Interview
Culture
Death & life
S&U interviews
8 min read

Rediscovering 'ordinary dying'

On the eve of her Theos annual lecture on 'Death for Beginners', Robert Wright speaks to former palliative care consultant Kathryn Mannix about the need for everyone to re-engage with the process of dying. Part of the Seen & Unseen How to Die Well series.

Robert is a journalist at the Financial Times.

 

A woman stands in an autumnal-looking park, with her hands in her pockets
Katherine Mannix.

Shortly after the late Queen Elizabeth died, in September last year, Kathryn Mannix, a former palliative care doctor, decided to point out something that had been going unremarked. Mannix, who spent 30 years in various palliative care roles in the North of England until retiring in 2016, wrote on the social media platform then called Twitter that the world had watched the late monarch live through a process that she called “ordinary” dying. But, she added, the dying had gone “unspoken, un-named”. 

Mannix’s 12-post thread pointing out what the world had been watching was to prove one of the most successful steps yet in her long-running campaign to refamiliarise the world with how people die, the signs that someone is dying and how the process works. The thread has been viewed several million times. Among the replies to her post, according to Mannix, were several from people saying they recognised from it that relatives were going through the process and they should prepare. 

Mannix hopes that her efforts will ensure people learn to cope better with their own and others’ inevitable deaths in ways that work better both medically and emotionally. 

“The queen’s death was no surprise to those of us who have been watching that process that we recognise as ordinary dying,” Mannix says, in an interview over lunch in Newcastle, near her Northumbria home. 

“The person got into hospital to have treatment to stop them from dying. When they died, that was a medical failure. That was an embarrassment.” 

Mannix will take another substantial step in her campaign on November 1 when she delivers the annual lecture for the religious think-tank Theos on Dying for Beginners. The lecture will revisit the lessons of her thread about the queen and two successful books about dying: With the End in Mind, recounting the lessons of her career in palliative care, and Listen, about finding the words for end-of-life conversations. All of her work has stressed the unhelpful aspects of medical practitioners’ increasing involvement in deaths. Doctors’ increasing power to prevent death in many circumstances and delay it in others has made it, in her view, damagingly unfamiliar. 

However, Mannix insists that, while the November 1 lecture has been organised by a faith-based think-tank, her principles are applicable whether people understand their lives through a spiritual prism or via something else like family, politics or art. 

“There are a number of constructs that give people meaning,” Mannix says. 

At the heart of Mannix’s message is the idea that death was once a familiar process that people knew how to manage. She argues that the last century’s medical advances changed that. 

“I think we’ve forgotten because over the course of the twentieth century life expectancies nearly doubled,” Mannix says. 

She points to a range of factors behind the shift, from improved sanitation and vaccination programmes to the founding in the UK of the National Health Service and the introduction of antibiotics. 

She dates the shift of dying from home to hospital to the second half of the twentieth century. 

“It was almost like dying was kidnapped inside hospitals then,” she says. “The process itself got slightly distorted by the medical interventions like intensive care units, so the process became less recognisable.” 

The key change, according to Mannix, was that death became “the enemy”. 

“The person got into hospital to have treatment to stop them from dying,” she says. “When they died, that was a medical failure. That was an embarrassment.” 

“It’s hard to have a conversation with a person who has no pegs to hang that conversation on. The current population has no idea about dying.”

Doctors started to keep in hospital people who would prefer to be at home with their grandchildren, in case there was one more thing they might try that would save their lives, Mannix says. 

“We need to celebrate that medicine can do so much more than it used to be able to do,” Mannix says. “But we need to remember that those achievements are only postponing dying. We’ve not cured death.” 

Clinicians need to recognise the point in illnesses where death becomes inevitable and speak to patients about their priorities for their remaining time, she adds. 

“Survival at all costs might not be what is most important to them,” Mannix says. “There may be things that they wish to fulfil.” 

Mannix is clear that the UK at least remains a long way from learning the lessons that she is trying to teach. She was prompted to write her thread about Queen Elizabeth’s death partly by the ending to a news bulletin announcing that the monarch’s family were rushing to her bedside at Balmoral. Mannix says the newsreader finished the segment, hours before the death was announced, by saying “Get well soon, ma’am.” She describes it as “a dreadful example of our death-denying”. 

She is giving the annual Theos lecture as the group is in the midst of releasing a suite of resources designed to provoke greater debate around death and dying. They include a video where Mannix explains the dying process. The group’s research paper Ashes to Ashes, published in March, showed that many British people had similar priorities for their own deaths and those of loved ones as set out in Mannix’s work. They wanted to be free of pain or suffering, surrounded by family, probably at home, to be reconciled to people and to be prepared. 

According to Mannix, however, even her fellow medical professionals feel poorly equipped to begin conversations with patients or their families about impending death. Many people had contacted her after reading With the End in Mind saying that they were convinced of the need for frank conversations about death but had no idea how to start them. 

“The feedback from doctors and nurses was the same as from the general public – ‘I don’t know how to talk about this bit’,” Mannix says. “’Nobody taught us about this in training’.” 

It is also a challenge for medical professionals that patients and their families are typically resistant to conversations about death, she adds. 

“The doctor doesn’t want to be the bad guy or girl and constraints in the NHS are such they can’t find time for the length of conversation that’s likely,” Mannix says, adding that many doctors are also unfamiliar with exactly how the dying process tends to unfold. 

“They’re not taught about dying,” Mannix says of trainee clinicians. “They’re not taught to see good dying as a good medical outcome and it could be.” 

Those conversations are all the harder, she adds, because society as a whole has so little conception of the process of death. 

“It’s hard to have a conversation with a person who has no pegs to hang that conversation on,” Mannix says. “The current population has no idea about dying.” 

In wider society, meanwhile, she would like to see far more communities taking the opportunity to support the dying. 

The questions fundamentally end up being spiritual or philosophical ones, Mannix says. She declines to be drawn on her own spiritual practices but describes herself as “spiritually curious”. She similarly declines to outline her position on the debate about assisted dying, saying that expressing a view on that would be a distraction from her primary purpose of promoting discussion of the ordinary dying process. 

But she says questions about how to manage death, whether to prolong life and the balance between quality and length of life inevitably raise “societal questions”. 

“We all want to think about our life being worth something and about the purpose that we think is the purpose of being alive,” Mannix says. 

Mannix hopes her campaign will prompt religious leaders to think more carefully about how they support families and dying people. In particular, she would like priests to acknowledge to those they are supporting that faith will not always banish fear and that the faithful will sometimes feel abandoned by God in the face of death. She would like to see far more thorough training for clergy throughout their careers in how to have such conversations. 

She would also like to see more clergy learn more about the process of death, so that they can reassure families about what they are witnessing – for example, that apparent gasping from the dying person does not indicate pain. She expresses optimism about the growth of civil society organisations – some based around religious organisations – seeking to encourage a more open discussion of death and dying. She speaks particularly warmly of the Death Cafe movement – where people meet for cake and coffee to discuss death issues – and the End of Life doula movement. End of Life doulas seek to shepherd people through death the same way that birth doulas assist women in labour. 

Both of those movements have a key role to play in bringing about the revolution that Mannix would like to see in society’s understanding of death and its role in life. 

Asked what a balanced approach to the issue would look like, Mannix says it would be “very helpful” if people were told at the outset when they were diagnosed with a long term, potentially life-limiting condition that it could be so. 

“Currently, people understand that cancer can kill you,” Mannix says. “But there are many people walking around the country who have long-term lung diseases, kidney diseases, who just wonder why they never feel as well as they used to do.” 

In wider society, meanwhile, she would like to see far more communities taking the opportunity to support the dying. 

“A decision for the public would be to think of an organisation or society or a community that they belong to and how could they be agents of change in that community to explore the concept or ordinary dying,” Mannix says. 

Such communities can decide how best to prepare and make available support for other community members when they are dying. 

“Their dying will come one by one,” Mannix says. “We’ll all take our own turn.” 

 

While most tickets for Kathryn Mannix’s talk on November 1 have been taken, some more may become available at theosthinktank.co.uk. For those unable to attend, the lecture will be filmed and posted afterwards on the Theos website. 

 

Review
Books
Culture
Economics
Politics
5 min read

Abundance and the attempt to build a better world

Is this policy the antidote to the zero-sum game of politics?

Josh is a curate in London, and is completing a PhD in theology.

Construction worker climb a steel framework.
Josue Isai Ramos Figueroa on Unsplash.

What do you do when more money won’t solve a government’s problems? Abundance: How We Build A Better Future, the new book by Ezra Klein and Derek Thompson is an extended polemic against a form of government—particularly as practiced by US liberals—that stymies policy delivery. However technocratic that sounds (and the book often is), it forces readers to confront deeper questions about the nature of politics.  

At the heart of the book is a critique of what the authors, drawing on the film Everything Everywhere All At Once, call 'Everything Bagel Liberalism'. In the film topping are added to bagel to the point that it becomes a blackhole. So too, Klein and Thompson suggest, with so much well-intended policy, in which in seeking to tick every possible box and satisfy a range of regulators it becomes a delivery blackhole and little is actually done. The authors ask whether parties of the left are focused on measuring spending to the exclusion of measuring what gets built.  

The first chapter gives a good sense of their approach.  It tells a familiar story about the way in which so many are being priced out of cities because of a lack of affordable housing. However, in doing so, it highlights a surprising harm: that geographical proximity remains an important enabler of technological innovation so a lack of affordable housing in cities means a loss of creativity. 

The diagnosis is perhaps even more surprising coming from American liberals. Special interests—including those seeking to protect the value of their own houses—weaponize interlocking sets of well-intentioned legislation to prevent homes being built. Subsequent chapters apply that similar logic—regulation and a lack of focus resulting in inaction—to infrastructure, government capacity, scientific research and the implementation of new inventions. 

The book's strength is that it is not particularly detailed in its policy proposals. Klein and Thompson instead offer abundance as a lens through which policy development can be viewed: what do we need more of and how do we get it? This lens can be applied from within a wide range of ideological frameworks. It is not itself a worldview but a challenge that any politics should be obsessed with effective delivery not simply desiring the correct end-state.  

The book is unapologetically focused on America and the failures of progressive governance, particularly in California. (One of this book's peculiar legacies will be to leave many who have never been there perpetually invested in California's struggles to build high-speed rail.) Nevertheless, the approach already has its advocates in the UK - for example, the Centre for British Progress which set out its stall last week, and it is not hard to see how an agenda here that could be seized by a less hesitant Starmer government.  

Any plausible political analysis must hold together the reality of scarcity and abundance. Losing sight of either unmoors us from the actual world we find ourselves in.

Indeed, perhaps the book might feel more realistic if it had other countries in mind. Reviewing Abundance, Columbia economist Adam Tooze describes the book as painful to read, characterising it as a manifesto for the Harris presidency that never was. Indeed, according to the authors, the book was originally scheduled for release in summer 2024 to influence the Democratic platform leading up to the 2024 elections. Instead, it appears in 2025 amid Trump's assault on institutions, Tooze's Columbia among them.  

In an interview on Pod Save America, the authors argued that the book is still relevant, offering a framework with which Democrats can oppose Trump. Thompson described the Trumpian view of politics as fundamentally shaped by scarcity. He suggests that behind 47th president's policies—most notably the tariff agenda—is the conviction that every interaction is zero-sum; for you to gain, I must lose.  On this analysis, the way to oppose a politics that pits groups against one another over limited resources—housing, trade, jobs—is to figure out how the government can provide more and argue for it. In its critique and its hopefulness, Abundance offers those who believe in institutions a way to navigate—even work with the grain of—the anti-institutional temperament of contemporary politics.  

There might be something to this messaging, but scarcity plays an unmissable role in Klein and Thompson's argument. Remember that they characterise what they oppose as "Everything Bagel Liberalism", policy that tries to achieve every outcome and loses focus in doing so. They may conceive scarcity differently to Trump, but their book is a warning policy cannot deliver as much as we think. It is a call for us to oppose, to compete against those special interests—whether they be residents’ associations wanting to hold up house prices or politicians wanting to cut research grants—whose policy priorities overload the bagel.  

At heart, the book is a reminder that ultimately the salient scarcity in politics is not housing or trade or even money. It is time. Abundance cautions governments that unfocussed policy yields the time entrusted to them by the governed.  

Humans cannot lead politics completely beyond its zero-sum logic. The world is so often a violent competition over resources and government must restrain that violence while avoiding being co-opted as a means of exploitation.  And yet, politics is also—even primarily—an avenue through which communities answer a primal summons to be fruitful, abundant.  

Ultimately, any plausible political analysis must hold together the reality of scarcity and abundance. Losing sight of either unmoors us from the actual world we find ourselves in. Yes, there is so much broken and warped to reckon with, and we must grapple too with our finitude’s bluntness, but so too is creation replete with goodness, among them our capacity to invent and deliver what we need together. 

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