One in five Americans still die using emergency services, with more than 14% of these deaths occurring among patients 85 years and older. Although death is our only exit strategy in life, few of us are preparing for it. Ask any person how they want to die and they will have a definitive response, “quick and painless.” Yet despite this authoritative choice, we remain shy when planning to achieve such an exit–which is why many of us will end up in an emergency room to die.
A classic study conducted in Oregon—which has a state law for physician assisted suicide—found that twice the number of terminally ill hospice patients chooses to speed their deaths by refusing food and drink rather than by physician assisted suicide. Their nurses reported that these patients, who typically died within two weeks, died more serenely than those who chose other methods.
Planning for death might involve a number of formal decisions, such as advance directives, living wills, powers of attorney, and Do Not Resuscitate orders, and hospice. However these options remain under utilized. An analysis of a random sample of all U.S. deaths in 1986 found that about 10% of decedents had living wills. In addition, when they were completed, it is not uncommon to find that the attending clinical staff ignored them.
In addition, although hospice is an increasingly-accepted choice, often considered to be the “gold standard” of optimal end-of-life care, less than half of eligible patients utilize these services, and when they do, most start hospice too late. Hospice care is not just for the dying patient, but also for the family. Caregivers of the dying are twice as likely to have depressive symptoms as the dying themselves. This is why the hospice setting is more likely to be at home than at a hospital, and involves the family.
Communication is especially important. One of the ways to initiate an end of life discussion is to start with “Five Wishes.” This document meets the legal requirements for an advance directive in California and in 41 other states. Answers to the following questions will start the discussion of how you can die with dignity:
- The Person I Want to Make Care Decisions for Me When I Can’t;
- The Kind of Medical Treatment I Want or Don’t Want;
- How Comfortable I Want to Be;
- How I Want People to Treat Me;
- What I Want My Loved Ones to Know.
Dying quickly and painlessly means that we are willing to discuss these final details with those around us. This level of dignity implores us to communicate about our eventual death and to design a course of action that reflects our wishes and desires. This is a difficult and uncomfortable topic. But no one said that ageing is for sissies.