“…A time to die…”…but when? And how?

Baby Boomers are the first generation in human history to be able to rely on medical advances to prolong their lives considerably. They have, in effect, added on average more than a decade to the traditional, biblical ‘three score years and ten’ as a result of medical advances enabled by technology  – accelerating in particular since the start of the twenty-first century.

However, in the universe we inhabit, light and dark co-exist: one does not come without the other.

The shadow side of this striking gain in longevity is that death can now be put off for a considerable time, often resulting in – on average – eighteen years of deteriorating health with its attendant misery for the individuals involved, their families and friends. The economic realities of this are becoming more and more pressing. Western countries, on average, are dealing with a population as a whole who consume more in health care resources in their final six weeks than in the whole of their preceding lives.

Most of us can now quote several cases from personal experience or from hearsay, of individuals whose lives were painfully prolonged: by those individuals not having made their end of life wishes clear; by families’ general inability to communicate with one another regarding the painful and threatening question of the inevitability of death; and by the medical profession’s increasing focus on the technicalities of technology-expedited care, rather than the humanity, compassion and tough-minded realism required to enable people to have, as well as a good life,  a good death when the time comes that life has no quality left and there is only distress and suffering.

On the latter topic, I highly recommend surgeon  Atul Gawande’s wonderful book Being Mortal: Medicine and What Matters in the End”, currently topping the best-seller lists. Here, the author  tackles the hardest challenge of his profession: how medicine can not only improve life but  needs also to address the hard problem of how to assist the process of its inevitable ending: with greater humanity, care and wisdom than is all-too-often practised at the moment.

In the UK, as the assisted dying debate rages on, with around 75% of the population supposed to be in favour of some form of assisted dying being legalised, increasing numbers of people are choosing to take matters into their own hands. For example, at the end of July 2015, a healthy 75-year-old former nurse took her life at a Swiss suicide clinic after saying she could not bear growing old. Gill Pharaoh – who had specialised in nursing the elderly – said old age was not ‘fun’ and that she preferred euthanasia to becoming ‘an old lady hobbling up the road with a trolley’. Only this evening, I found in my email inbox the following from the UK’s Dignity in Dying campaign:

“Today, Bob Cole had an assisted death at Dignitas in Switzerland and his story has been covered by almost every major media outlet in the country, including a front page in The Sun newspaper.”

I would be most interested to know where my readers are on this crucial issue. My husband and I have completed Advance Directives, stating clearly in writing what our wishes are – and are not– regarding medical care at the end of our lives. To this we have added Power of Attorney documents which give added weight to our Advance Directives. The latter at present have legal force in England but not in Scotland.

I also persuaded our GP to obtain Do Not Resuscitate forms, normally kept in hospitals, which we have included, signed by him. Copies of all these are now with us, our GP and geographically closest next of kin.

All this, of course, may not be enough if either of us is painfully and terminally ill and palliative care,  which in theory should be fully available to everyone but regarding which anecdotal evidence –sadly– is building to show where such measures have failed or are inadequate. What would one, other, or both of us do then? I have to admit that, at present, I do not know the answer to that….I’ve also lived long enough to know that, often, you really can not know what you would do in a very tough situation until you are actually there….

Anne and Peggy

Anne and Peggy

A year or so ago, before my husband and I had sorted out what we would do in terms of advance wishes, I had a discussion on the topic of what one does at the end of life with my dear friend Peggy. In her mid eighties, she is still amazingly active, enjoys life, and continues to be a wonderful support to other people as well as a shining example to those of us coming behind her regarding how we should grow older. Peggy, of course refuses to be complimented – “Away with you!!’ is her usual retort.

I recorded our conversation, which is quite short, and have Peggy’s permission to share it. It has the usual mix of Peggy’s and my conversations: a rich mix of grave seriousness, black humour, and sheer irreverence. I hope to post this conversation next week, to continue the dialogue on the topic of how we face and deal with death and dying in the 21st Century.

In the meantime, do let me know what your thoughts are on this, one of the most important issues of our era.

**********

900 words copyright Anne Whitaker 2015
Licensed under Creative Commons – for conditions see Home Page

 

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18 responses to ““…A time to die…”…but when? And how?

  1. This is also a HOT topic in the US, with assisted suicide valid in a few states like Oregon. I for one am absolutely for it. The advances in medical technology have gone too far in extending a life that is terminal by diagnosis when the patient has no more quality of life, never mind the pain management issue. When I was in grad school I had to take an ethics course and our single grade was based on a 5 minute presentation. I presented myself as Hippocrates arguing in front of the Supreme Court on this issue pointing out that my oath of ‘first do no harm’ could also be applied to the concept that to extend life beyond a reasonable means for the patient and family– emotionally, physically and FINANCIALLY, was in fact, ‘doing harm’…much applause!

    Liked by 1 person

  2. I can’t conceive of taking my own life. And I must say, my reaction to that statement by the healthy 75 year old who didn’t want to deal with growing old, and who felt life wasn’t “fun” any more was deeply offensive to me.

    Now, the question is: why was it offensive? I’m not sure. That requires more thought.

    On the other hand, I have no desire to prolong life through an assortment of tubes, treatments, forced feeding, and so on. I need to get serious about finding someone who will take on the responsibility of carrying out my wishes. Having no family complicates this exponentially (or not, I suppose, depending on the family!)

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    • Yes, it does very much depend upon the family, in many situations…I have heard of more than one case where the person’s clear instruction eg not to be resuscitated, was overruled by family members – presumably because they did not want to let their loved one go. It is a grimly difficult issue, but one we are running out of time to face and deal with rationally and humanely before the demographic increase in longevity without much accompanying quality of life threatens to swamp us economically.My own view, cynical though it may be, is that eventually assisted dying legislation with appropriate safeguards will be passed in the UK, and probably in other western countries. However I think the driver of this will be increasing public pressure allied to economic necessity, rather than ethics…

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  3. Thank you for raising this issue. I feel it is one that is valuable and beneficial on a soul level to consider. My own position is that our attitude towards death must be examined even though it is the one thing we least want to think about and one of the most difficult issues to wrap the brain around. I believe that, at some point after death, we will get to objectively review our attitude towards our death and how it influenced the choices we made. Better to do that sooner rather than later.

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  4. Anne, kudos to you for raising this important conversation we all need to have with partners and/or family. We all wish for a quiet, peaceful passing however this seems to be rare at the end of life. Given my spiritual beliefs, at this time in my life at least, I cannot see myself choosing my own time of death, however like you said, the outcome can certainly change depending on the circumstances.

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  5. Well, Bev, I suppose because of our beliefs we both fear not our passing or what may lie beyond – but the manner of that passing. I have similar views to you, but know also that one cannot determine in advance of an imagined situation of extreme difficulty, what we would ACTUALLY do. All the more reason to live in the present, having made responsible provision to the point where it is feasible to do so!

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  6. I’m seventy and have a DNR. Easy to say while I’m still relatively healthy, but I believe in quality, not quantity.

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  7. Recently went through this with my father-in-law. No advance directives or even any talk about his death wishes resulted in every possible medical intervention. He was 87, frail, and suffering with dementia. He should have passed with the initial stroke, and when he coded, they brought him back only to die disoriented, swearing, and tied down a week later. I heard a doctor on a TV program recently say we need to do what is reasonable NOT what is possible. I want an advance directive (eventually) and my husband knows my preferences on quality of life. We really need to have these tough conversations in families before things happen.

    Liked by 1 person

    • Your being willing to share this family pain is appreciated, Ellis. Sadly, I have now heard too many stories like this and you are right. This topic is something we collectively need to face up to if people are to die with peace and dignity.

      Liked by 1 person

  8. Patricia Halliburton from Facebook, 15th August 2015…” I am whole heartedly in agreement with you, am not sure if Spain have the legal infra structure to assist with this, but am in the process of finding out……infinitely preferable to go with dignity…….”

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  9. Judith Earnshaw from Facebook, 15th August 2015…”So difficult to know. I am in my seventies, but my main problem is not being a burden. I am moving into an apartment where I can have care if I want but retain complete independence if I don’t. I spent about two decades caring for two parents until they died. The circumstances were such that though very tough it was also a privilege. I think now there are real choices. But interminable moral difficulties. My husband died long ago now…”

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  10. Thank you for your contribution , Judith, much appreciated. As you say, there are indeed interminable moral difficulties. But I think the time has come for us to have to face them…

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  11. This has been on the screen since you posted it, and I’m finally able to get back for a comment! I loved this post and suspected you’d get lots of comments.

    I think that decisions like that vary from individual to individual, and it’s not our place to judge what others want to do. Each case is unique and part of the growth and life story. As for me, I hope that I live to be ancient while still able to get around without aid and also have my senses/wits/mind/memory. I want to squeeze out every drop of my life and look forward to what’s ahead.

    It’s sad when one has health but has lost the memory. May we find ways to reverse or prevent these illnesses that rob people of their rights to live full lives.

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    • Many thanks, Lisa, for this thoughtful and compassionate response. You are certainly a person who is squeezing every drop out of her life – and bringing a great deal of beauty and inspiration to many of us in the process. Long may you flourish!

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