Academic journal article The Hastings Center Report

Going to Meet Death: The Art of Dying in the Early Part of the Twenty-First Century

Academic journal article The Hastings Center Report

Going to Meet Death: The Art of Dying in the Early Part of the Twenty-First Century

Article excerpt

Up until recently, most people died quickly and too soon. Now, with many illnesses curable or held at bay, many die very slowly and too late--sometimes many years too late. It's time to rethink dying.

I have talked with many different groups about the end of life--health professionals, church and civic groups, ministers and chaplains, adult continuing education groups, AARP chapters, and college students. I talk a little about the traditional fear that death will come too soon. Then I ask, "How many of you are afraid that death will come too late for you?" The result is always the same: about half the audience members raise their hands. Obviously, this fear is widespread and close to the surface. (1) Subsequent discussion reveals that for many of them, too late is not restricted to conditions of chronic or terminal illness, but also can include situations where they are lucid and free of significant pain or illness, yet nevertheless believe they have reached a good time to die. This article is an attempt to give voice to their conviction that death may often be worth pursuing--a conviction that I share.

Our New Kind of Death

Historically, most people died in childbirth or war, of accidents or infectious diseases. These deaths were usually quick--a matter of a few hours or days between the onset of a terminal condition and the arrival of death, or at least delirious noncomprehension. They also almost always came too soon, before one had a chance to live a full life, raise a family, complete life-defining projects, or make the contribution one had hoped to make. And those who managed to avoid an early death did not have to contemplate the threat of being debilitated and bedridden for years. Old people who became bedridden usually developed pneumonia, the "old man's friend." Since pneumonia could not be treated, they died and were thereby delivered from the peril of a long period of debility at the end of life.

But we have killed the old man's friend. With better public health measures and the development of medical technology since World War II, we now find ourselves facing a very different kind of death. This new technology has given us better health and longer lives. But it has also given us more debility, dementia, and protracted chronic and terminal illnesses. (2) Joanne Lynn has said that the average American male now is debilitated for five years before he dies, and the average American female for eight years. These numbers will probably grow larger by the time we reach the end of our lives, as better preventive measures and treatments become available, making some illnesses chronic instead of terminal and lengthening the time that terminal illnesses take to end life. Unlike most people in earlier times, we now face the prospect of dying very slowly and at an advanced age.

None of this is news. It is what has been called the fourth stage of the epidemiologic transition. (3) But the differences between this new death and the death of former times are profound. When the sensible fear is that death will come too soon, the reasonable course is to flee it--try to postpone it or put it off. We know we cannot avoid dying, but we do what we can to avoid it for as long as possible.

However, many of us now worry that death will come too late--long after life has lost its usefulness and its savor, long after we have ceased to have a "life," perhaps long after we even are ourselves. When the more sensible fear is that death will come too late, the reasonable course is to make death come sooner--to seek it out. Learning how to go to meet death is, I believe, one of the basic tasks of our time. (4)

Most members of the generation that is dying now were caught offguard by this new kind of death. They had little or no firsthand experience of long, drawn-out deaths until they came to their own. My mother watched her mother die "a beautiful death" lasting only a few minutes. …

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