Whether at Home or in Hospice, We Should be Able to Choose to Die
with Dignity
September 17, 2013
A hospital death means that many patients are virtually tortured during
their final days, as desperate attempts are made to prevent the
inevitable.
In the 15th century, a book called The Art of Dying was a bestseller.
Death was seen not as a failure of medicine, but as an entry into the
afterlife. Family and friends gathered around the dying person’s bed to
recite prayers and bolster his or her faith and hope.
Six hundred years later, strong religious belief is less common, so the
emphasis has shifted to hanging on to life for as long as possible, no
matter the expense, and heedless of the pain and indignity to the dying
person. The Mercury-News
reported
that “Seventy percent of healthcare expenditures are spent on the
elderly, 80 percent of that in the last month of life—and often for
aggressive, life-sustaining care that is futile.” As Katy Butler notes
in her new book Knocking on Heaven’s Door: The Path to a Better Way of
Death,
About a quarter of Medicare’s $550 billion annual budget pays for
medical treatment in the last year of life. Almost a third of Medicare
patients have surgery in their last year of life, and nearly one in five
in their last month of life.
If all that money were making things better for the dying person, it
might have some justification. But evidence suggests that the extreme
measures taken in the final months and weeks of life actually worsen
quality of life for both patients and caregivers. According to
an article in The New Yorker,
In 2008, the national Coping with Cancer project published a study
showing that terminally ill cancer patients who were put on a mechanical
ventilator, given electrical defibrillation or chest compressions, or
admitted, near death, to intensive care, had a substantially worse
quality of life in their last week than those who received no such
interventions. And, six months after their death, their caregivers were
three times as likely to suffer major depression.
Having a close-up view of this phenomenon,
most doctors say they would decline extreme interventions for
themselves if they had irreversible brain damage.
Japanese Buddhist mortician Shinmon Aoki has been washing and coffining
corpses for almost fifty years. In his
memoir he writes that in the 1960s, most people died at home, and
their bodies
looked like dried-up shells, the chrysalis from which the cicada had
fled. Along with the economic advances in our country, though, we no
longer see these corpses that look like dead trees. The corpses that
leave the hospital are all plumped up, both arms blackened painfully by
needle marks made at transfusion, some with catheters and tubes still
dangling. There’s nothing natural about the way they died, as the image
of dried leaves falling in autumn would impart.
Katy Butler wrote poignantly about how her mother
died under her own terms by refusing surgeries that were repeatedly
urged upon her. Yet when her mother was unconscious, it fell to her
daughter to beat back the doctors who were already preparing her for
open heart surgery. Not everyone has a feisty daughter to stand up for
them; those patients often simply go under the knife.
What can we do, while still strong and healthy, to make sure we won’t
spend our final days on earth being brutalized by the worst that modern
medicine has to give? An
advance directive doesn’t guarantee that your wishes will be
respected, but it’s a start, especially if you give it to someone with
the backbone to stand up to doctors and hospitals, many of whom are
focused on avoiding malpractice suits because they didn’t follow
standard procedure, no matter how lacking in common sense standard
procedure may be.
Many patients are reluctant to make the move to
a
hospice facility, believing that it may hasten death. But certain
kinds of patients
live longer in hospice than in the hospital, which is not
surprising. The hospice is not only more humane and caring—it often has
better food and does not subject patients to lights going on and off all
night long.
Palliative care
differs slightly from hospice in that it begins with a life-threatening
diagnosis, and not when death is in sight. The emphasis is on “caring,
not curing,” and encompasses emotional and spiritual concerns, the needs
of the family, and practical help in navigating the healthcare system.
Seventy percent of Americans
say they would prefer to die at home, but in fact 70% die in a
hospital or other institution, while only 25% die at home. If there are
sufficient resources,
dying at home all but ensures that no extreme measures will be taken
against your will. Most hospice patients die not at a hospice facility
but at home, with frequent visits from the hospice staff to help family
members give good care to their loved ones.
If we want to die with dignity, we should make our wishes known in
advance, and if possible in a legal document. It might also be a good
idea to append this article to the document, to clarify what we are
looking for.
Copyright © 2013 Alliance for Natural Health USA (ANH-USA).
http://www.anh-usa.org/die-with-dignity/
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