Saturday, March 10, 2012

Musings about death


To be born is to die. Or, in words from Ecclesiastes, There is a time to be born and a time to die. That truism may seem blindingly obvious. However, many people, as they approach death, seem to live in denial of death’s inevitability.

Over the last forty years, a change seems to have occurred in the medical profession. When I was in seminary, almost forty years ago, the conventional wisdom was that physicians generally insisted on employing every possible means to prolong life. Their attitude suggested that a patient’s death represented professional failure.

Yet a recent survey of medical doctors showed that 64% of physicians, compared to 20% of the general public, had advanced directives in case of medical disability or incapacity. Unlike TV programs in which CPR enables a person to return to a normal life about 70% of the time, in real life only 8% of people who receive CPR survive longer than a month; only 3% return to anything that resembles a normal life. Doctors, perhaps more than any other group, know the limits of modern medicine and recognize that treatments that may extend life briefly usually entail a greatly diminished quality of life. (Ken Murray, “Why Doctors Die Differently,” Wall Street Journal, February 25, 2012, http://online.wsj.com/article/SB10001424052970203918304577243321242833962.html?mod=WSJ_hp_mostpop_emailed)

Abundant living sometimes necessitates choosing the best balance between quality and quantity of life. No one answer fits everybody; longer is not automatically better. This highly personal choice is a matter of prudential wisdom exercised in consultation with knowledgeable professionals (who provide the best possible summary of facts and probabilities), loved ones (whose love makes life valuable and suffering worth enduring), and spiritual guides (who affirm the worth and humanity of the dying, helping them find courage with which to face death).

Facing death squarely – not yielding an inch prematurely while not futilely tilting at windmills – helps people to die with dignity and love (hence the popularity of the hospice movement).

Facing death squarely can also save the healthcare system huge amounts of money. Approximately 25% of Medicare expenditures fund care during a person’s last year of life. The percentage of chronically persons treated by ten or more doctors increased from 30% to 36% from 2003 to 2007. In other words, in spite of doctors having changed their personal attitudes about the benefits of extreme measures to prolong their own lives, the healthcare system continues to treat chronically ill persons as if death was not inevitable and that prolonging life at any cost is worthwhile. (Cf. a Robert Wood Johnson Foundation study report at http://www.rwjf.org/qualityequality/product.jsp?id=72192)

In fact, the U.S. spends 50% more on healthcare than any other developed nation, with poorer results. (Ezekiel J. Emanuel, “Spending More Doesn’t Make Us Healthier,” New York Times, October 27, 2011, http://opinionator.blogs.nytimes.com/2011/10/27/spending-more-doesnt-make-us-healthier/) Acknowledging death’s inevitability is not defeatism but realism, not pessimism but essential for prudential management of scarce financial resources. Expensive medical procedures that do not significantly extend life with an acceptable quality of living (e.g., an extra week either in great pain or a drug induced stupor that is a side effect of pain control medication) simply do not make sense or cents.

Thinking about one’s death is a good annual Lenten discipline. Death can come to anyone, anytime. Being prepared for the unexpected helps one to value the present more and expresses love for the bereaved (this love may take the form of financial planning that includes insurance, end of life instructions, advanced healthcare directives, a will that identifies guardians for minor children, and perhaps even funeral or memorial service planning). Jesus’ exhortation to John to care for Jesus’ mother upon Jesus’ death represents a form of planning for one’s death (John 19:26-27).

Discussing the possibility of dying – when not a preoccupation – is not morbid but prudential. As with one’s individual thoughts, conversations about death can help people focus on the present, cherish times together (whether long or short), and discuss issues of mutual importance and concern that often are ignored in the press of the urgent.

Death is too important to ignore. Yet that is what happens all too often, at great cost to society, to one dying, and to those left behind.

5 comments:

PMG said...

You might already be familiar with them, but the Sacred Dying Foundation is great for spiritual resources concerning how to die. Although they are officially non-denominational, it's very much rooted in the Episcopal church.

George Clifford said...

Here's the link to the Sacred Dying Foundation: http://www.sacreddying.org/

Ted said...

Oh my goodness. You have finally come over to the dark side. At least this is what people will think.
My family just went through this exercise with my brother. The doctors kept him alive in ICU for weeks playing doctor. They used multiple tests, procedures, and drugs to keep him going. To do some of the tests, they had to drug him to get his body capable of doing the test.
The doctors were more concerned with his cancer returning or his heart bypasses clogging up, which are good for only seven years, than letting him pass with dignity.
All the prayer in the world will not keep us from dying. It is only good medical ethics that can let a person and family go with quality of life and a bit of dignity.

George Clifford said...

Ted, I'm sorry to read what your brother endured. His story provides a prime example of why end of life directives are so important.

Andi said...

It is never easy to lose a loved one. I'd suggest the families to look into www.deathletters.org. The grieving process is a long and painful one but knowing someone is going through the same thing gets it a little less difficult.