How Do You Want To Die?

by DavalosMcCormack on September 22, 2009

I am a sucker for those cartoons that show a man, up against a wall, in front of a firing squad, being asked if he has a final word or final request. They always seem to take place in some rundown ramshackle prison with the condemned man, unshaven and usually in rags, facing a firing squad dressed in shabby, ill-fitting and sweat stained uniforms, holding World War 2 era rifles. The officer in charge is standing next to the prisoner and, in one of my favorite versions , is offering him a last cigarette. The prison shakes his head and says “No thanks, I’m trying to give them up.”

I love the irony of someone about to die worried about doing something bad for his health.

I don’t know what country the prisoner is from but I’m pretty certain he’s not American. Most of us don’t give that much thought to how we are going to die! In fact most of us don’t really think about death at all, until we are forced to by the bad news about our own health or the health of someone we love.

By itself that’s no big deal, after all, who wants to think about their death. It’s never going to be high on anyone’s list of fun activities to do on a rainy afternoon. But by not thinking about it, and more importantly not preparing for it, we are leaving our leaving in the hands of others. Is that really what we want?

Ask most people and they’ll tell you quite emphatically that they don’t want to end up dying in an Intensive Care Unit, hooked up to all manner of machines, pumping liquids in, draining fluids out, helping keep their heart pumping, their blood flowing, while they remain drifting in and out of consciousness.

Yet when it comes to doing something to prevent that happening, most people do nothing. Which is a shame because there is something very simple that could help you avoid that.

All you have to do is sign an advance care directive, it makes it clear how much care you want, how intensive the intervention should be if you become seriously ill. In effect it allows you to plan ahead of time the instructions that will help guide your family and doctors on how to care for you. That can be just as important for them as it is for you, because it will help them understand and follow your wishes at a point when you may no longer be able to express them.

Research by the Center for Ethics and Humanities in the Life Sciences at Michigan State University shows that maybe just one in five people has an advance care directive. Not all of them are calling for no intervention either; on the contrary some expressly request everything possible be done to save them should anything happen.

The point is not to say that if you have a serious cold that they should pull the plug on you. The point is to think about what you would like, how you want to live, and how you want to die, and to then share that information with those closest to you and your doctor.

This is a topic that has come up a lot lately with health care reform making it’s troubled passage through the corridors of Congress. You may have seen the report from the Urban Institute, a Washington D.C.-based organization, showing that some 30 percent of all Medicare spending comes in the last year of a person’s life and that trimming that amount by just 5 percent could save the nation more than $90 billion over ten years.

That’s no small amount, even by U.S. government standards, and it’s certainly one reason why as a nation we need to think more about signing advance care directives.  But this is not about national policy, it’s about personal choice.

One vital element of a good life is a good death. When my dad died it was a long, drawn-out, lingering affair that was horrible for him and equally grim and draining for my family. His body was crumbling after 75 years of neglect and almost 65 years of smoking unfiltered cigarettes. Everything was failing except his heart, which kept beating, refusing to let him go, and the doctors and nurses worked hard to support that stubborn organ until after months of pain and struggle he finally slipped away.

I have no desire to go the same way.

Do you? If not, what are you going to do about it.

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