How do you want your life to end? An even more difficult question: how do you want the lives of your loved ones to end? An article in New York magazine, about a family’s struggle with their mother’s long, slow decline — and the related emotional and societal costs — raises those stark heartbreaking issues.
I think most people would like to go out like my grandfather did. He lived to be 99, kept his mental and physical health until the end, then had a stroke while eating breakfast and died later that day. No institutionalization. No dementia. No months or years of a twilight existence, apparently unaware of his surroundings, experiencing bedsores and diaper changes and incomprehension.
Of course, we don’t get to make stark choices between the ideal and the awful. Instead, families deal with impossible judgment calls. Should the frail 84-year-old woman with the bad hip endure the pain, or have an implant operation that could give her a pain-free existence — or produce a shock to the system that causes her to slide into an irreversible downward spiral? If an elderly relative decides not to undertake life-extending treatment, should the grief-stricken children try to argue him out of his decision? How should a family deal with an institutionalized Alzheimer’s victim in the bewildered, angry, unrecognizing end stages of mental decline and the guilt that comes from not wanting to see their relative in that terrible condition?
The author of the New York article yearns for a “death panel” — he calls it a “deliverance panel” — where family members could appeal for a relative’s death. There’s a reason why the concept of such panels provoked such opposition during the recent debate on health care reform, however. What modern Solomons would staff such panels? The doctors who want to sharpen their skills at an aggressive life-extending procedure and get paid for their efforts? The bureaucrat who sees his health care budget exploding and wants to rein in costs? The hospital administrator who thinks the room the patient occupies could be better used by someone receiving more care and treatment? The children who are heartsick about the potential loss, hoping for a miracle, guilt-ridden, exhausted, overwhelmed, and concerned about their inheritances, all at once?
There are no easy answers to these terrible issues. I think the appropriate first step is for everyone to make their own decisions about their own care, when they are still healthy and capable of doing so, and memorialize those decisions in some kind of binding way so that their surviving relatives aren’t saddled with impossible choices. Is the prospect of long-term institutional care and constant pain a source of unimaginable horror, or would you be willing to put up with it in order to meet your great-grandchildren? Only the individual can know how much of a deviation from the ideal end-of-days scenario they are willing to endure.