If one were to plot a person’s life on a number line, then death would be nothing more than an infinitesimally thin point, nothing more than a nanosecond demarcation from one state of being to another state of being. So why is it that some of us fight death with our last full measure while others embrace it like a new born baby? Have you thought of your death lately and asked yourself how your impressions of death were formed? Just how did you learn what you know about death? Perhaps you’ve felt conflicted in your views of death as I once did. In this two-part article I will briefly share what I believe to be the sources of that confusion: Religion, Medicine, Technology, Pharmaceuticals, Commercials, TV and Hollywood, social colloquialisms, and an absent education system.
The only clarity I’ve gotten on death has come from Webster and my own experiences. Webster describes death as a noun, “an act or fact [of dying]” while dying is described more as a process “to lose force or activity, become weak, faint, and unimportant, etc.” In the minds of many, death the noun and dying the transitive verb are often confused and used interchangeably, yet when people speak of their fear of death they primarily speak of agony and pain, which are characteristics associated with the dying process, not death the noun.
Most of the major religions discuss death but not dying. So religion may not lend much clarity, but it may help in the art of acceptance. Raised in the Christian tradition, as a child I became confused when I learned of death as “a wage or consequence”. Death was also naturalized by having a “sting”, and I so hated bee stings, avoiding them at all costs. So naturally, I learned to hate and avoid death. In the Holy Bible, death has many descriptions such as: “destroyer”, “thief”, and “robber” just to name a few of such ominous titles. Then, confusion was amplified when I was told that eternal life was gained for all, by the death of one. So, was death a bad thing that I should fight or a good thing that I should embrace? I didn’t know.
From a scientific perspective, there is little room for argument that we are an “anti-death” society. Quite possibly, we would be better served to live our lives as “anti-dying”– by making better lifestyle choices near the end of life. All we need to do is to view the statistics on dollars spent by Medicare. It is fortunate for acute care institutions that there are no Medicare spending figures to track the dollars spent on acute care procedures that would have been more effectively spent on hospice. What is documented is that in 2012 Medicare spent a total of $522 Billion on health care. Medicare dollars spent on aged persons was 77% of that total which calculates to $401 Billion, (MedPAC Report, 2013). In-patient hospital expenditures, for this population, according to MedPAC were 25% or $100 Billion (MedPAC Report, 2013, see below). In contrast, Medicare spending on hospice was 3% or about $13.8 Billion (MedPAC Report, 2013). Hospice spending grew from 2006 by only 1% while total Medicare spending grew from 2006 by 30%.
There can be no doubt of the unholy alliance of medicine, technology, and pharmaceuticals to wage relentless war, in a vain attempt to prevent the inevitable outcome of death. In my personal life, if my family or friends observed me spending every penny on an outcome that I could not change, they would label me ‘crazy’. Yet this alliance has convinced the masses that we should push out the inevitable as long as possible, at any cost.
Many life extending products and procedures which we have come to depend upon have come from this alliance such as: artificial organs, replacement procedures, wonder drugs, screening and testing technologies, chemical therapies, laser surgeries, and many more. I have been a benefactor of these modern wonders, and I have the video of my gall bladder operation (something that would have caused me to die at 36 years of age a century ago) to prove it. How sexy is that!? I’ve shown it at parties so my friend can know me “inside and out”.
Why do we spend so much treasure on extending life when the outcome is inevitably death, and so little treasure on ensuring patient-centered symptom management so that death arrives as pleasantly and painlessly as possible? In the U.S., it can be difficult to determine whether medicine serves the patient or the industry. Most U.S. medical school curricula focus on teaching our young doctors how to cure. Only recently have some medical schools required coursework on aging, managing pain, and palliative care as graduation requirement.
We may discover that the origins of our “fight” or “embrace” death mentality lie in a TV show, a favorite movie, or fun tradition. In a famous movie line (“Oh God!” with renowned comic George Burns) it was said, “Everybody wants eternal life but nobody wants to die to get it.” And who can forget the dashing Captain Kirk who on several post-trauma occasions told his medical officer Dr. “Bones” McCoy, “I didn’t beat death, I only cheated it,” as if death is a player at a poker table. Like the CSI series and many other shows where complicated crimes and medical situations, that normally lead to death, are solved with wizard-like technology and last minute heroics, (all in an hour or less) we have begun to have the same sexy Hollywood expectations of our real life health system. Huey Lewis sung about it in his 1980’s smash hit, “I Want A New Drug” to cure his lack of confidence when he’s with a new woman. Hey Huey, how about giving honesty a try! Honesty, now there’s an eternity pill for the taking. Honesty often is a bitter tasting medicine, but oh “how sweet it is”, as Jackie Gleason would say, when we finally know the truth! Billy Joel craves it in his song, “Honesty”.
So who do you think has more honesty: institutions and vendors making money from the avoidance of death, or your local Hospice who works tirelessly to help you and your loved one manage a good death experience? When it is your time, or your loved one’s time, will you cast your vote in the direction of money-laden-avoidance-institutions to counsel you on the best end (telling you about the latest and greatest “last shot”), or, will you cast your vote for the Hospices and other non-profits who’s goal it is to see you have a satisfactory and peaceful ending?
Medicare Payment Advisory Commission, Med PAC, 2013. June 2013. A Data Book, Health Care Spending and the Medicare Program. Internet: http://www.medpac.gov/documents/Jun13DataBookEntireReport.pdf
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