How To Die

I have stolen the title of this blog from an op-ed piece in the New York Times that deals with the contrast between the attitude toward dying in this country and the attitude in England. The piece focuses on the case of a man in the East of London who had been told he has a number of inoperable tumors and was subsequently taken off life-support at his own request and moved to a quiet room elsewhere in the hospital to spend his last moments with his family.

. . .  the hospital that treated him offers a protocol called the Liverpool Care Pathway for the Dying Patient, which was conceived in the 90s at a Liverpool cancer facility as a more humane alternative to the frantic end-of-life assault of desperate measures. “The Hippocratic oath just drives clinicians toward constantly treating the patient, right until the moment they die,” said Sir Thomas Hughes-Hallett, who was until recently the chief executive of the center where the protocol was designed. English doctors, he said, tell a joke about this imperative: “Why in Ireland do they put screws in coffins? To keep the doctors out.”

The article does give one pause. We don’t like to talk about death and we are committed as a culture to the notion that life in and of itself is of value. We don’t ask whether or not the quality of life may be the central issue, as it assuredly is, we simply insist that no one should have to die.

Further there is a great deal of talk about the “right to life” which tends to focus on an unborn fetus while at the same time tending to ignore the lives of those who have been accused of capital crimes they may not have committed. It also tends to side-step such issues as war and the population explosion which is already overwhelming a planet stressed out from massive and relentless exploitation. But we don’t talk about death or the right to death. We simply assume that prolonging human life is the highest of values. But why do we think this? What about other animal species? And when it comes to humans, why shouldn’t a person be allowed to die if and when he or she has determined that the pain is no longer tolerable, the doctors have done all they can, and the cost to their families will be prohibitive?

The editorial goes on to mention that end-of-life treatment in England was not without its critics but it also addresses the question whether the attitudes about death in this country are likely to change and whether we might take steps toward a more enlightened approach to the subject. The author thinks not and responds as follows:

The obvious reason, of course, is that advocates of such programs have been demonized. They have been criticized by the Catholic Church in the name of “life,” and vilified by Sarah Palin and Michele Bachmann in the pursuit of cheap political gain. “Anything that looks like an official protocol, or guideline — you’re going to get death-paneled,” said Dr. Ezekiel Emanuel, the bioethicist and expert on end-of-life care who has been a target of the rabble-rousers. . . . Humane end-of-life practices have quietly found their way into cancer treatment, but other specialties lag behind.

Though Mary Tyler Moore tried years ago to teach us how to laugh at death (when appropriate) it does seem that certain topics are taboo and that we shy away from asking pertinent questions and opening doors that might have important answers hidden behind them; we have knee-jerk reactions to certain topics and cultural biases that tie our hands and blind our eyes to unpleasantness. We simply don’t like to talk about death and dying even though they are facts of life.

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