Pushing Up Daisies

GraveyardPushing up daisies. Taking the dirt nap. Meeting one’s maker. Kicking the bucket. Giving up the ghost. We have lots of creative ways of avoiding the real word, but at some point, all of us will do it.

I’m talking about death. When it happens to an older person, it’s generally more expected and accepted, especially if it’s the result of a long-term illness. But when it happens to an attractive, vivacious 29-year-old, and by her own hand, people sit up and take notice.

Brittany Maynard’s decision to end her own life on November 2nd refocused attention on the “death with dignity” debate that has been raging in this country since at least 1891, when ethical culturist Felix Adler argued that those in excruciating pain should have the right to end their own lives. In 1906, legislatures in both Iowa and Ohio introduced, but failed to pass, euthanasia bills. The debate erupted again on the national stage in 1990, when Dr. Jack Kevorkian helped Janet Adkins end her Alzheimer’s-afflicted life at age 54.

Currently in the U.S., four states (Oregon, Washington, Vermont and New Mexico) allow physicians to assist in the death of a terminally ill person by prescribing medication that is then self-administered. Montana does not prohibit physicians from aiding terminal patients. The New Jersey legislature will vote on an Aid in Dying bill today, and five other states are actively reviewing bills.

Here are some facts and figures about how we handle end-of-life health issues in this country. At least a quarter of Medicare’s $492 billion dollar 2013 budget was spent on treatment or procedures undertaken in the last year of a person’s life. One in three Medicare recipients have surgery during the last year of their lives; one in five do so in the last month. Despite the fact that survey after survey tell us that the vast majority of people would choose to die at home, only about one quarter of those that die do so in their own beds.

But facts and figures are never totally reliable. They can be manipulated according to the author’s prejudices. If you’d like to do some independent reading on the subject, you could look over the 507-page report issued this September by the Institute of Medicine entitled Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. In it, a 21-member panel of experts in the field proposes a model for advanced-care planning that would require overhauling and restructuring Medicare, Medicaid, and other health plans. More importantly, they recommend re-framing the way we look at end-of-life and suggest that education about palliative care and advance care planning are paramount.

Others have certainly beat them to the punch on this front. In 1959, the American Psychological Association held a major symposium about the psychology of dying. Elizabeth Kubler-Ross published her groundbreaking work, On Death and Dying, in 1969, proposing that there were five stages of grief related to the process of dying.

During the 1970s, Americans were introduced to the concepts of hospice and palliative care. In 1980, The Hemlock Society was established as an end-of-life care organization, helping those with incurable diseases. The 90s saw numerous legislative and judicial initiatives aimed at providing more (or in some cases, less) patient self-determination about accepting or refusing life-extending treatments.

Award-winning journalist Ellen Goodman started The Conversation Project in 2010 to encourage everyone, no matter the age, to have a frank and honest conversation about end-of-life wishes with the significant people in their lives. The Conversation Project’s website includes a starter kit that provides guidance for beginning and following through with talking to loved ones about this difficult subject. The site also gives people an opportunity to record their own personal story as method of personal validation as well as a resource for others struggling to articulate their own feelings about death and dying.

The ethical, religious and spiritual ramifications of intervening in the natural progression toward death will be discussed, debated and deliberated endlessly, and rightfully so. But there’s no denying that death is the most intensely personal experience of your entire life. How each of us handles this final passage is our last work on earth. We should have access to choices, assistance and support, no matter what our customs, beliefs or personal wishes involve.

Blog by Holly Deni