Planning for Worse Than Taxes
It is hardly surprising that a society incapable of agreeing on when life officially begins cannot agree on when life can end. What’s dumbfounding after 30 years of disputed unpluggings, from Karen Ann Quinlan to the politically suspended passing of Terri Schiavo, is that enlightened Americans still prove largely incapable of drawing the obvious conclusion, taking responsibility for themselves and making advance preparations to shape their own ends.
We’ll all die. But in an age of increased longevity and medical advances, death can be suspended, sometimes indefinitely, and no longer slips in according to its own immutable timetable.
So, for both patients and their loved ones, real decisions are demanded: When do we stop doing all that we can do? When do we withhold which therapies and allow nature to take its course? When are we, through our own indecision and fears of mortality, allowing wondrous medical methods to perversely prolong the dying rather than the living?
These intensely personal and socially expensive decisions should not be left to governments, judges or legislators better attuned to highway funding. Yet that is precisely what’s happening this week and beyond because individuals abdicate responsibility for deciding and communicating, in advance, end-of-life values and decisions.
Schiavo left no word. What vibrant young woman or man contemplates death or, worse, suspended animation early in life? Yet that’s precisely the problem. Her relatives and others elsewhere are left to fight over their own inarticulate intuitions.
Our society is exposed to commercials for personal maladies from acid indigestion to flatulence to erectile dysfunction. Yet when a comfortable Grandpa tries to discuss his end of life at a family gathering, the relatives interrupt, “Oh, Gramps, you’ll outlive us all.”
A loved one is diagnosed with a serious illness. Those who gather around censor themselves, for fear of insensitivity or appearing defeatist, and fail to ask how the patient would like to be treated near the end. Doctors report that the healthy are the only uncomfortable ones, that advance discussions actually give the afflicted a sense of control and peace.
Creating advance instructions is relatively simple. (Times reporter Valerie Reitman provides details today on A13.) The process could still be much simpler. States have widely varying laws; a national standard would help. Driver’s license applicants already decide on donating organs in the event of calamity. Let’s hand out advance directive forms at the same time. If governments can require cyclists to wear helmets for fear of public medical liability, why not more vigorous official encouragement of advance guidance about much more expensive end-of-life medical care?
Instead of year-old magazines, doctors and dentists (even ministers giving premarital counseling) could dispense forms and actively encourage discussions with family and patients. In the absence of such preparations, it will be the doctors left to cope in a litigious society.
There is ample evidence that once confronted, most families can reach a reasoned if pained consensus on desired treatment. The American Hospital Assn. has estimated that 75% of hospital deaths are somehow negotiated. That is, once faced with bad news and unable to procrastinate, the family, doctor and patients, if possible, reach a quiet agreement. They decide a fluttering heart will be allowed to stop, pain medication will be administered even if it slows breathing dangerously. Pneumonia, once called “the old man’s friend” because it delivered a more peaceful passing than many underlying diseases, would be less aggressively treated.
About 50 years ago, cancer was the C-word, a death sentence barely whispered, as if patients were shamed for catching a then-largely incurable disease. The same for HIV/AIDS 20 years ago.
Through education, Americans have come to grips with new medical information and challenges, and now address them openly and behave differently. Think smoking, for example. With 6,696 Americans dying on the average day, the same shift ultimately must hold true for the subject of death and its preparation. Next to love and birth, it is the most normal of occurrences. If any self-centered generation should be interested in controlling its own destiny, wouldn’t that be the now-aging baby boomers?
These days, we’re planning and preparing for the other inevitable, paying taxes. We should do at least as much for something that otherwise threatens to leave loved ones not only in pain but forever adrift in ignorance, confusion and guilt. What an unfortunate inheritance.
