. But meditation is this intentional deconstruction of the ego so that you can meet yourself in the ground of being of [00:24:00] simple awareness. And it’s not an exciting place as much as the ego might be afraid of it, because the ego, it doesn’t want to disappear.

Any efforts to do so will trigger ego defense mechanisms for self preservation. That happens in our relationships all the time, and that’s why I propose that medical assistance in dying is the ultimate act of ego, self preservation. It gets very complicated when you move that from an individual level to a cultural level, then it becomes the ultimate cultural, spiritual bypass around the homework that’s waiting for all of us to do.

Diane Hullet: And so would you say, do you feel like current modern Canadian culture is bereft spiritually? Is that part of where this arises from?

David Maginley: No, because maybe it’s my bubble, but I [00:25:00] experience quite an appetite for an authentic spirituality. I think our culture is ripe for it. Now, religions in general have been the crucible for teachings around that, but they don’t have the trust of the public anymore.

And they’ve lost that vocabulary that’s more relevant to the modern mind where we need to talk about. The nature of consciousness, not the nature of God. We can experience the nature of God, but yeah, the issue is around consciousness. I’m not surprised in our culture that physician assisted dying is becoming more popular and the majority of Canadians, according to some polls, like the idea of, of made think of it.

It makes sense that it’s arisen at this time. We painted ourselves into a corner. With our medical advances, we’re able to enable you help you live into your suffering far longer than ever [00:26:00] before. It was only what a hundred, 150 years ago that pe most people who die from infection. Yeah. Now we can design chemotherapy specific to your genetics.

Individualized treatment. Now we can resuscitate you after you die of a heart attack. So you live longer into your suffering. You end up relying on medical technology to rescue you and prolong your life. We have very high rational intelligence, but very low spiritual intelligence and nuance. That’s a bad combination.

We live in a culture that emphasizes autonomy in the individual. It’s no wonder that people like Maid and that that it, it seems so popular. But I, I think, I think it’s moving in the wrong direction. I think it’s an inappropriate response. And really we don’t have a right to [00:27:00] die in any specific way, any more than we have a right to be three dimensional.

You’re gonna die. And your medical treatment is not something you can insist on. It’s arrived at collaboratively with your experts, your medical team, and then there’s the whole factor of death is not a medical event. It’s not a medical issue. Breathing is not being three dimensional is not a medical issue.

It’s just life dying. Yes, medicine can help but should not cause.

Diane Hullet: Well, this comment that we’ve painted ourselves into a corner, I think is a really interesting one that medical advances have led us to be where we are now. And, and the comment I hear most often is with when people are supportive of maid is they say, say things like, we’re kinder to our animals, we’re kinder to our dogs.

I just put my cat down and I wish it could be that simple for me. What, what is the, what is the thinking behind [00:28:00] those kind of comments?

David Maginley: So I really appreciate those comments and I completely understand. However, there’s a nuance that people are not aware of a dog, a cat, an animal. I am asserting, and I I have not found anyone to refute this postulation.

They don’t have an ego. They have a personality, right? You know, I’ve had pets all my life. But they don’t have an ego that perceived sense of the separate self. They know themselves as what they authentically are, but me, no, I am, I’m a jumbled mess. I am a circus up here and I am ridiculous in my inconsistent behavior and grappling for power and position and authority and agency.

Now euthanasia for an animal then. Doesn’t sabotage or interrupt the [00:29:00] natural and spiritual growth that results from mego deconstruction, we’re relieving them of their physical suffering. But with maid, we’re treating existential suffering because the ego’s resisting its deconstruction. It’s a world of difference there.

Diane Hullet: Interesting. Yeah. Yeah. So it, it, which, which would kind of say. F for some people. You know, I’m not sure Maid is always a spiritual bypass in my experience. Like, I certainly have had experience with people who chose Maid, but deliberately did so much work in the way that they approached that, which for whatever reason, it felt a little different to me than a quick escape.

But it’s interesting to think that we’re helping dogs or cats or horses with physical suffering. But we’re not bypassing something for them because they are in the moment. They are with the ground of being [00:30:00] all the time.

David Maginley: I hear you and I’ve been with made cases that have been beautiful and that the people appear to have done their spiritual homework.

There’s been great love and they have been unafraid and they’ve been anticipating and very curious about whatever weights the other side of the veil. So I know that. And yet the very act. Desire for made when you’re in that state over the final reduction of the ego to the state of being that the mind has no language for is that’s still being resisted.

The person still wants made, so why? Why is that any less? Spiritual or noble. I’m not saying it’s less, I’m saying it’s an impoverished response. And, and why? Because that individual as loving and beautiful and [00:31:00] spiritual as they may be, as well as the person performing, made the advocates who want it, the family who approve of it, the politicians who voted for it and, and spoke to it.

All of these people, in fact, most of our culture. He’s unaware of the psychospiritual process of ego deconstruction as a functional role of suffering. They don’t know. So I put the book out. So it’s, it’s a mistake. It’s an oversight, but it’s not to be judged as, as something you know. Impoverished, or I don’t know how to put it.

There’s no judgment upon a person who chooses it, and I’m not even judging those who perform it, right, but I’m offering them my book and my insights on what’s really going on, and I’d like to have a deeper conversation.

Diane Hullet: Ah, [00:32:00] beautiful. Well, David, I think that’s a perfect place to pause for our first half of our 30 minutes, or I think we’ve gone a little over, I don’t know.

And we’ll pick it up again next week. So again, I’m talking with David McGinley, author of Early Exits Spirituality, mortality and Meaning in An Age of Medical Assistance. And Diane, get David McGinley author, chaplain. Cancer survivor, so many things that you bring to this incredible work. Thanks for joining me, David.

David Maginley: Thank you.

Diane Hullet: You’ve been listening to the Best Life Best Death podcast. As always, you can find out more about the work I do at bestlifebestdeath.com. Thanks for listening.