Why is it so hard to help people die?

“If the goal of medicine is to prevent death, then the entire enterprise is a complete and utter failure.”  Dr. Robert Taylor of the Ohio State Medical Center was speaking to us at the Newman Center on a Thursday in early December.  We had gathered to examine the question of why it’s so hard to help people die in America.  Dr. Taylor has spent his career examining the ethics and spirituality of palliative care, and has concluded that the goal of medicine isn’t to prevent death, but to relieve suffering.  He and his colleagues are re-thinking the ethical paradigm for providing medical care to the elderly in an aging world, and he graciously shared their discoveries with us.

People who are seeking a good death help their families prepare for their absence.  One of the frequent questions that patients ask Dr. Taylor is, “how much time do I have?”  In some cases, they are really asking him to try to extend their time on earth.  But in most cases they’re thinking through all of the things they’ll need to do to arrive at a good death.  One of the most important aspects of a good death is called “completion.”  It means a chance to thank those who have been important in our lives, to forgive those who have hurt us, to express love, and to ask for absolution.  People who are seeking a complete end to their lives are willing, in general, to cede medical decisions to their loved ones, because they care more about their loved ones’ well-being than their own autonomy.  Seeking completion is a way of helping those loved ones prepare for the dying person’s absence.

Ceding one’s autonomy can be very counter-cultural, especially among white middle-class people.  Dr. Taylor pointed out that being dependent on others is often the worst thing that white middle-class people can imagine.  Which made me realize that even a healthy person in mid-life, such as myself, can begin preparing for a good death by surrendering my self-reliance daily.  As I listened to Dr. Taylor, and thought about my own eventual death, I realized that I want it to be fearless.  I don’t want to cling to life because I think that I can somehow control it.  I also don’t want to fear death because of a sense that too many things have been left undone.  A good death, it seems to me, is a reflection of a good life.

Hospice is a unique cultural institution, one of the only American institutions that explicitly bless death in a culture that is youth-obsessed and death adverse.  Our faith-communities can sometimes do this, but with less consistency and intentionality.  What if we were to adopt the questions of hospice and ask them of our members?  Dr. Taylor gave us four questions to ask.  What is most important to you?  What gives your life meaning?  What is your greatest fear?  What is your greatest support?  These questions can be asked of anyone, at any time.  They are questions that help us understand our lives as we live them.  And because of that, they are questions that can help us understand, and accept, our deaths.

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