A good friend died recently, so I've been thinking a lot about the ultimate health concern — dying.
It is, of course, a hard thing to contemplate, which is why most of us, even physicians, shy away from it. Our reluctance to think about and discuss the inevitable — as individuals, as medical professionals and as a society — means many of us will miss the experience of "dying well".
Dying Well, written by Ira Byock, powerfully describes his experiences as a Montana hospice physician. He says the process of dying can lead to personal growth and fulfillment.
Without adequate medical care, dying can be horrible. With skillful medical care and attention to the personal experience of the patient and the person's family, dying can be made bearable. When the human dimension of dying is nurtured, for many the transition from life can become as profound, intimate and precious as the miracle of birth.
This is not just wishful thinking — these are words Byock backs up professionally every day as he cares for dying patients and their families. After caring for his dying father at home while in his medical training, Byock subsequently devoted his career to hospice care.
Many people jump from the concept of dying well to the concept of physician-assisted suicide. What Ira Byock and his colleagues do makes suicide as unreasonable for dying patients as it is for everyone else .
Byock says most people do not want to die in pain, do not want to die alone and do not want to lose their personal autonomy and dignity in death. All this can be accomplished with what we know now. If dying patients are cared for in a nurturing way, most can die at home, in peace with their families.
But this takes planning and resources. As Byock says,
...good deaths [are] not random events or matters of luck; they [can] be understood and...fostered.
Dollars that might be spent for intensive, yet futile, medical care in a hospital can be diverted to home care and hospice support. Our current health care system is poorly equipped to do this as it still favors reimbursing pointless end-of-life interventions for the dying, rather than nurturing care at home. Byock's book was published 12 years ago and we have made only a little progress with this universal health concern since he wrote Dying Well.
Few of us will get a chance to do this last event over. My mother-in-law did. In her early seventies, she had a massive hemorrhagic stroke and spent a few weeks in the hospital, mostly in an inhospitable intensive care unit. She made an improbable recovery and returned home to her usual life.
Two years later, this most rational of women was diagnosed with an inoperable brain tumor. In the time since her stroke, she had made clear to the closest family member that she wanted no intervention for a terminal condition if it exchanged quality of life for only a little longer life. A few months later, she died in peace, at home, just as she chose.
With recent and earlier losses in mind, my husband and I are updating our wills and medical directives. It is an odd experience to read one's will, but far easier to do when death is presumably distant rather than imminent. We are taking particular care with expressing our end-of-life wishes.
Whether one believes in an afterlife or not, dying is a major event, and if circumstances allow, we want some say in how it takes place.
Most of us want pretty much the same things when we inevitably die. Let's hope our health care system can adapt itself to those wishes.
