“I am not afraid of dying,” friend of mine said, “I just don’t want to be there when it happens.” It would be interesting if we could ask or pay someone else to do it for us, but I don’t really know how to approach this proposition .
Most people die in the hospital. For most, this is not necessary it just happens because of our collective inability to arrange to die at home. A good and decent death has three components no pain, no tubes, and no loneliness. When these three criteria are satisfied.
Death is rarely characterized by pain that is not manageable. I surveyed the terminal trajectories of the ninety seven patients in my practice who died in 1989. I analyzed their abilities to move, think, and toilet, and whether they had pain at the end of their lives. Only four did, and it was easily managed.
Tubes are a related issue. Modern medicine couldn’t get along without all the tubes at its disposal, but these should be very carefully used. Tubes are often extremely valuable for acute situations, but they almost never need to be used for long. It is hard to have a life of high quality when tubes are involved.
Loneliness as an accompaniment to death is a social issue that goes way beyond medicine. Someone said that “old age is a time of life spent among strangers.” If this sad commentary carries any truth, it is saddest at death.
The final leave taking most appropriately belongs at home, in the bosoms of those you love. If you can get it together and assure yourself that these three aspects of pain, tubes, and loneliness will not be yours to bear at the end of your life, then the issue of euthanasia pretty well evaporates. The broad public support of euthanasia results from the sense of dis empowerment associated with dying.
A vital way to maintain control over this final passage is the establishment of your wishes with your primary physician, and the reinforcement of a living will or durable power of attorney for health care. I do not want my death to be in someone else’s hands, and I intend to make sure that I call the shots. I hope you do, too.
All of us have a right to die, but we also have an equal responsibility to live. Once we have squeezed every drop of good living out of our lives, then the right to die may be asserted. However, insistence on the right to die when there is still abundant living possible diminishes that right.
So live well and fully, then die well.