Learning to die a good death

Americans have never been terribly comfortable with death. Since our culture promotes individuality and prizes success, we motivated, ambitious Yanks almost view death as a character flaw, something that could have been avoided if we really made the effort. Also, death happens in a place removed from our daily lives. We only go to the hospital a few times in our lives, and that’s where many of us check out. Death remains a mysterious event we’d rather avoid at all costs.

Within the next 15 to 20 years, Americans are going to need to get better at the idea of helping people have good deaths. First, a few trends:

1. The Boomers are about to double the number of senior citizens in America, from 35 million to 70 million. (Grey is the new black.)

2. Experts forecast that healthcare spending may balloon from $2 trillion a year to $4 trillion a year.

3. Most of our spending comes in the last six months of life.

Dying is really expensive, and we are going to be doing a lot of it in just a few short years. To keep from breaking the bank, we will be forced to learn much more about the process of dying, and to optimize it, both financially and spiritually.

The spiritual component is definitely attached to the financial side. As my lovely new bride is an internal medicine doctor, we get to discuss end-of-life issues a lot, since many of her patients die. In her view, a great deal of expense comes when people have seen too much “ER” and say:

“Do everything you can to save Mom — including full codes, peg tubes, long hospital stays, ventilators, drugs, EVERYTHING! If Jesus wanted to take Mom, he would.”

Never mind that Mom is 84 years old with failed kidneys, congestive heart failure, out of control diabetes, and dementia, avoid death at all costs! Instead of peacfully meeting this transition, we engage in combat during the final moments.

What happens is that in the fight to avoid death and stigmatize it, we spare no expense and no suffering of the patient to avoid the inevitable. Often, the end is dragged out for weeks with no potential for meaningful recovery. This person will never play tennis or recognize her grandkids or enjoy a sunset. But in our fear, we cause greater suffering and spend thousands of public dollars.

So new policies will be needed to meet these challenges. Some will be controversial. Take for example, this piece in the Boston Globe about the use of psychedelic drugs to ease the suffering of death. It seems there is a resurgence in the use of Ecstasy (MDMA) to help cancer patients achieve peace during their final moments. Despite the stigma of the illegality of the drugs, some families find this the only option that brought solace to their loved ones.

Of course, with an administration that opposes giving marijuana to cancer patients for fear that kids will take away the wrong message, don’t expect this kind of solution to be accepted without discussion.

I suppose that once the kids see end-stage cancer patients doing marijuana, all the kids will want to go get Stage III gastric cancer — you know teens, all following the fads. “Mom, Jimmy got lymphoma, can I?”

Seriously, if we continue our policy of drawing out deaths with no concern for cost, it’s a good bet that we will need to reexamine a number of policies to make sure they fit with our financial and social realities. And maybe Ecstasy tabs for the dying may seem like a much more humane future.

–Garland