Living to die well: Find freedom the body offers
We live alongside death. It speeds down highways recklessly and blooms clandestinely within our bodies. We have no idea when we will meet death, or how. Living with an awareness of this specific uncertainty can be terrifying, yet I've found that death also shimmers with a singular magnificence: the possibility of living freely.
Popular culture would have us believe in cliché bucket lists, which call to mind outlandish activities that defy the physical limitations imposed by illness or the emotional limitations of common sense. Morgan Freeman and Jack Nicholson skydive in 'The Bucket List", despite terminal lung cancer. Queen Latifah withdraws her life savings and jets to Europe after learning she has weeks to live in 'Last Holiday".
Greeting death with the fantasia of daredevil activities or adopting a newly carefree persona is a tempting salve for our fear of that last great unknown. But in my experience, considered reflection on mortality nudges people towards a more complicated version of the ordinary, not novel permutations of extremes. I often hear variations on similar wishes: A daughter wants a small wedding ceremony in the hospital so her dying parent can attend. A brother calls an estranged sister, asking her to visit so that he can say goodbye. I have heard uncommon goals too: wanting to take a long-postponed trip to the Alamo, to write a romance novel, to breed one last litter of puppies and inhale, one final time, the milky sweet of their young fur. These wishes are at their core the same desire, reconciling the differences between the life we have and the one we longed for.
While contemplating our deaths can guide us to a place of deep honesty with ourselves, sometimes helping us to live more fully, it also can teach us to inhabit and understand our bodies more fully, too. Death will unravel our bodies in ways we cannot predict. Will we die in a sudden car crash, avoiding the indignities of a physical decline? Or will dementia claim our bodies and minds in an uncertain sequence? Our bodies absorb our lives; terror and joy alike live in our skin. My patient began to cry regularly about the traumas of his youth and losing his loving relationship with his wife. Dying offers the opportunity to face what we have simply accepted as part of our lives — formative events and experiences that we don't challenge or question, but simply accept and accommodate like a messy roommate.
But we don't have to wait until we are dying to consider what it means to live freely. For all of us, reconceptualising death as a guide can help us to begin an ongoing conversation with ourselves about who we are and what we'd like our lives to mean. Think about how you spent the last six months. What and who brought you fulfilment and joy? What would you do differently if you could? If those were the last six months of your life, what would your regrets be? These questions, deceptively simple, are as commonplace and ordinary as death itself. Our answers to these questions evolve as our lives unfold. What and who seems to matter the most to you right now may change. If we begin this inquiry before death arrives, we may die as fully as we have lived.
Rearranging our waning lives around previously buried desires isn't always practical or possible, emotionally or financially. But even if we cannot upend our existence in the name of slumbering passions, we can find freedom in the life the body offers, paying attention to the burn of grief and the pulse of joy, the intensity of an embrace or the taste of butter on toast. Even as we die, our bodies are capable of more than devolution from illness.
Several months after I first met my patient who dreamed of European travel, his wife rushed him to the emergency room, her voice trembling as she described the way his skin glowed yellow seemingly overnight, the ferocity in his voice when he refused to go to the hospital, their daughter's decision to leave school to help care for him. He smiled when I pulled up a chair next to his bed.
'It would have been so nice to see Belgium,' he murmured. 'I could have brought you some really good chocolate.' — The New York Times
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Living to die well: Find freedom the body offers
My patient, stoic and pensive, told me that he'd made it through his last year of work by dreaming of the European cruise he and his wife planned to take the week after he retired. 'I thought I'd paid my dues,' he whispered. 'I was just waiting for the best part of life to finally start.' He rarely took time off and had pushed through nausea and occasional abdominal pain that had worsened during his final months of work. Freedom, he'd thought, lay just beyond the newly visible finish line. But a diagnosis of stomach cancer, which had spread to his liver and lungs, had left him too breathless to walk, too nauseous to endure a boat ride, too weak to dress himself. Instead of living out his dreams, he was living out his death. We live alongside death. It speeds down highways recklessly and blooms clandestinely within our bodies. We have no idea when we will meet death, or how. Living with an awareness of this specific uncertainty can be terrifying, yet I've found that death also shimmers with a singular magnificence: the possibility of living freely. Popular culture would have us believe in cliché bucket lists, which call to mind outlandish activities that defy the physical limitations imposed by illness or the emotional limitations of common sense. Morgan Freeman and Jack Nicholson skydive in 'The Bucket List", despite terminal lung cancer. Queen Latifah withdraws her life savings and jets to Europe after learning she has weeks to live in 'Last Holiday". Greeting death with the fantasia of daredevil activities or adopting a newly carefree persona is a tempting salve for our fear of that last great unknown. But in my experience, considered reflection on mortality nudges people towards a more complicated version of the ordinary, not novel permutations of extremes. I often hear variations on similar wishes: A daughter wants a small wedding ceremony in the hospital so her dying parent can attend. A brother calls an estranged sister, asking her to visit so that he can say goodbye. I have heard uncommon goals too: wanting to take a long-postponed trip to the Alamo, to write a romance novel, to breed one last litter of puppies and inhale, one final time, the milky sweet of their young fur. These wishes are at their core the same desire, reconciling the differences between the life we have and the one we longed for. While contemplating our deaths can guide us to a place of deep honesty with ourselves, sometimes helping us to live more fully, it also can teach us to inhabit and understand our bodies more fully, too. Death will unravel our bodies in ways we cannot predict. Will we die in a sudden car crash, avoiding the indignities of a physical decline? Or will dementia claim our bodies and minds in an uncertain sequence? Our bodies absorb our lives; terror and joy alike live in our skin. My patient began to cry regularly about the traumas of his youth and losing his loving relationship with his wife. Dying offers the opportunity to face what we have simply accepted as part of our lives — formative events and experiences that we don't challenge or question, but simply accept and accommodate like a messy roommate. But we don't have to wait until we are dying to consider what it means to live freely. For all of us, reconceptualising death as a guide can help us to begin an ongoing conversation with ourselves about who we are and what we'd like our lives to mean. Think about how you spent the last six months. What and who brought you fulfilment and joy? What would you do differently if you could? If those were the last six months of your life, what would your regrets be? These questions, deceptively simple, are as commonplace and ordinary as death itself. Our answers to these questions evolve as our lives unfold. What and who seems to matter the most to you right now may change. If we begin this inquiry before death arrives, we may die as fully as we have lived. Rearranging our waning lives around previously buried desires isn't always practical or possible, emotionally or financially. But even if we cannot upend our existence in the name of slumbering passions, we can find freedom in the life the body offers, paying attention to the burn of grief and the pulse of joy, the intensity of an embrace or the taste of butter on toast. Even as we die, our bodies are capable of more than devolution from illness. Several months after I first met my patient who dreamed of European travel, his wife rushed him to the emergency room, her voice trembling as she described the way his skin glowed yellow seemingly overnight, the ferocity in his voice when he refused to go to the hospital, their daughter's decision to leave school to help care for him. He smiled when I pulled up a chair next to his bed. 'It would have been so nice to see Belgium,' he murmured. 'I could have brought you some really good chocolate.' — The New York Times
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After compiling and analysing hundreds of peer-reviewed studies, the Global Council on Inequality, Aids and Pandemics (of which we are members) found that poor and marginalised people struggle to access health services during disease outbreaks, leaving them more susceptible to infection, illness, and death. Viruses and other contagions prey on these vulnerabilities, turning outbreaks into epidemics, and epidemics into pandemics, which deepen inequalities and reinforce the cycle. In the early days of Covid-19, this inequality-pandemic cycle was on display in Global North countries. White-collar professionals worked safely from home, thanks to high-speed Internet and teleconferencing platforms, whereas small businesses and factories closed, throwing blue-collar workers into financial crisis. In these countries, the pandemic hit low-income and Black and minority communities the hardest. The unequal impact of the pandemic was also felt between countries. Vaccines were developed in record time – the result of a remarkable multilateral investment in strategic industries – but high-income countries purchased most of them, and then refused to share excess doses with the developing world. This vaccine hoarding caused more than one million deaths and cost the global economy an estimated $2.3 trillion. The same pattern played out in the early response to the Aids pandemic. At the end of the twentieth century, effective antiretroviral drugs became available in the Global North. But Aids continued to kill hundreds of thousands of people in the Global South, and especially in Sub-Saharan Africa. The unconscionable denial of access to lifesaving treatment sparked global outrage, leading to the establishment of the Joint United Nations Programme on HIV/Aids (UNAIDS), the Global Fund to Fight Aids, Tuberculosis, and Malaria, and the President's Emergency Plan for Aids Relief (PEPFAR) in the US. In 2002, fewer than one million people living with HIV had access to antiretrovirals, whereas more than 30 million do today; expanding access to treatment has so far saved an estimated 26 million lives. And, before the recent foreign-aid cuts, the world could have achieved its goal of ending Aids as a public health threat by 2030. The decades-long journey to end Aids has underscored the importance of investing in health systems, medical research, and vaccine and drug production in both the Global North and the Global South. Moreover, it has highlighted that people's living conditions – often called the social determinants of health, including job security, income level, access to education and affordable housing, and respect for rights – determine their well-being. For example, in 1996 Botswana, which was hit particularly hard by the Aids pandemic, effectively added a year of secondary school to its public education system. This policy created a natural, population-level experiment on the effect of schooling on the risk of HIV infection. An analysis of huge cohorts of young people who went to school under the old system and the new system found that each additional year of schooling reduced a young person's risk of HIV infection by 8.1 percentage points. This protective effect was strongest among women, whose risk of contracting HIV decreased by 11.6 percentage points for each additional year of school. Building fairer societies leads to healthier populations that are better prepared to react to disease outbreaks and prevent pandemics. By contrast, defunding public education, slashing social safety nets, imposing tariffs, closing borders, cutting foreign aid, and disengaging from multilateral cooperation will widen inequalities, fuel political instability, accelerate economic migration, and create the conditions for viruses to thrive. This is evident in Ukraine, where an over-burdened healthcare system has accelerated the spread of drug-resistant infections through war-torn communities. Meanwhile, outbreaks of Ebola, mpox, measles, and Marburg are on the rise, partly owing to globalisation and climate change. Weakening the global health system will enable these outbreaks to fester and spread, taking lives, deepening inequalities, and potentially destabilising societies. Experts are already warning that cuts to US programmes (including those delivered by USAID) could lead to a 400 per cent increase in Aids deaths by 2029. The abiding lesson of pandemics is that no one is safe until everyone is safe. Building walls and shutting out the world will not protect people. The only way to do that is by reducing inequalities and investing in the global health system. In this context, cooperation is the ultimate act of self-interest. @Project Syndicate, 2025 Michael Marmot The writer is Director of the Institute of Health Equity and Professor of Epidemiology at University College London Winnie Byanyima The writer is Executive Director of UNAIDS and an under-secretary-general at the United Nations
