Why and How We Are Doing the Final Days Wrong

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Although as a society we work hard to adopt aging-in-place more widely and implement enlightened policies of aging well, the end of all aging is death. Interestingly, in our society the subject of death is something of a taboo. We do all we can to deny its inevitability. Modern medicine connives to foster this deception, from age-defying plastic surgery to a doctor prescribing one last hopeless procedure for an aged body that gives every indication it is ready to shut down.

In pushing away thoughts about death, we also push away wisdom about it. In this way we deny ourselves and our loved ones the comfort and calm of sound perspective during the last days, months, and years of life.

What calmer wisdom of death is found than in these words in the Bhagavad-Gita: “Worn-out garments are shed by the body; worn-out bodies are shed by the dweller”? A book on pet loss, Will I See Him Again?, by Tom Waldron, says important things about death: 1.) We should accept death because all living beings will die, 2.) After a death the survivors often punish themselves with guilt thinking they could have done more. Waldron says, yes, more could have been done, but by doing more, more harm could have been done, too.

A last emotional and agonizing rush to the hospital characterizes the last days and hours of many people. Yet, is this the final experience we want? Atul Gawande, the bestselling author of Being Mortal and a surgeon, describes this experience: “You lie attached to a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said good-bye or ‘It’s okay’ or “I’m sorry’ or ‘I love you.’”

Dr. Ken Murray is more explicit in an article on how doctors themselves choose less, rather than more, treatment as they face their ends. Dr. Murray says doctors “want to be sure, when the time comes, that no heroic measures will happen–that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).” Doctors, he assures us, do this so they can face deaths that are peaceful, dignified and preoccupied with family, love, and making peace with God as the person understands God.

“In a war you cannot win, you don’t want a general who fights  to the point of annihilation. You don’t want Custer. You want Robert E. Lee.” –Atul Gawande

What if we, as a society, just faced death, accepted it, and gave in to its final power? After all, death may be an enemy, but it is an enemy that is certain to win. Gawande says: “This enemy has superior forces. Eventually, it wins. And in a war you cannot win, you don’t want a general who fights to the point of annihilation. You don’t want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end.”

Isn’t it better to be prepared?

Death has been institutionalized in our society, perhaps to avoid facing it. Isn’t it better to be prepared? Gawande recounts that in the Middle Ages, guides to good deaths were widely read. Drew Gilpin Faust, author of This Republic of Suffering, about the Civil War, agrees.

Many features of what was considered a “good death” in the Middle Ages resembled what our U.S. Civil War hospital workers looked for in terminally ill or wounded soldiers: resignation, acceptance of his fate, a desire to forgive and be forgiven, and a letting go of all earthly attachments and possessions, declarations of faith and hope for salvation, and meaningful last words for loved ones.

By the time the Civil War started, Faust says this formula for “The Good Death” was firmly rooted in people’s consciousness. North and South, soldiers, their families, hospital personnel, and chaplains worried less about death than whether the death had been a “good death.”

North and South, soldiers, their families, hospital personnel, and chaplains worried less about death than whether the death had been a “good death.”

Although we may agree with all the features of what constitutes a “good death,” few would argue against a death of acceptance, reconciliation with loved ones, and peace as being highly desirable. How can we attain such deaths for ourselves and those we love?

Elisabeth Kübler-Ross advocated home deaths: “If a patient is allowed to terminate his life in the familiar and beloved environment, it requires less adjustment for him. His own family knows him well enough to replace a sedative with a glass of wine, or the smell of a home-cooked soup may give him the appetite to sip a few spoons of fluid.” This is a better death than the “lonely, mechanical, dehumanized” experience that Kübler-Ross described as the death many people experience in a hospital.

… grieving family members have more peace and suffer less depression…

Many persons seem to agree. Gawande notes that about 45% of Americans died under hospice care in 2010, most of them in their own homes, where invasive and fruitless medical measures were suspended. Instead comfort, pain relief, peace, quiet, and time to interact meaningfully with relatives were their priorities. Gawande notes too that grieving family members have more peace and suffer less depression about a hospice or death at home than they do when the final days occur under the glare of fluorescent lights among strangers.

When death becomes something we do not run from, something we do not insist must take place in sterilized hospital rooms while a last, hopeless procedure is performed, we will feel more peace about this natural part of life.

 

 

 

Sources

Faust, D. G. (2009). This Republic of Suffering. New York: Vintage Books, a Division of Random House, Inc.

Gawande, A. (2014). Being Mortal. New York: Metropolitan Books. Henry Holt and Company.

Kübler-Ross, E. (1969). On Death and Dying. New York: Scribner.

Murray, K. (November 30, 2011). How Doctors Die. Zocal Public Square. Nexus. Available online at: http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die/ideas/nexus/.

Waldron, T. (2006). Will I See Him Again? Xulon Press.

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