Her death was lamented by her friends and family at the time, and we still mourn today for the premature loss of an extraordinary individual and a transcendentally gifted artist.
We Janeites tend to be very proprietorial about "our Jane," responding with indignation to her critics, and in the case of her death, wishing that there was something more that could have been done. But Dr. Helena Kelly takes this proprietorial attitude to new heights. As I have previously noted, she tends to discount and dismiss any other interpretation of Austen's life and work but her own. And by "dismiss," I mean that she calls Austen's own relatives liars and fibbers who didn't understand Austen nearly so well as she does...
The nature of her illness was unknown at the time, and various diagnoses have been put forth subsequently. Medicine was of course very limited in those days, but although her "medical attendant" Dr. Lyford was unacquainted with x-rays, CAT-scans and blood tests, he was very well acquainted with death, and I suggest that he could recognize its approach. Shortly before Austen's passing, her brother James wrote to his son to say "Mr. Lyford has candidly told us that her case is desperate... with such a pulse it was impossible for any person to last long."
After Austen's death, Cassandra described her sister's final days and hours in letters to her nieces and others. Everyone involved in Austen's care, and Austen herself, wrote that she experienced little severe pain during the course of her long illness, except near the very end, when she struggled and was restless. Cassandra, undoubtedly wanting to provide relief, asked her if she felt pain and if so, where, but Austen was unable to articulate an answer. "She was seized again with the same faintness, which was followed by the sufferings she could not describe." Dr. Lyford was summoned and "applied something to give her ease."
Dr. Kelly, recounting this scene in her book, Jane Austen: the Secret Radical, warns us that we ought not to take Cassandra's version at face value for "this kind of text is always suspect. Lies cluster to death like flies." Kelly declares that it is not a foregone conclusion that Austen's malady was fatal or that her end was near: "We may have to consider the --frankly horrifying--possibility that Jane's illness wouldn't, on its own, have proved fatal, or not so soon, that it might have been the drugs, and only the drugs, that killed her."
Shortly before death some people become restless, agitated and confused, however, they are usually unable to tell us why. This is known as terminal restlessness and it often occurs within the last few days of life and affects nearly half of all people who are dying.
There may be a variety of causes for this and sometimes sedative drugs are needed. A calm, quiet and stress-reduced environment, with reassurance from those who are close to the person, can often help to relieve this symptom.
I witnessed this phenomenon myself during the recent death of a family member who chose to die at home. Cassandra's description strikes me--based on my experience--as exceedingly accurate, down to the detail of the dying person lying in an awkward position, despite one's best efforts to help them get comfortable. After our relative spent a miserably restless night, trying to climb out of bed when he could no longer support himself, we anxiously called the hospice care team. The nurse came and explained that this was a sign that the end was coming. Fortunately, the restlessness soon subsided, and my relative passed away less than 24 hours later.
Seeing your loved one thrash about murmuring on their death bed is a harrowing experience and naturally you would want to ease their suffering with pain medication. But it does not follow that whatever dose Austen received was entirely responsible for the stillness which followed the period of restlessness--again this is a natural part of the dying process.
I see nothing suspicious about Austen's end and no reason to assume, as Dr. Kelly suggests, that Austen's "depressed respiration" at the end was due to an opiate overdose and not Cheyne-Stokes breathing, which is another extremely common and widely-reported harbinger of approaching death.
It would be charitable to lay Kelly's eagerness to accuse others of criminal actions and lies, to her respect for Austen, and her wish, which we all share, that she had been as long-lived as the rest of her family.
Update: more thoughts on Jane Austen's final days here.