Professor Chris Palmer, School of Communication

“Don’t seek comfort; rather seek something to be passionate about.”

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  • A Good Death and How to Achieve It 

    Is it possible to create a good death? Or is someone simply lucky if he or she dies well? These are the fascinating questions Dr. Ira Byock, a professor at Dartmouth Medical School, raises in his important 1997 book, Dying Well: Peace and Possibilities at the End of Life.

    Both my parents have died (four years apart), and neither experienced what Byock would call a good death. None of us in the family—neither my parents, nor their three sons, nor their eleven grandchildren—experienced increased closeness, expressed much gratitude or affection, or offered much in the way of tender goodbyes. In retrospect, I fear that my parents felt lonely and frightened as they were dying.

    This sad experience has led me to think about whether it’s possible to prevent the kind of suffering my parents experienced—in short, to die better. Can someone create meaning and purpose out of the dying process?

    Byock says a good death includes expressing love (for example, saying I love you), accepting love, thanking loved ones, expressing appreciation, forgiving, apologizing, and saying goodbye.

    The goal is to find peace and satisfaction by completing and resolving the issues that deeply matter. Of course, there is no need to wait until the last year of your life to do these things.

    But let’s get real for a moment. Dying isn’t pretty. An implacable and ravaging illness can undermine your sense of who you are. Your very identity, what gives your life purpose and meaning, can wither and bring on feelings of profound despair.

    When deteriorating, you are no longer all those things—father or mother, husband or wife, nurturer, initiator, organizer, caregiver, resource, breadwinner—that once defined you as a person. You are no longer living as you did at your peak. All the “work” that used to give your life meaning has disappeared.

    In dying, you become a different person. The strong, independent, loving person you once were painfully fades away and the memories of you in peak health grow faint. You can no longer fulfill your responsibilities and in fact have become a burden to those you love. Sickness and senility leave you a far less appealing and attractive person.

    In the face of losing your responsibilities, roles, and abilities, is it still possible for you to have mastery in some sense as you weaken inexorably and slip towards death? How do you avoid feelings of helplessness, humiliation, fear, and despair? These are the issues that Byock’s book grapples with. He argues persuasively that a dying person and his or her family can take many steps to achieve a good death.

    One of them is not to let doctors do what they’ve been taught to do in medical school. Doctors are taught to give patients aggressive life-prolonging treatments and to keep them alive by whatever means possible. This makes no sense if the only thing accomplished is to delay death by a few days accompanied by intense pain, suffering, and even trauma (to say nothing of the incredible expense). What is the point of allowing a semi-conscious, terminally ill patient to linger? We don’t treat our dogs this inhumanely. Each of us has a right to choose a good death.

    Good deaths can also be prevented by failing to control pain, especially when it is agonizing and explosive. I’d rather be sedated than be in unbearable pain or have my family see me in such pain. I know there is a fine line between sedation for the treatment of extreme terminal pain and euthanasia. Byock points out in his book that the line between ensuring comfort and hastening death—between refusing unwanted medical intervention and euthanasia—is a fine one.

    For some, a good death means assisted suicide, but, says Byock, better efforts by doctors at relieving pain might make discussions of assisted suicide or euthanasia less necessary.

    A good death is fundamentally about a person experiencing something that has meaning and value. Is it possible to transform the experience of dying into a process which includes peace and serenity? The question may seem absurd when most of us associate dying with emotional anguish and extreme misery, exacerbated by the morbid prospect of annihilation and leaving projects unfinished. Still, it’s a question worth asking and Ira Byock provides a great service by provoking his readers to reflect on how it might be possible.

    This coming March, Dr. Byock will publish a new book called The Best Care Possible. I will be the first in line to buy it.

    Tags: , , dying, Ira Byock, old age, parents   

  • Thoughts on aging 

    I associate aging with deterioration, disease, and suffering. Loss of mental and physical agility is inevitable. The indignities of old age harass the elderly relentlessly. Moreover, old age is accompanied by a growing physical repulsiveness. Our physical features and bodies become repellent in various ways, exacerbated by frailty, despair, and pain. Chronic, debilitating illnesses force people into feeble, unproductive, and grouchy lives. I dread and fear old age. I’d rather die than suffer the ignominy and humiliation of senility.

    At least, that’s how I used to think. But recently my youngest daughter Jenny gave me for my 64th birthday John Robbins’ book Healthy at 100: How You Can Dramatically Increase Your Life Span And Your Health Span. Reading this inspiring and evidence-based book has given me new hope that it is possible to live a long life with vigor and vitality, and that aging can be a time of good health filled with purpose, meaning, exuberance, creativity, joy, love, learning, and laughter.

    In favor of his argument that old age can embody deep wisdom, profound joy, and vibrant good health, John Robbins marshals the evidence in favor of a plant-based diet, daily rigorous exercise, and strong, loving relationships so skillfully and fairly that it is hard to imagine how anyone could possibly refute it. It is amazing how wrong doctors have been in the past (for example, claiming that women doing strength training would endanger their ability to have children).

    One particular story fascinated me, and that was the story about runner Jim Fixx. He wrote books extolling the virtues of running, and when he died of a heart attack at age 52, everybody scoffed and said, “That just shows exercise and running won’t stop you from dying early from a heart attack.” Late night comics found in Fixx’s early death rich material for barbed humor aimed at health nuts like me. Jim Fixx’s death seemed to say that it was OK to be a sedentary couch potato.

    It was only in reading John Robbins book that I learned the full story. Apparently Jim Fixx did not eat wisely. He attached little value to good nutrition, and in fact criticized people who stressed how important it was. He ate fast food meals without enough vegetables and fruit. An autopsy revealed that three of his coronary arteries were more than 70 percent blocked, and one was 99 percent obstructed. Poor eating habits killed him, not running, which is not the impression the media gave in 1984 when he died.

    My goal is to never eat anything again with a mother or a face. If I eat like a vegan (as President Bill Clinton now does), keep exercising, and surround myself with a loving family and friends, I’m convinced that it is possible to be vigorous, purposeful, creative, and wise while also being in my 90s or even older. I don’t have to be ill, grumpy, irritable, and irrelevant.

    Tags: gerontology, John Robbins, old age, senility, vibrancy   

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