How Do You Want to Die?

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Has anyone—a family member, a friend, a pastor, a doctor—ever asked you this question? Have you ever initiated a conversation with someone else about what your wishes are for the end of your life, or what their wishes are for the end of theirs?

These are not comfortable conversations, and lots of people never have them. That’s a problem.

It’s a problem because what people want is too often not what they get.

When people are asked what they want for the end of their lives, most of them express a wish for a gentle death. They want to be at home, in the company of family and friends and familiar caregivers. They want to have access to skilled hospice and palliative care services. They want to have their pain controlled and their dignity preserved. They want their final months, days and hours filled, to whatever extent is possible, with experiences that are meaningful to them.

This is not how most people die. In early 21st-century America, most people do not leave this life gently.

In early 21st-century America, most people do not leave this life gently.

The sicker people get, the more aggressively they are treated. Every new health event brings a new intervention, or a slew of them: another hospitalization, another drug, another surgery, another test, another scan, another procedure, until finally the person is in intensive care, unconscious, bristling with tubes and wires, while in their last moments medical professionals break their ribs in an unsuccessful attempt at resuscitation.

Why does this happen? Why is it that, absent any intentional effort to do something different (and even sometimes in the face of strenuous attempts to do something different), this kind of medicalized violence is the default option?

One reason is our commitment to violent metaphors.

Images of violence and warfare dominate public and private language about illness and death. Richard Nixon declared “war on cancer” in 1971, and the language of warfare has since been extended to other illnesses and conditions: there is a war on obesity, a war on AIDS, a war on heart disease, a war on Alzheimer’s.

We no longer treat pain; we kill it, with drugs we call “painkillers.” Friends and family members say admiringly of an adult, a child, even a baby who is gravely ill, “She’s a fighter!” When someone dies, his obituary notes regretfully that he “lost his battle.”

When we frame human life as a battle that everyone is destined to lose, we simultaneously frame death as the final failure of medicine.

When we frame human life as a battle that everyone is destined to lose, we simultaneously frame death as the final failure of medicine.

And who wants to fail? “Successful” medical treatment, then, becomes treatment that never ends, even when the patient is dead.

This can get grotesque. One doctor recounts the story of when he decided to research what happened to patients in his hospital who were discovered in their beds without a heartbeat.

Hospital policy dictated that in such cases an all-out attempt at resuscitation be made—chest compressions, the placing of a breathing tube, administration of stimulant medications, the whole works (all of which typically result in serious injury, particularly in critically ill or elderly persons, who are obviously the patients most likely to experience cardiac arrest while in the hospital).

Upon reviewing the records of 50 patients who had been the objects of such resuscitation attempts, the doctor discovered that not one patient had survived to leave the hospital. He went to the board and said, “Can we stop doing this? It benefits no one.”

The board refused. The hospital continues to attempt the resuscitation of dead old people. They are not going to stop fighting death. Warfare is all they have.

Christians, at least, ought to have something else. Jesus offers us an alternative to war. He calls it peace. “Blessed are the peacemakers,” Jesus says, “for they will be called children of God.”

What might it look like if, instead of waging war on illness and death, we were to make peace with mortality?

Margaret Kim Peterson is Associate Professor of Theology and Psychology at Eastern University. She is the author of Sing Me to Heaven: The Story of a Marriage and Are You Waiting for “The One”? Cultivating Realistic, Positive Expectations for Christian Marriage.

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