I just spent a glorious week disconnecting from my ordinary workaday world and escaped to paradise… northern Lake Kootenay in the Canadian Rockies. I was there with my wife and dear family friends staying in a gorgeous mountain home where our major decisions were whether we had wine and hors d’oeuvres before or after the bocce-ball game, or what garden greens to pick for that evening’s meal.
Along with the house came with three big dogs, including Maggie, a 20 year old Black Lab mix nearing the end of her life. She was virtually immobile, spent the day sleeping only getting up to eat, drink or relieve herself. She struggled to get up, moaning in obvious discomfort. Watching her, filled me with pain and I thought I would’ve put her down long ago, but the family said she was eating, drinking, surrounded by love, and they didn’t want to hasten her demise.
Seeing her every day made me reflect on what is a good death, and I think it’s dying at home surrounded by loving family. As a dog we could relieve Maggies’ suffering but that’s not an option for humans. We seem unable to end the current epidemic of unnecessary end-of-life suffering in people who are dying. Our technology allows us to subject people to unending tortures that may fend off death, but that do not restore health.
Let’s stop fighting for maximum longevity and start providing a good death for people; to live at home for as long as you can with pain managed, support, kindness, and surrounded by love; not a prolonged struggle in a hospital surrounded by doctors, nurses and machines.
How is that going to happen? We need less interventional care and more palliative care doctors, and we need to pay them more. Medicare pays meagerly for palliative care, but they will pay over $100,000 for open heart surgery on a patient who may be too fragile to survive it; they will pay an oncologist a 4.3% markup on drugs they administer (some costing more than $10,000 per dose) but they will not reimburse hospice without first requiring patients to forgo whatever other treatments they are currently on.
Finally, watching Maggie’s struggle, reminds me that all life is relational; stay connected to those you love in life and in death… leave an emotional legacy that includes witnessing death at home and dying with dignity.