Legacy Matters
Most of us will be old and sick when we die and will have had years to tell our loved ones just what it is about dying that most frightens us and, in broad brush strokes, just how we hope to die. The trouble is, most of us aren't talking. The silence is another example of our ambivalence about death, our unwillingness to look it straight in the face even as we make noises about accepting it.
According to the National Hospice Foundation, one-quarter of American adults over 45 say they would be unwilling to talk to their parents about their parents' death -- even if their parents had been told they had less than six months to live. Half of all Americans said they were counting on friends and family members to carry out their wishes about how they wanted to die -- but 75 percent of them had never spelled out those wishes to anyone. A significant subset of that 75 percent had probably never even articulated their wishes to themselves.
As J. Donald Schumacher, president of the National Hospice and Palliative Care Organization, said last April to the Senate Committee on Health, Education, Labor and Pensions, ''Americans are more likely to talk to their children about safe sex and drugs than to their terminally ill parents about choices in care as they near life's final stages.''
From, Wlll We Ever Arrive at the Good Death? by Robin Henig in the August 7 New York Times Magazine.
Death has become a great taboo. As free as we have become in talking about sex - life's other great mystery - the more constricted we have become in speaking of death. The inability to talk about death makes a good death far harder to achieve.
While hospice has made great gains in the U.S - about one third or some 710,000 die in hospice - it comes too late with most patients dying within two or three weeks of entering hospice care. Even palliative medicine, the prevention and relief of suffering, particularly in terminal stages, comes too late. Instead, we expect hospitals to treat old age as a disease using every power, every treatment at their disposal.
Sharon Kaufman, a professor of medical anthropology at the University of California, San Francisco writes in her book, "And a Time to Die : How American Hospitals Shape the End of Life" that over the past 80 years the idea of a good death has morphed from one that gave the dying an opportunity to say farewell and to prepare to cross the threshold to the afterlife to one that is quick, unconscious or at least painless. More recently, the emphasis is on the individual patient's control of the style of death and 'good' mostly indicates a death that is 'aware, pain-free and in which psychological and worldly business is completed".
It's quite unlikely that such a death can take place in a hospital. But dying at home is not easy either.
Dying at home is not easy. Even though surveys indicate that about 70 percent of Americans say they want to die at home, few realize how grueling the work of dying can be. Almost everyone eventually needs care from either a paid assistant or, more often, a relative -- and the toll is enormous.
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To be continued
Posted by Jill Fallon at August 11, 2005 12:38 PM | Permalink