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Time and meaning in the void between hope and despair
  1. Dan Mahoney
  1. Pediatrics, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Dan Mahoney, Pediatrics, Baylor College of Medicine, Houston, Texas, USA; dxmahone{at}

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It is with gratitude to Professor Wilkinson that I assemble these thoughts to the beautiful and haunting melodies of Schubert’s String Quartet No. 14. In the practice of paediatric palliative care, the wavering tension between the Maiden’s Cry and Death’s Response, that dance between hope and despair, unfolds daily in similarly beautiful and haunting ways. Schubert’s interpretation of the dialogue offers welcome connection across time and space.

In that context, Wilkinson takes on the challenging question of what it means for children to die well or to die poorly. Through examples of deaths (including Schubert’s) that went poorly, he explores the many ways that death and dying can be bad. From the loss of valuable future life to the presence of pain and suffering, to the manner of dying being contrary to an individual’s wishes, to the negative impacts of a bad death on family members, caregivers and clinicians, each element that may contribute to a bad death is addressed. He then looks to the opposite of those bad elements to illuminate what makes a good death or dying process, and suggests a temporal consideration for evaluating a death’s relative value: ‘sometimes it would be better to die sooner rather than later, because longer existence would not in any meaningful way …

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  • Twitter @DanielMahoneyMD

  • Contributors DM is the sole contributor to the design, drafting and revision of this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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