The Cost of Dying

It’s a profoundly sad commentary on the “debate” about healthcare in the U.S. Congress that the pivotal issue of “end-of-life” medical care can no longer be discussed without invoking ridiculously offensive terminology such as “Death Panels” (thanks Sarah Palin!).

In this regard, last night’s edition of 60 Minutes featured a very incisive and sometimes disturbing piece on the subject, explaining why, as palliative care physician Dr. Ira Byock contends, many Americans are “dying badly” in the present system.

Could it be that profit, greed and fear of litigation, combined with a fundamentally irrational inability to confront mortality in a realistic way are behind so many people dying without dignity or comfort?

Note: Unfortunately, CBS hasn’t posted the complete episode on YouTube yet, but it can be watched here and the full transcript of the piece is available here.

p.s. Just to add a wry little footnote to this, what I found most provocative was Byock’s assertion about the delusional nature of a great many people when coming to grips with death, especially given that the overwhelming number of Americans claim to believe in “God” and existence in the Great Hereafter awaiting them following the magical teleportation of their spirit to the ethereal realm of Heaven or whatever… As such, their grimly determined reluctance of shake off this sinfully mortal coil would seem to indicate an alarming lack of the “faith” they’re so adamantly convinced of otherwise. Curious that.


16 Replies to “The Cost of Dying”

  1. Red – My mother died at 85+. We don’t know if she or had a massive stroke or heart attack. Towards the end of her life she believed in euthanasia, as she did not want to live more or less like a veggie, as her roommate did at 99. I’m so grateful she died quickly.

    I’ve gone through chemo twice, stage IV, but so far have beat the odds. When my time comes, I’d like to be able to take a ‘pill’ or a ‘needle’ and be done with it. We treat our pets far more humanely. I’m hording stuff, but worry I may not have enough energy to actually consume them when the time comes.

    I don’t give a shit about religion as I grew up with the hypocrisy of it.


  2. I’ve faced these issues many times during the past few years. I’ll summarize …

    Mom, alzheimers, age 82, 1996; Dad, cancer & stoke, age 89, 2003; father-in-law, Parkinsons, age 93, 2004; mother-in-law, conjestive heart failure, age 90 (3 days before 91st birthday), 2008.

    There is much stress, and, thankfully, by each that could express themselves, acceptance. Both my wife and I are only children – bit of pressure to deal with these alone. My mom-in-law’s case (the last) was most stressful at the end. She was in a nursing home (and, my wife is a nurse and constantly on their case to provide the minimum they were supposed to – although each home can be very different, and some really do a great job). Mom-in-law, her doctor and us believed it was time to “let go”. The “Director of Care” at the nursing home plain out said, “We do not practise euthanasia here!”. Holy sh!t!. How can such a person be “Director of Care” in a figgin’ nursing home?!

  3. BTW – Each was in a nursing home (“Longterm Care Facility”) for anywhere from 3 weeks to 2 1/2 years.

  4. I’ve already promised myself that when I cannot:

    1. Bathe myself
    2. Dress myself, and
    3. Feed myself

    I will slip surly bonds of Earth. The idea of spending my dying days being fed by and having my ass wiped by strangers sickens and frankly, frightens me more than the idea of dying.

    As such, their grimly determined reluctance of shake off this sinfully mortal coil would seem to indicate an alarming lack of the “faith” they’re so adamantly convinced of otherwise.

    I find that those types of people are usually afraid of dying most likely because they fear the punishment of their angry, vengeful God. Most likely they’ve done things they’re not proud of and figure they’ll burn in hell.

    Like a former co-worker who not only threw his teenage daughter out of the house upon learning that she was gay, but didn’t go to her funeral when the girl killed herself, citing religious conviction as a reason to shun his own flesh and blood. Not to mention putting his mother in an old folks home, liquidating her assets and buying himself a cottage.

    The man had a very minor stroke, but ended up in the hospital. When I went to see him, he was in tears telling me how he was afraid of dying alone. I asked him how he thinks his kid felt. He clasped his hands to his face and said, “Oh God!” He knows he’s going to hell.

    I’m an agnostic and fear not the after life. In fact, I view it as a challenge–I’ll challenge my maker to a bunkhouse brawl with a best two out of three falls. From what I know about God, he’s an old codger with a long white beard. I’ll wipe the mat with him.

  5. Penny — I can relate. My mother died a few years ago at the age of 82. It was quite sudden (about a month or so from onset of acute pain to terminal expiration). I’m glad it wasn’t a protracted affair. She was admirably stoic to the end and eschewed any care that may conceivably have prolonged her life somewhat.

    I think it was liver cancer that did her in, but can’t be sure as she was reluctant to pointlessly impose on the system or bother the doctors at the local clinic in order to find out definitively. Seriously. That was the kind of person she was.

    She died with dignity and I would say, kind of heroically insofar as confronting death with an absolutely fearless sense of contentment and persistent sense of wry humour about the whole ordeal. Her utterly contemptuous refusal of the last rights still makes me laugh…

    My Dad… not so much. Possessed of “magical thinking” he irrationally hoarded material things with a compulsive passion towards the end. Why, I have no idea. Perhaps it stoked his fantasy of living indefinitely in some fantasy dreamworld of blissful retirement. Alas, at the age of 74, the old fellow succumbed to lung cancer that rapidly metastasized to his brain, robbing him of all cogent sentience at the end — resulting in his mistress scamming all of his estate. A sad wind-up to a life gone wrong.

    I blathering… Sorry.

  6. Paul — I’ll challenge my maker to a bunkhouse brawl with a best two out of three falls.

    That’s brilliant.

    As an atheistic existentialist I’ve no fear of the after-life, but that doesn’t mean I necessarily welcome the void… at least, not just yet. But when the appropriate time comes, I’ll be quite happy to slip the surly bonds of Earth without trepidation. In the meantime, each day is a joy of sorts — just as it should be.

  7. Only weeks before my husband died (of Alzheimer’s), at a time when I was well aware of everything that was coming at us and all the options, a young resident scared me by suddenly describing the (to me) heroic measures he simply assumed were to be taken next. He looked shocked when I interrupted him and said, “No. You’re not doing anything without consulting me. And I’m not agreeing to that.” I knew that I had that authority, and yet I felt shaken enough by his arrogance that I spent the next several hours talking to nurses on the floor and searching out his superior, just to make sure that no one did anything stupid without telling me.

    My guy never had a chance to say exactly what he would and would not have wanted among the things that happened to him, were done to him, in the last few years of his life. I responded to the life that was there, partly because I had no better theory to run on but more because the life really was still there, still responding to me. If you’re close enough, I think you just know what’s going to nurture or comfort and what is not.

    I would fear laws or bureaucracies that leapt one way or the other. If each of us, as we die, had someone truly close who could read us, we wouldn’t need those. Unfortunately, most of us don’t have that person at the end. There are workers in the healthcare system — some doctors, some nurses, some careworkers — who have the right antennae, but we’re damned lucky if we meet some of those.

    We are lonelier than we should be. Partners are lucky — at least the one who goes first is. But the rest of us are lonelier than we should be as we age.

    And now I’m blathering too.

  8. I had a neighbour with an aging mother. She,the mother,at age 102 was sharp as a whip but her body was giving up on her. Each morning when she awakened to find herself still alive she raged in disappointment.
    I found that I got some comfort from her rage at being alive.
    The daughter died of a heart attack while her mother was still alive.The mother shortly after. No one ever mentioned God.

  9. As such, their grimly determined reluctance of shake off this sinfully mortal coil would seem to indicate an alarming lack of the “faith” they’re so adamantly convinced of otherwise. Curious that.

    Curious indeed … I suppose the biological drive to live outweights “faith”?

    Hmmm … 😉

  10. Skdadl — That was very touching. I would like to think that a lifetime of intimate experience with another person would give one an intuitive understanding of what they would have wished for at the end of their brief sojourn here on planet Earth. Even so, it seems that dying is a rather lonely and solitary affair — indeed, that may be most intimidating aspect of things prior to confronting the bleak prospect of non-existence

  11. Mentarch — Indeed, but why is the biological imperative for perseverance apparently so much stronger in those with supernatural pretenses to the certainty of a mystical afterlife that, logic would seem to dictate, should be more than glad to cast off this grubby mortal coil and hurry off to their great reward? Unless of course, they’re full of shit… That’s always a possibility, I suppose.

  12. I suspect that many “conservative” Christians find death abhorrent because of the outrageous lack of private, for-profit afterlife options.

    Frankly, it’s scandalous that we’re forced to give our souls over to an anonymous, unaccountable (and downright invisible) bureaucracy of angelic commissars whose sole legitimacy flows from the fiat of a largely unreadable volume of socialistic fables compiled by a cabal of dead European élites.

    It’s especially vexing when–at this time of genocide, pandemic and perpetual low-level conflict–end-of-life output is being nurtured through unprecedented levels of global investment. Why should the afterlife sector remain shielded from the discipline of the free market? Why deny it the growth and diversification that would inevitably accrue to it through partnerships with North America’s dynamic, visionary investor class?

    Once we get Yahweh to sign onto NAFTA, our “conservative” friends will be much happier to die…

  13. The “afterlife sector”… LOL

    I love it. “Marketing in the Great Beyond” (a treatise on post-existential commercialization and the manner in which free-market principles operate in absentia of material considerations).

  14. I’ve had this conversation with more than a few doctors and they hate the thought of prolonging life with horrible treatments. They are the last ones who want to do it. And they themselves? Would almost to a person agree to euthanasia for dying and terminally ill patients instead of watching them drown in their own tissues or being required to resuscitate someone half dead.

    The problem lies in a couple of areas. The criminal code doesn’t allow them to take any overt action that would cause death, or they could be prosecuted for murder. There is no exception for medical personnel who are acting on a patient’s wishes even when they are expressly written up in a DNR, or living will. Families often disagree about what kind of care should be given and if Grandma has signed a DNR but the family is ordering the Doc to “save” her, the Doctor is in a terrible position. He can’t risk jail time or losing his license, and sometimes there are only seconds. If the patient is alone, or doesn’t have a living will, they have to resuscitate or else.

    Another issue is that most living wills are very poorly written and do not take into account the myriad of possibilities that can occur. When my heart rate briefly disappeared and I was bleeding out during my son’s delivery last year, I definitely wanted to be resuscitated and given transfusions, but if I had become oxygen deprived and brain damaged? No way. The difference in those two states is ten minutes, sometimes 6. Sometimes only a minute. A living will has to cover that. But if someone could use my organs, I would want to be on a ventilator long enough for them to be taken, to save another person’s life. So that has to be written in.

    And yet often it’s not. So many Doctors feel like they have no choice, and every time anyone talks about the criminal code amendments to just allow less aggressive treatment and require Docs to follow living wills—the uninformed freak out and start yelling about Death Panels, blah blah blah.

    It’s the irony of Pope John Paul II’s death that gets me the most. Catholic doctrine allows people to refuse medical treatment, and have as much morphine and ativan, etc. as they need in hospice care, and at the end, he refused food, IVs, and antibiotics for his UTI and septicemia, said goodbye and drifted off in a haze. Yet most laypeople think they have to stay on a vent, as vegetables. The media portrayals are so inaccurate.

  15. Aurelia — It’s no secret that there’s a tacit form of euthanasia that goes on in hospitals, at least here in Canada. Doctors aren’t nearly as aggressive in prolonging life beyond all reason as frequently seems to be the case south of the border. Quite often they simply allow nature to take its course and do what they can to alleviate the pain in the meantime.

    Perhaps it would be a good thing to have this sort of behaviour codified in law, but then again, maybe its best that we just carry on with the present nebulous arrangement of unwritten behaviour that’s decided on an individual basis — quite uniquely Canadian when you think about it (similarly, look at how we handle abortion).

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s