The end of life today
My grandmother had an advanced directive saying that she did not want life-saving measures. After falling, she was admitted to the hospital. That night, she had a heart attack and the doctors provided life-saving measures.
That same week, a once-vital octogenarian friend elected to have heart surgery that resulted in a stroke. Her advanced directive said that she wanted “no extraordinary [life-saving] measures” The hospital felt that a breathing machine and feeding tube were not extraordinary.
Resuscitating my grandmother was followed by three subsequent heart failures within a year. She never lived on her own again but was well aware of her sagging skin and sinking finances. Her still sharp mind witnessed the failure of her body. My friend regained just enough brain activity to acknowledge through blinking and nodding that she understood her condition. She had been a WWII pilot who lived independently until the day she went into the hospital. Both suffered a horrific ending to their active, spirited lives.
I am a man of faith who is also grateful for science. When it comes to death and dying, American society focuses too much on the latter and not enough on the former. I believe that we do not do enough to address an individual’s desire for a dignified end to life in the face of diminished capacity.
We are living longer, and life is being sustained regardless of its quality. The line between extraordinary and common procedures is less distinct. The legal profession cannot keep up with the changing landscape of medicine and life expectancy. Doctors are trained only to save lives and families are simply overwhelmed by the issues that must be addressed — in the lawyer’s office or the emergency room.
Currently, there is more infrastructure in place to manage the documentation than the discussion. In the end, it didn’t matter that both of these fine women had legal documents that expressed their wishes. In my grandmother’s case, the hospital said that they required their own forms to be signed and there wasn’t time to have that done. They were appalled that we would even ask about their decision.
I believe that end-of-life planning can bring dignity to death. We have seen this with the rise in hospice care for terminally ill patients, whom we consider to be morally positioned to give up the fight for life. This is ironic, given that there are significantly more medicines available today to manage the pain and suffering of diseases like cancer and AIDS than there are for old age.
I recognize that end-of-life issues are thorny. My friend had adult children with a variety of belief systems. They brought these with them to their mother’s bedside. The helpless final months for both of these women were beyond anything they ever wanted for themselves or their families. It simply didn’t matter what the documents said, or even that they existed. Once revived, it was beyond their conscious ability to let go. Both embodied, literally, the deep conflict at issue.