Friday, November 29, 2013

Dying Well

I just put my mom in hospice and felt moved to write this.

At some point, we start thinking more about dying. Perhaps it’s when you get a serious diagnosis or your last parent dies leaving you next on the conveyor belt. In my case, as a lifelong hypochondriac and catastrophizer, I’ve been thinking about it since I was a child, a half-century ago.

What might dying well look like?

I suppose it starts with living well. If we are aware of our mortality and that time is our most valuable possession, we’re more conscious how we spend each moment: Should we work more, less, or on something else? Spend more or less time with certain people?

It’s probably time to make a will or, to avoid probate, a trust. Even if you’re poor, to whom or what organization do you want to leave your assets? Yes, you might want to leave it all to your family but it may be worth asking yourself if a charity or another individual might make better use of the money? Would leaving a substantial sum to a family member encourage sloth or profligacy?

Your will/trust should include an advance medical directive. For example, when you have an irreversible disease and are in bad pain, do you want extraordinary measures to keep you alive, for example, when you no longer can swallow, intubating you so you can be fed with a feeding tube? Or would you prefer hospice, which provides comforting drugs and other palliatives to make the end of life more peaceful?

Your will should also name a person to make medical and financial decisions in case of your incapacity or death. Think hard about whom you’d most trust. It may or may not be your closest relative.

It may feel good for you to include in your will a letter to your family and friends, perhaps reminiscences, lessons learned, and suggestions for them.

Although we may know some people who are vigorous and sharp well into old age, most people do decline. Part of dying well is to forgive yourself when, for example, you forget things you would have remembered when younger. Easier said than done. No easier but also helpful is accepting that senescence is part of the natural order of things. 

As we get older, most of us become more set in our ways, resistant to change. But is there something new you want to do? Many people want to travel, but change can occur at home: a new hobby, volunteer activity, job, business, or attitude. Changing the latter may be tougher even than accepting aging. 

Some people choose to tell others about their health problems. Others keep them as private as possible. It may be an act of generosity to not burden people with your worries unless they can help and you want their help.

Then there’s the decision of when to fight the good fight and when to accept that the chances of winning are too small. As the song, The Gambler, says, “You gotta know when to hold ‘em, know when to fold ‘em.”  For example, should you keep fighting for your political beliefs? To rapproche with a relative? To stay alive?

We still don’t allow people to decide when to die. That strikes me as a terribly unfair intrusion of government into one of our most personal decisions. Fortunately, some physicians will give a terminally ill person a final cocktail of tranquilizers and sleeping pills. And if you can't access such a physician, a right-to-die group called the Final Exit Network makes available comfortable ways to go.

This article hasn't been fun to write but I hope it might help you or someone you love to die well.


Maria Lopez said...

One thing about death and aging is that most people have to deal with their own or a relative's decline eventually. My mother is severely disabled due to to Parkinson's disease. My father thinks she won't last much longer but if she does he will shortly no longer be able to care for her without help.

I have been haven't needed to care for her much due to the good work of my father and my brother but I've recently agreed to become more involved to give my dad a respite.

Some advice for you, don't assume that you will be willing and able to commit suicide before you face terminal decline and be sure you put a plan in place for your own care if you become incapacitated.

Michael said...

My uncle was terminal cancer with no health insurance. He took the shotgun and went out his way. I respect that.

I wonder if the old cowboy way of going with a bottle of whiskey, a cigar and 45 out in the back forty is the way to go...

ST said...

My dad just died, leaving me the next on the conveyer belt (my mother died a couple years ago, I'm the oldest sibling and male).

My dad suffered from mini-strokes (ischemia) for 8 years. It was basically a form of dementia, affecting his mobility (walking and strength) 8 years ago, to finally losing ability to swallow and basically starving to death in a way (he told the nurses he was hungry, while on his death bed). He went through the feeding tube and the IV for short periods, but it was just temporary. We and he decided against the feeding bag, because according to the doctors, it really wouldn't prolong life. So, I was at his bedside a lot in his final days (nursing home with visiting hospice). Eventually, his body stopped working (all he really could do was blink a little as it was) and his heart and lungs finally went out.
It's hard watching someone die (watched mom die, too with cancer). They were relatively young (76 and 79). You have to appreciate everything you can do at this point (like swallow), and try to do what make sense for you in life.

I hope your mom is comfortable (they said Dad was).

Anonymous said...

Hospice is a wonderful, comforting service. Peace be with you, Marty.

Maria Lopez said...

A future comment concerning cryonics. While I am skeptical of this for it to have the best chance of working you need to die in such a way that your body is infused with cyroprotective chemicals within a very few minutes after your heart stops.

Prolonged lack of oxygen turns brain cells to mush and assuming that your brain structures do contain the information that makes you yourself you want that structure to be preserved as well as possible.

I, myself, will have nothing to do with cryonics since I actually don't care much about what happens to me after I die once, but to each his own.


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