BOGUE: On dying well
We must make peace with death, even in the age of modern medicine
My grandfather died about three years ago. His last several weeks were spent in a hospital bed, hooked into gleaming machines, undergoing countless tests and treatments that ultimately proved useless in the face of death’s advance. Watching him go through this process was painful for me, even at a distance. For my mother, who tended to him for months, it was even worse. Despite the best efforts of his doctors, my grandfather was not destined to stay on this earth for much longer. And we couldn’t know that until it was all over.
Looking back, it is difficult to say we should have done anything differently. Fighting for Granddaddy’s life was both natural and humane, and I would not feel right if we didn’t expend our best energies supporting him as he struggled through his medical crises. But I couldn’t help thinking that, when all was said and done, we had reached the same outcome — death — with significantly more financial expense, heartache, and, most importantly, loss of dignity for my grandfather. He left this world after months of being manipulated by impersonal medical devices and potent medications that dulled his senses. His final sights and sounds and smells were not those of his cozy bedroom back in his home, but those of a sterilized hospital room that many before had shared. Had our relentless efforts to prolong his life, even for a few more days, stripped him of his capacity to die well?
Over the weekend, the Wall Street Journal published a poignant article, “The Ultimate End-of-Life Plan,” written by a daughter who had recently lost her elderly mother. What was remarkable about the story was the mother’s decision to refuse, several times, a potentially life-saving surgery because it carried with it a significant risk of stroke and debilitating mental illness. She refused to risk a death that stripped her of her dignity; she refused to subject herself to a gauntlet of treatments that would prolong her life only at the cost of stretching it thin. Instead, she prepared for her death. The article’s author states of her mother: “She died well because she was willing to die too soon rather than too late.”
While it is difficult, if not impossible, to draw some bright moral line from such stories — as every situation regarding life and death is intensely personal and contextualized — the point the article raises is important: in its obsession with prolonging life, the Western world may have lost its ability to grapple with and accept death. What was once viewed as inevitable and natural has increasingly become viewed as something that can be indefinitely put off with one more surgery, one more round of treatment, a few more days of multi-thousand dollar hospital stays.
I’m not saying we should welcome death with open arms, refusing any medicine or treatment altogether. I’m not here to demonize Western medicine or claim that the lifesaving technologies that have been invented in the past half-century aren’t extraordinary boons to the human race. But what I think what we must recognize is that with our armada of respirators and open-heart surgeries and newly minted drugs comes the false idea that death is something that can be indeterminately delayed. We may not think this consciously, but we act on it, especially when someone we love is facing death. Perhaps it’s not necessary to buy and consume the full menu of treatments, especially when one considers the indignities that often accompany them. Weighing these options is up to every family, but the stark reality is that there are simply not enough resources for every person to disregard cost when making such difficult decisions.
Indeed, the decisions we make at the end of our lives have tangible ramifications and costs. According to the Wall Street Journal article, a quarter of Medicare’s $550 billion budget is spent on end-of-life treatment. As our grandfathers, grandmothers, and eventually mothers and fathers pass away, we are often faced with a lineup of procedures and treatments, each one more expensive than the last. Often these costs prolong life only for a few more days or weeks. Now, should we refuse to take medicine because we have a cold? No. Should we start preparing for hospice care at the first sign of frailty? Of course not. But we should recognize that taking a “no holds barred” approach to end-of-life care means exerting a costly burden on our health care system, one that will eventually be shouldered by the millions of patients still depending on it.
Such decisions are ultimately up to the family and the patient to make. Normatively, no government decree should strictly ration health care simply because it becomes expensive to keep a dying person alive for a little while longer; moreover, carrying my argument too far risks treating those near the end of their lives without the full measure of respect and care they deserve. We should not make the mistake of denying treatment solely on the basis of cost. But I feel there has to be a healthy middle ground, where we grapple with the inevitability of death and make our peace with it, fully recognizing that coming to terms with our own and our family members’ mortality may mean declining to take every course of treatment available. In the end, coming to this conclusion may improve the currently bleak future for the health care system of the United States.
Russell Bogue is an Opinion columnist for The Cavalier Daily. His columns run Thursdays.