On Dying Well

Death smiles at us all, all a man can do is smile back.” ~Marcus Aurelius

The first significant death in my life was that of Buddy, the gerbil, when I was five years old. He had lived for almost two years, which I gather is quite a long time for any gerbil to boast of (especially one whose primary caretakers were all under the age of six,) and we all knew for months that he had been creeping towards the inevitable clutch of death. Although I was sad to lose Buddy, the most memorable part of his death was the moment my parents told us the news. I remember the speech distinctly; my father told us that Buddy had “gone to gerbil heaven,” and my mother repeated that he had “passed on” to a “better place.” Even as a five-year-old, their deliberate dodging of the D-word seemed unnecessary. As I have grown older and experienced the death of others in my life, this shirking of a direct acknowledgement of death has continued to surprise me. After all, despite medical advances that mean we are living longer than ever, sooner or later all of us must die.

Roughly every half a second, someone, somewhere in the world dies, yet ours is an age in which death has become taboo. “For all but our most recent history death was an ever present possibility,” writes Atul Gawande, author of the bestseller Being Mortal. “It didn’t matter if you were 5 or 50. Every day was a roll of the dice.” But in our most recent history, things have changed, and drastically. While 70% of us would like to die at home, only 12% do so, leaving millions to die in hospitals, hospices, or care homes.

While hospitals are often seen as bastions of medical advances, for the elderly, they can be just the opposite. To begin with, there are very few medical professionals equipped in the care and treatment of the elderly, a field known as geriatrics. In America last year, less than 300 people received their degrees in geriatrics, a jaw-stretchingly small number compared to the millions of Americans over 85 who most need such care. What’s more, doctors and nurses often do not want to treat elderly patients. At their core, such patients are fundamentally unrewarding–no matter how excellent the care they receive, they will never truly recover. In fact, there is a very high possibility that they will die in the care of that doctor or nurse, an outcome that medical professionals dread above almost all else, and which they are not taught to deal with in medical school.

This fear of a patient dying on your watch, combined with a general unease in talking about death, can lead to what the brain surgeon Henry Marsh describes as a “folie à deux, where both doctor and patient cannot bear reality.” And this, in turn, can result in late-in-life treatments and operations that are painful, expensive and ultimately futile, when really the humane and sensible thing would be to allow a patient quietly to slip his moorings. It’s particularly bad here in America, where health care is profit-driven, and where hospitals and insurance companies can actually profit by extending someone’s life in order to charge them more in medical bills. However, throughout the world people struggle to die with dignity.

In many European countries, as well as in certain states in the U.S., doctor-assisted suicide has become legal in some form or another. Yet this solution, if it can be called such, does not sit well with many. There are consoling stories of assisted dying, such as that of Rietje Bakker-Vlessing, an elderly Dutch woman diagnosed with terminal cancer and given two months to live. A doctor administered two injections, one to put her to sleep in 10 seconds, and another to paralyze her heart within three minutes. She died smiling; surrounded by her friends, family, and those she loved. However, many are justly concerned that passing laws that legalize assisted dying would send a horrible message to those who are suffering or ill. Society would be telling these people that the proper response to suffering is to end their lives, instead of providing them with the support and resources that many of them need.

I cannot tell you how you can have a good death, so if that’s why you read this whole blog post I hope you are not too disappointed. This issue is painful and hard to address, yet we all must think about it eventually. There is nothing but gray area in this topic; it is a tangled, messy, and painful problem that exists in our world today. Yet, as we all must die, it is a problem worth tackling.

I thought, as I explored this issue tonight, of some words written by Oliver Sacks shortly before he died in August. “And now, weak, short of breath, my once firm muscles melted away by cancer,” he wrote, “I find my thoughts drifting to the Sabbath, the day of rest, the seventh day of the week, and perhaps the seventh day of one’s life as well, when one can feel that one’s work is done, and one may, in good conscience, rest.”