This article hit home for me. In 2009, me and one of my brothers ran alternate shifts schlepping our 82 year old dad to and from hospital, doctor, nursing home, home, hospital - believing to the very end that at some point somebody would tell us what we needed to know, that he was not getting better and was nearing the end.... in January he had had a little breathing trouble, by September he was dead. And in between, he was ambulatory, lucid, constipated, hungry, in pain, not hungry, smoking outside, and, up to the night he died, not aware that the infection he picked up during his first January visit was not fixable. He was getting all this "treatment" and he had a "care team." So the night Dad died, in ICU where they had moved him, neither my brother nor I were there. When I finally saw my dad, dead in the ICU bed, the grimace on his cold lifeless face said everything the doctors never had. No family should be put through that. When my mom started to fail in 2014, I made sure I was in control, and she passed in her own bed at home.
53
"Palliative care" is actually a euphemism for euthanasia, usually sought for economic reasons, whether people like this writer want to admit it or not. The writer probably is really pushing for legislation that would give hospitals the right to over ride both family and patient wishes, and just "pull the plug" when a patient becomes too costly for the hospital. I notice NYT never reported on or commented on this recent breakthrough in understanding of comatose patients: http://www.thedailybeast.com/articles/2017/01/31/computer-lets-fully-par.... It turns out some of those helpless human beings often referred to as "vegetables" DO have feelings and consciousness after all. How many of these human beings were killed off because they inconvenienced some hospital or hospice?
18
In regards to all teachings about ''life'', we must exclude the religious aspects.
We must, as parents take control of what we ''program'' into the little minds of our children. We must teach them the hard facts about science and biology.
We must be straightforward about how and where we come from, and when that last breath is taken, where do we go. ( the physical ) We become worm food. Simple.
As to everything in between, knowledge is power. Empower your children. Tell them ( at an appropriate age ) about the penis and the vagina, and not the birds and the bees. Tell them about everything life entails and that it includes death at the end.
Tell them that if they take care of themselves, both mentally and emotionally and more important; physically, that that ending can be prolonged.
It costs us all much less in the long run.
We must, as parents take control of what we ''program'' into the little minds of our children. We must teach them the hard facts about science and biology.
We must be straightforward about how and where we come from, and when that last breath is taken, where do we go. ( the physical ) We become worm food. Simple.
As to everything in between, knowledge is power. Empower your children. Tell them ( at an appropriate age ) about the penis and the vagina, and not the birds and the bees. Tell them about everything life entails and that it includes death at the end.
Tell them that if they take care of themselves, both mentally and emotionally and more important; physically, that that ending can be prolonged.
It costs us all much less in the long run.
12
"A third said he was looking forward to playing “Go Wish” with his grandfather, who recently had a health scare."
Is this supposed to demonstrate the value of your course? How sad that a young boy would reorient his grandfather to choices about dying, rather than celebrating his life after a health scare. (Indeed, the use of the word "scare" implies that Grandpa was not yet feeling "ready" for the end). How much better to act on a renewed appreciation of this grandparent by asking about family history, playing Scrabble together, or learning a new skill from his elder. Ageism is rampant enough without reinforcing the notion to 13 year olds that their older relatives should be thinking about dying rather than celebrating the lives they have lived so far and savoring the time they have left. In my work with geriatric patients, I find that those who are psychologically aging well are fully focused on the present -- not the irretrievable past, nor the uncertain future. While certainly planning their affairs, thinking about death is not a regular--nor welcome-- part of their day. And neither should it be for a teenager. Among the wonderful things about being young are those feelings of immortality, complete with infinite possibilities and an endless future. Why rob them of it? In due time, life itself will gradually acquaint them with death, and bring a view of it that will be unique to them as individuals -- and undoubtedly different from the spiel of an M.D. back in 7th grade.
Is this supposed to demonstrate the value of your course? How sad that a young boy would reorient his grandfather to choices about dying, rather than celebrating his life after a health scare. (Indeed, the use of the word "scare" implies that Grandpa was not yet feeling "ready" for the end). How much better to act on a renewed appreciation of this grandparent by asking about family history, playing Scrabble together, or learning a new skill from his elder. Ageism is rampant enough without reinforcing the notion to 13 year olds that their older relatives should be thinking about dying rather than celebrating the lives they have lived so far and savoring the time they have left. In my work with geriatric patients, I find that those who are psychologically aging well are fully focused on the present -- not the irretrievable past, nor the uncertain future. While certainly planning their affairs, thinking about death is not a regular--nor welcome-- part of their day. And neither should it be for a teenager. Among the wonderful things about being young are those feelings of immortality, complete with infinite possibilities and an endless future. Why rob them of it? In due time, life itself will gradually acquaint them with death, and bring a view of it that will be unique to them as individuals -- and undoubtedly different from the spiel of an M.D. back in 7th grade.
17
Thanks for this great article. For years (I'm 86) I have been puzzled by the fact that we spend much time and attention on teaching children how to grow up; but we spend little or no time or attention on teaching adults how to grow "down," i.e., old. How to prepare for and plan one's own death seems to me of crucial importance. I sympathize with "Roger" in Michigan who says it's unhealthy to bury the fact of death in euphemisms.
"To pass" is listed in the dictionary as North American euphemism for "to die".
My own father always used to say you could pass water, pass wind (gas), pass "GO" or pass another person in the street, but you couldn't pass death no matter how smart you thought you were. Thanks again to Jessica Zitter and thanks to the Times for publishing her article.
"To pass" is listed in the dictionary as North American euphemism for "to die".
My own father always used to say you could pass water, pass wind (gas), pass "GO" or pass another person in the street, but you couldn't pass death no matter how smart you thought you were. Thanks again to Jessica Zitter and thanks to the Times for publishing her article.
39
" For example, 80 percent of Americans would prefer to die at home, but only 20 percent achieve that wish."
Very sad but why is that? Is it because the patients did not make an advanced directive ( living will) or the treating physician, nurses and the family members ignored those preferences and opted for drastic futile measures misinterpreting what the dying person really wanted? This may be more to do with culture, religion and guilt feelings. Educating youngsters in schools about death is not going to help much nor sole the problem. This is a complex issue, not appropriate for school kids
" Too many of our patients die in overmedicalized conditions, where treatments and technologies are used by default, even when they are unlikely to help"
That clearly shows that the problem lies with the medical community. You cannot blame the patients because by the time patients are approaching the end, they are often too weak or disabled to express their preferences, if those preferences were ever considered at all. The fault lies either with family members or the medical community. It is a fact that doctors and hospital make a tremendous amount of money of the dying patients and they are not going to allow patients die easily, they will quote the malpractice risks if they do not do everything possible.
Very sad but why is that? Is it because the patients did not make an advanced directive ( living will) or the treating physician, nurses and the family members ignored those preferences and opted for drastic futile measures misinterpreting what the dying person really wanted? This may be more to do with culture, religion and guilt feelings. Educating youngsters in schools about death is not going to help much nor sole the problem. This is a complex issue, not appropriate for school kids
" Too many of our patients die in overmedicalized conditions, where treatments and technologies are used by default, even when they are unlikely to help"
That clearly shows that the problem lies with the medical community. You cannot blame the patients because by the time patients are approaching the end, they are often too weak or disabled to express their preferences, if those preferences were ever considered at all. The fault lies either with family members or the medical community. It is a fact that doctors and hospital make a tremendous amount of money of the dying patients and they are not going to allow patients die easily, they will quote the malpractice risks if they do not do everything possible.
8
I work as a social worker in an intensive care unit where end of life is constantly being faced. Families and patients are being done a disservice by doctors either afraid of lawsuits or their greed, and the lack of knowledge and education about what the future will be for that poor person we call the patient. Mostly the choice is between a less painful fast death, or a slow and mainly death in the nursing home where infection finally kills the patient.
If we want to save the healthcare system this is the place to start where high dollars and poor outcomes are found.
If we want to save the healthcare system this is the place to start where high dollars and poor outcomes are found.
14
By ten their favorite pet may have already died. I think perhaps our own anxiety about death wants to protect and by protecting we keep reality away. There's obviously ways to discuss it depending on age.
Remember where the name living room comes from and also not that long ago the family preparer the body at death.
I high recommend "living old" to observe the real outcomes of prolonging life and "the undertaking" which is one of the best documentaries on death I've ever seen. Not for ten year old maybe....but worth seeing.
Remember where the name living room comes from and also not that long ago the family preparer the body at death.
I high recommend "living old" to observe the real outcomes of prolonging life and "the undertaking" which is one of the best documentaries on death I've ever seen. Not for ten year old maybe....but worth seeing.
3
I was not spared from death or life in my well educated family and the period I lived in. Children visited the sick i went to Cemetery every week to visit my father's grave till I left my country. Wakes and burials were no strangers. Then anyone died a great grand aunt or 6 year old playmate or my father or my grandmother some were saved and some were not especially those with heart ailments back then without the resources of today.
The risk is too quickly not to save. The cruelty of poorly financed so called hospices and a mentality that the sick should die. Especially the old.To continue to inculcate this mentality without balance is not wise.
Because here in Florida we are seeing terrible things. And one suspects that in some cases people who could be saved die. Yes no one should suffer unnecessarily but no one who can live should not be given a chance.
Who would not pray for a peaceful death. But the NY Times articles about the end is I suspect to instill the idea that most of the old or the very sick should die and cost less. Hospice is one thing a blessing but not frankly when abused by companies. Your mission is a blessing but that is not how it is being applied . it is a,racket As any clinic gives services and people I'll are farmed to indelibly awful hospices.
The risk is too quickly not to save. The cruelty of poorly financed so called hospices and a mentality that the sick should die. Especially the old.To continue to inculcate this mentality without balance is not wise.
Because here in Florida we are seeing terrible things. And one suspects that in some cases people who could be saved die. Yes no one should suffer unnecessarily but no one who can live should not be given a chance.
Who would not pray for a peaceful death. But the NY Times articles about the end is I suspect to instill the idea that most of the old or the very sick should die and cost less. Hospice is one thing a blessing but not frankly when abused by companies. Your mission is a blessing but that is not how it is being applied . it is a,racket As any clinic gives services and people I'll are farmed to indelibly awful hospices.
6
Molly, remember at least you can do it with your grandkids... Who better?
Yes, very prescient. We must teach doctors too. Atul Gawande's book is excellent on this and I am sure there are others. MDs bring their family values and beliefs about death to practice. And they like all of us merit learning more about facing death, especially our own.
5
If death ed is as effective as sex ed, heaven help us all. I'm not sure where you pulled your statistics about "declining" sexually transmitted disease and unwanted pregnancy rates correlating with sex ed.
Finally, the embarrassment you caused your daughter really doesn't play as nicely as you think that it does.
Finally, the embarrassment you caused your daughter really doesn't play as nicely as you think that it does.
3
Sad, very sad. So many suffer through the anxiety others have about death. It's clear we need this conversation at all kinds of levels.
3
Very interesting article. Yesterday I saw a film called "Jamie Marks is Dead" which depicted our clumsy American classification of grief and grieving as a psychiatric dysfunction. The connection between death and grief would appear to be as important a chapter in courses on Death Ed as the connection between sex and love. But I'm not really sure whether Sex Ed handles its connection well, either. Would like to hear more about that.
3
I am 69 and until last year I had never witnessed the last of the end stages of life. This was in an Asian country, I will not say which in order to avoid introducing prejudice. Grandfather had all-systems failure and the process went on in hospital for many months. Traditional practices and ignorance of about death processes meant that even the man's closest relatives prevented them from touching him except for washing and feeding. he could talk, but the look in his eyes said, "please release me, let me go."
Every day, his 11yo grandson and I held his hand and gave him the warmth of our eyes. His smiles were reserved for his grandson; clearly he felt delight when he saw the young man. My son now has the the experience of seeing the death process first hand, and when I end up in the same position of grand-dad, my son (and wife) will know what to do.
The experience was enough for me to begin preparing the legal process to ensure that my life is not unnecessarily prolonged by a few days when I am in desperate need to fade away, without pain, but naturally.
Every day, his 11yo grandson and I held his hand and gave him the warmth of our eyes. His smiles were reserved for his grandson; clearly he felt delight when he saw the young man. My son now has the the experience of seeing the death process first hand, and when I end up in the same position of grand-dad, my son (and wife) will know what to do.
The experience was enough for me to begin preparing the legal process to ensure that my life is not unnecessarily prolonged by a few days when I am in desperate need to fade away, without pain, but naturally.
12
I would find it infinitely easier to talk about long drawn out deaths with a teenager than with an aging parent. No one wants Mom or Dad to think that we are encouraging them to shuffle off the mortal coil as quickly as possible.
The time, of course, is to talk long before they are ill. But many people are not comfortable talking about death and refuse to have the conversation about themselves or their spouses. And many people prefer the idea of not going gentle into that good night. They'd rather rage.
Maybe the best we can do is to help the people left making the decisions understand the options and give them words to help the person who is dying understand the options. But all the talk before, when you are young? It pales and changes when the reality hits decades later. Making sure that there *are* options, better palliative care, ways to die at home, and letting people know how to make it happen may be the best thing the medical community can do.
The time, of course, is to talk long before they are ill. But many people are not comfortable talking about death and refuse to have the conversation about themselves or their spouses. And many people prefer the idea of not going gentle into that good night. They'd rather rage.
Maybe the best we can do is to help the people left making the decisions understand the options and give them words to help the person who is dying understand the options. But all the talk before, when you are young? It pales and changes when the reality hits decades later. Making sure that there *are* options, better palliative care, ways to die at home, and letting people know how to make it happen may be the best thing the medical community can do.
9
The biggest problem with this otherwise lovely article is its focus on adolescents, who should not be responsible for stepping into the gap left by their elders' unwillingness to think about, understand, and plan for matters related to illness, medical treatment, death, and dying. Yes, adolescents are a captive audience. It can seem easier to tell them to take the lead in their families' end-of-life conversations, than to get the adults in those families to take the lead. But children (while they are still children, which adolescents are) need to be able to rely on their parents, not the other way around, especially when it comes to matters of life and death.
17
I wholeheartedly agree that death education is needed. We also need advocacy for a nation-wide Death with Dignity Law. In the State of Washington we have such a law and it is one of the most comforting laws we have on our books. It is also a law that removes religious beliefs from our laws regarding the most important decision a human being makes; how one might die in a dignified manner. Thank your engaging this type of education for our nation's youth.
17
Excellent idea.
The restraints, tubes, etc. are all things that my Dad had to endure (d. 1983) and just recently my wife and I set up our health directives etc...and we both did NOT want all the "life" extending falderal when it is blatantly obvious that we are dying.
Anyway, plan ahead.
The death rate, is 100% no matter how you go.
The restraints, tubes, etc. are all things that my Dad had to endure (d. 1983) and just recently my wife and I set up our health directives etc...and we both did NOT want all the "life" extending falderal when it is blatantly obvious that we are dying.
Anyway, plan ahead.
The death rate, is 100% no matter how you go.
13
I've never understood why we don't make the connection between birth and death. If one is born, one will die. It's pretty simple. Perhaps this is grim. But rather than sex education and death education, why not talk about the relationship between entering the world and one day leaving the world. I was so surprised when a friend did not understand that the world will still be here when he died. He equated his own death with the end of the world. Those who have come to terms with their own mortality can help those who have not.
6
A wonderful commentary. I hope your efforts spread widely throughout school districts in this country. If for no other reason to make talking about death a natural part of living.
I would add a discussion of Living Wills and Heath Care Power of Attorney and making sure you have a family doctor that not only has a copy but commits to the patients wishes. (I actually left an internist who did not believe in my end of life decisions.) Many states offer these documents for free as well a many hospitals. You should also make sure that that the hospital you are likely to frequent has a copy of these documents.
Thank you for teaching these young girls about real life.
I would add a discussion of Living Wills and Heath Care Power of Attorney and making sure you have a family doctor that not only has a copy but commits to the patients wishes. (I actually left an internist who did not believe in my end of life decisions.) Many states offer these documents for free as well a many hospitals. You should also make sure that that the hospital you are likely to frequent has a copy of these documents.
Thank you for teaching these young girls about real life.
13
Great article!
When my beloved horses got old and were in extremis, my vet put each down humanely with a shot. My dog vet came to my house, gave a soothing shot and then put the retriever down with me petting her.
When a panel of doctors were asked if they wanted various kinds of medicalized resuscitation near the end of their lives, almost all of them
said no. No tubes, no nothing.
Too much $ being spent inhumanely on end of life tubes and machines. . Death with dignity, please when we decide that it's time, and in home if possible or in a comforting place. Why not allow people to have the same death benefits as our beloved animals?
When my beloved horses got old and were in extremis, my vet put each down humanely with a shot. My dog vet came to my house, gave a soothing shot and then put the retriever down with me petting her.
When a panel of doctors were asked if they wanted various kinds of medicalized resuscitation near the end of their lives, almost all of them
said no. No tubes, no nothing.
Too much $ being spent inhumanely on end of life tubes and machines. . Death with dignity, please when we decide that it's time, and in home if possible or in a comforting place. Why not allow people to have the same death benefits as our beloved animals?
39
It is best to have these conversations before they become relevant. Thus you discuss sex with your children (or make sure that someone is doing this right, and then you extend the conversation) BEFORE they become sexually active, so you are not intruding on their privacy, or discussing "them," but instead "it." Then the conversation can continue. Discussing death with high school students makes even better sense in that for them their own deaths are unthinkably remote, unless they have had the misfortune to lose friends at a young age. Perhaps an advanced care directive should be a requirement for a driver's license, a passport, or any official form of identification. Unfortunately, these documents are viewed by many as the paper equivalent of "death panels." It will take a lot of conversation to change this. And a Supreme Court willing to give us freedom of ourselves, and hence our bodies.
34
I have now helped three loved ones through hospice and death. The lack of continuity of care was a searing rupture each time. When the slick, highly monetized "cures" offered by staggeringly costly institutions failed (as, in hindsight, they were bound to do), we were utterly on our own. No one called to see how things were going or replied to queries, because once you are not going to recover you are no longer their problem. Lovely home hospice providers we located offered what they can--an aide to bathe intermittently, and oversight of the needed drugs. But it is a profoundly private experience. Until it happened, and then happened again and again, it had never occurred to me that assisting death was a life skill I would need. And yet this journey ends in only way for any of us, so how could it not be? I often wondered how we all manage to get through this. At times we felt stretched to the very limit of emotional capacity and we had enough money, some help, stable family and kind friends. So I was always aware that it could have been more difficult, and for many people must be. We tried at all times to reassure the one who was dying that he was in good hands, that the process would unfold in a bearable way--but no one ever felt completely convinced.
54
Last year I saw a documentary on end of life choices. An elderly gentlemen was lying on his side, apparently unable to communicate and just he stared straight ahead. The doctor was consulting with the family and he said: "This is as good as it gets." (his words). The choices were they could take him off life support, keep him comfortable (morphine?) and he would pass in a few days. Or, they could keep him on life support and he might live a few weeks or months, but eventually organ failure would overwhelm the science available. The family consulted and they opted for continued life support. Wait a second! Don't I get a vote here? If the patient's care is covered by Medicare or some other government program, then this decision will impact resources that will not be available for me when my time comes. What is the quality of this patient's life? He appeared to be borderline comatose and definitely could not participate in decisions regarding his own care. How much will it cost to maintain this patient on life support for, say, 3 months? Would there be any benefit to either the patient or the family to justify this cost? If you want to invoke the "sanctity of life" argument, then you can pay for it. (When money enters the argument, somehow sanctity of life quickly turns into no more than pious baloney.) Death with dignity, all the way.
JD
JD
81
Before adding Death Ed. to Sex Ed., how about reviving Civics Ed., before we lose both and Science Ed. in the bargain.
119
Thirty years ago I attended a good-size Christian high school that offered a semester course on death and dying. We read, learned about theories of death and dying, stages of grief, and had physicians, lawyers, counselors and pastors visit our classroom. We visited a funeral home where the undertaker talked about his role, about alternatives and costs for cremation and burial, and about the physical processes of embalming. It was the first time I had ever seen a dead body. Now, as I watch my parents die and serve in a hospital chaplaincy where families must make decisions about palliative care, the choices are so much broader. Yet my children have never, ever had a course option to learn about or discuss these things. Thanks for a useful column.
52
Dr. Zitter describes death education as a civic duty. I believe high school civics (Is this subject still on the curriculum in schools? One has to wonder, at times.) would be a perfectly appropriate venue to teach about the dying process, in all its forms but with particular emphasis on those resulting from terminal disease and aging. The subject would certainly not be the powder dry and boring recitation of city, state and national governments, even though government at all levels has inextricably involved itself in the choices that are available at life's end. This latter issue should be a key element of the discussion. It's really not a subject that lends itself to testing and grading. These two aspects might actually encourage classroom participation.
As a final point, keeping religious teachings regarding post-mortem reward or punishment at a long arm's length would be desirable.
As a final point, keeping religious teachings regarding post-mortem reward or punishment at a long arm's length would be desirable.
32
This is something I've thought about a lot. It seems our society has become something like Tolstoy's description of Russian society in his Death of Ivan Ilyich. In that book, a Russian magistrate lives a superficial life, playing by the rules and doing what he is supposed to do. Nobody talks about death; it's too morbid. He has friends and family but those relationships turns out to be superficial too when he begins to die. Suddenly he is left alone facing his own mortality in a world which wants no contact with his death and dying.
My mother worked as a counselor at a hospice and saw hundreds of people die. I have seen a few people die myself. It's not easy. It changes you fundamentally to see the moment when a living human being transitions to a corpse. But it is also supremely natural. There are comforts to it, to being there with the person at that moment. We should not shrink from the dying but seek to relieve their suffering, physical, mental, and otherwise. Not just for their sake but for our own. A culture which can face dying honestly and be present during death is one which we would all benefit from one day.
My mother worked as a counselor at a hospice and saw hundreds of people die. I have seen a few people die myself. It's not easy. It changes you fundamentally to see the moment when a living human being transitions to a corpse. But it is also supremely natural. There are comforts to it, to being there with the person at that moment. We should not shrink from the dying but seek to relieve their suffering, physical, mental, and otherwise. Not just for their sake but for our own. A culture which can face dying honestly and be present during death is one which we would all benefit from one day.
12
Death Ed comes with maturity, and the gradual visceral admission of its inevitablity.
To "educate" teens in DeathEd is nothing more than indoctrinating them in the secular religion of liberalism, the religion that so many Californians worship.
As a doc, I am here to tell you we cannot choose how we die, or when, unless by suicide.
To "educate" teens in DeathEd is nothing more than indoctrinating them in the secular religion of liberalism, the religion that so many Californians worship.
As a doc, I am here to tell you we cannot choose how we die, or when, unless by suicide.
4
Death ed for students is a great start but that leaves much of our population in the dark. How about a death education short course when you hit 50? It could be a standard health requirement like a colonoscopy at age 50. As someone with a chronic health condition I am personally well acquainted with the medical industrial complex. The whole system from hospitals to retirement homes is designed to extract every last dime from people at their most vulnerable stage in life. If you haven't filled out and signed advanced directives you and your family are at risk of what has become the great American fleecing.
17
Teaching death ed in high school, give us a break. Life teaches plenty of things much better than any textbook can, especially about death. It's a sad world we live in today where it's felt as if schools have to be the source of everything. Why was the world even made? God could have just made schools, and spared himself those other six days worth of trouble making stuff we don't even notice or want to care about.
1
I couldn't agree more. Making decisions equals having control over our lives. That empowerment should belong to the individual who's life is affected. I'm a sixty-eight years old, retired psychotherapist. My favorite word in the English language is autonomy. I cherish having as much of it as possible. My death, however and whenever it comes, is something I wish to be in charge of. One aspect of the "Go Wish" game that I practice is thinking about how I want to be remembered and what music to play at my memorial service.
6
I work in a large urban hospital, and see the need for death ed often. I believe strongly in every person's right to dignity in death, if at all possible. When we ignore an inevitable death people can be tortured with care. Physicians are taught to do everything they can to save a life, and sometimes fear a lawsuit if family urges them continue care beyond what is reasonable. Thank goodness for the specialty of palliative care.
14
Good for you! I wish the NYT could run more op-eds as excellent as this.
2
I mean, this is a wonderful idea--but you can't possibly think that this could actually become part of the public school curriculum. A large part of the Republican party thinks that teaching kids about contraceptives and STD protection = teaching them to be sluts. What are they going to think about a "Death Ed" class? If you want this to pass muster, change it to a "Life Ed" class and add some stuff about different views on the afterlife, or something.
6
Teaching and "talking about it" will have little value, as long as the process of obtaining a peaceful death on ones own terms is so difficult. What we need is not "rights" to this, but abilities. We need the "peaceful pill", readily available to any adult by prescription, or even administered under doctor supervision, on simple request, without "interventions".
10
A wonderful article.
This morning I took a sick relative to an emergency walk-in clinic and the first thing I noticed was a sign on the wall that said:
NO MORNING AFTER PILLS WILL BE PRESCRIBED AT THIS FACILITY
With better education, more realistic parents, less shaming, and better sex education for boys, fewer young women would find themselves seeking such help.
This morning I took a sick relative to an emergency walk-in clinic and the first thing I noticed was a sign on the wall that said:
NO MORNING AFTER PILLS WILL BE PRESCRIBED AT THIS FACILITY
With better education, more realistic parents, less shaming, and better sex education for boys, fewer young women would find themselves seeking such help.
8
Not this again. Please. It creeped me out when it first popped up in the nineties. How Brave New World can you get?
2
I was four when I first became aware of death. There was a private gesture between my Mother and me which signaled that I was going to enter a phase of melancholy. She understood, because we had discussed it, and she made allowances for my behaviour until I cheered up.
But I wouldn't trade that melancholy for ignorance or bliss.
Consciousness is our last great mystery, and it must always remain so. Awareness of death is awareness of life, and throughout my life I've had regular re-boots of that private moment with my Mother, though she's not here to comfort me any longer.
What does comfort me is life, a brief flash of light between two eternities. It's our job to make the most of it, and enjoy ourselves whenever we can.
But I wouldn't trade that melancholy for ignorance or bliss.
Consciousness is our last great mystery, and it must always remain so. Awareness of death is awareness of life, and throughout my life I've had regular re-boots of that private moment with my Mother, though she's not here to comfort me any longer.
What does comfort me is life, a brief flash of light between two eternities. It's our job to make the most of it, and enjoy ourselves whenever we can.
7
A fine article that addresses a real problem. I spent most of my life in England and have lived in the States only for a few years. When I first mentioned here that someone had "died", I saw a rather startled look on the listener's face. My first encounter with the word "passed" about someone we knew, prompted my question: "passed where?"
Death is inevitable and we should deal with it appropriately. It is not healthy to bury the subject under euphemisms.
Death is inevitable and we should deal with it appropriately. It is not healthy to bury the subject under euphemisms.
147
Estate planning attorneys routinely have this discussion with clients while completing standard Health Care Power of Attorney documents. I love your idea about bringing this discussion into the classroom. It's so much easier on family members if they know how their loved ones feel about end of life decisions. Great article!
21
If we paid more attention to death, and the horrifying prospect of our own mortality, we could better get on with the business of living.
29
Thank you for this important commentary. Having experienced the nightmare of the medicalized death of loved ones (machines, tubes, etc.), I know for sure that is not the route I would choose for myself. Bringing out the big guns when it is obvious what the end result will be is tantamount to torture.
I am fortunate to work for a "comfort care home," a small two-bedroom house for the terminally ill, where families and the resident craft the scenario for their final days. Our volunteers keep coming back because of the joy and peace they find in this work. And the families find peace as they honor and celebrate their loved one in his or her final days. In a perfect world, everyone would have this option to exit the earth.
We need more articles like this to remind people that we should be as proactive in planning death as we tend to be when planning birth. Each event is the landmark bookend to all the wonderful stuff that comes in between. Let's not leave this important transition to chance.
I am fortunate to work for a "comfort care home," a small two-bedroom house for the terminally ill, where families and the resident craft the scenario for their final days. Our volunteers keep coming back because of the joy and peace they find in this work. And the families find peace as they honor and celebrate their loved one in his or her final days. In a perfect world, everyone would have this option to exit the earth.
We need more articles like this to remind people that we should be as proactive in planning death as we tend to be when planning birth. Each event is the landmark bookend to all the wonderful stuff that comes in between. Let's not leave this important transition to chance.
45
That's so cool! I'm going to look up the kind of place you work. A comfort care home- never heard of it . Sounds marvelous.,
2
A very nice essay, thank you. Relating death-ed to sex-ed is the perfect way to introduce the topic. My one comment is that when a young person thinks about their own end of life and how they might want that handled (no artificial breathing, etc etc etc) I think it's important that they revisit their perspective every maybe five years, throughout their lives. In fact, that's what we're supposed to do anyway, but seldom do. It's especially important for a very young person, whose perspectives can change throughout their lives. I don't think a high school student should be expected to lock in on a lifetime career, and end-of-life decisions will develop and mature, as well. It would be great if such learning and decisions started in high school, and then carried on throughout our lives.
9
I was my mother's caregiver for the last 8 years of her life. She had several comorbidities one of which was rare and most doctors had little experience with it. As her condition deteriorated, I received confusing and contradicting info about her diagnosis and prognosis. As all my time and effort was increasingly spent on caregiving duties, I realized I needed to educate myself about what was to come. How would her diseases progress? What accommodations would I need to make? When I asked a doctor family member what the end stages of her disease and likely death would look like, he told me I was being morbid.
Thankfully I ignored him. I did my research, I asked every question that I could think of, I reached out to doctors in the family, I got rid of any doctor who was not willing to work with me. Many doctors wrongly assumed all I wanted was to keep her alive at all cost. But, since no one could tell me how long she had to live, my sole focus was to make each day she had left the best it could be. In the end, after a semi-successful attempt at reviving her, no one had to tell me she was gone. No one had to convince me to "pull the plug". I was clear headed and understood everything that was going on. I was ready to let her go. I can't imagine how terrifying it must be for patients and families who have no understanding of what they are facing. I often tell my story in the hope that it will help others to prepare themselves.
This is something everyone needs to know.
Thankfully I ignored him. I did my research, I asked every question that I could think of, I reached out to doctors in the family, I got rid of any doctor who was not willing to work with me. Many doctors wrongly assumed all I wanted was to keep her alive at all cost. But, since no one could tell me how long she had to live, my sole focus was to make each day she had left the best it could be. In the end, after a semi-successful attempt at reviving her, no one had to tell me she was gone. No one had to convince me to "pull the plug". I was clear headed and understood everything that was going on. I was ready to let her go. I can't imagine how terrifying it must be for patients and families who have no understanding of what they are facing. I often tell my story in the hope that it will help others to prepare themselves.
This is something everyone needs to know.
77
Hospice would help you with all of your questions. Hospice does not mean a death sentence as I have watched patients "graduate" from Hospice to live more life.
3
Where is any mention in this well written piece of hospice care. This is a critical end of life topic that the author does not mention.
39
Excellent point, Thomas!
She does mention palliative care which is part of the hospice philosophy.
1
My first understanding about death came at funerals of family members. There was little of use, truth or accuracy to serve as a guide.
I helped care for my grandmother at home, but had to say goodbye to her at a hospital. Not a helpful lesson at all. They said they were trying to "save" her life. She was 82.
It wasn't until long after my medical training, in my father's home (he was 69), that I came to understand death and dying by caring for him, being with him when he refused food, then water and some days later took his last breath.
A year later, my brother died (at 44), then another year and my mother (75). My husband's mother and father died during this time too. I was fortunate each death was at home, or in hospice and we took the time to talk about things that mattered and I was part of each family member's process, plan and fulfillment.
Now, in my seventies, my husband and I talk about and plan for our deaths in a very matter-of-fact, natural way. This often centers on when and how to get medical advice, but avoid most medical 'care.'
I do not think any classroom, whether in a high school or medical school, is yet adequate to substitute for life on matters of death and dying. I know that Dr. Zitter's intent, to spark conversations among high school students, is much needed and long overdue. I wish her well.
I helped care for my grandmother at home, but had to say goodbye to her at a hospital. Not a helpful lesson at all. They said they were trying to "save" her life. She was 82.
It wasn't until long after my medical training, in my father's home (he was 69), that I came to understand death and dying by caring for him, being with him when he refused food, then water and some days later took his last breath.
A year later, my brother died (at 44), then another year and my mother (75). My husband's mother and father died during this time too. I was fortunate each death was at home, or in hospice and we took the time to talk about things that mattered and I was part of each family member's process, plan and fulfillment.
Now, in my seventies, my husband and I talk about and plan for our deaths in a very matter-of-fact, natural way. This often centers on when and how to get medical advice, but avoid most medical 'care.'
I do not think any classroom, whether in a high school or medical school, is yet adequate to substitute for life on matters of death and dying. I know that Dr. Zitter's intent, to spark conversations among high school students, is much needed and long overdue. I wish her well.
83
Death has a bad reputation but it comes to all living things. So why do we cling to life if it is near existence? I, for one, have no desire to keep on living when I can do no more that sit in a chair or lie in a bed. That to me is not living. I'm 79 and fortunately in good health now but I know that my time will come and I've thought about it a good deal. Fortunately, assisted suicide is now legal in California. It's an option that I plan to take advantage in the case of terminal illness and maybe, at some point, it will be expanded to cover living vegetables.
70
BJS: by living vegetables I am thinking you are referring to those that are too incompetent or are comatose? "Living vegetables" is fairly insensitive. Living Wills and The Five Promises are available through Hospice and doctor's offices (at least the latter is). Anyone can document exactly how they wish to be treated at end of life in case they are no longer capable of speaking for themselves. I learned this well and had my own living will made out when Jeb Bush interfered with Terry Schiavo's long-term vegetative state. Politicians have no say on my life/end-of-life. Period.
8
This should be required reading for the politicians who are currently reviving the "lie of the year" that the Affordable Care Act (aka Obamacare for those who don't know) is mandating "death panels", when it is reimbursing physicians' time spent in discussing end of life care options with patients.
But then, the current group of politicians are "fact-free", and prefer to spread their alternative reality so that they can continue looting the American public.
Their health care plans should not be any better than those of their constituents. I bet when their own time comes, they will welcome these discussions with their doctors, and will pay from their own pockets (filled with their constituents' taxes).
But then, the current group of politicians are "fact-free", and prefer to spread their alternative reality so that they can continue looting the American public.
Their health care plans should not be any better than those of their constituents. I bet when their own time comes, they will welcome these discussions with their doctors, and will pay from their own pockets (filled with their constituents' taxes).
77
S: Your reply was perfect but if we could stop being so partisan about every comment we make, it would be quite pleasant.
2
I guess you haven't noticed that our "politicians" don't care anymore.
2
I'm a nurse who worked in an ICU for a few years. It wasn't the patients who died that bothered me. It was the patients we didn't allow to do. I will never forget a lung cancer patient who had already a couple of lobes removed, and had cancer in his remaining lobe. He remained intubated, restrained, on a ventilator for three months, because his wife refused to let him go. He was awake most of the time, but not lucid enough to make a decision. He was tortured by the medical profession, until he finally did die.
164
But...but.....Death Panels! This was great, but until the schemers and scammers stop twisting this subject to their own ends, ain't gonna happen.
The opinions of the ignorant and delusional get more attention than thoughtful, rational discussions.
The opinions of the ignorant and delusional get more attention than thoughtful, rational discussions.
5
Dying is a natural part of life but death is not, for there is no life, as we know it, when one is dead. However most of us instinctively feel, even if we are not religious, that there is something that follows death, a different kind of life. Otherwise the life lived here on earth seems pointless and meaningless . Longfellow writes in "A Psalm of Life ".."Life is real! Life is earnest !...And the grave is not its goal...Dust thou art, to dust returnest...Was not spoken of the soul."
5
You don't talk about assisted suicide. Why not? You call this death ed? Seriously?
5
Amen!
1
There is a book called, "The Denial of Death" by Ernest Becker. Although in my opinion it is too heavily focused on a psychoanalytic approach, the basic premise is very strong. Physicians that won't talk to patients about their looming death are under the sway of denial themselves. Penis, vagina, orgasm, hunger, thirst, death. See, that wasn't so hard.
4
How to psychologically prepare oneself for death, and therefore, presumably, with this clarity increasing chances of making proper choices at end of one's life?
It seems to me humans have yet to handle the shock of becoming conscious so it becomes impossible to speak of a proper stance toward death unless this problem of shock of consciousness is handled first--or rather to properly handle shock of consciousness is to simultaneously prepare for death.
"Shock of consciousness"? Humans are born, and with any honesty as consciousness increases they realize with almost mathematical perfection their utter insignificance in face of the immensity of the universe. Consciousness in such light appears a very cruel thing. What is it to have it driven home that you are nothing? Humans in fact seem to have panicked in this situation and we are continuing to panic. We seem to constantly be communicating and increasing this terror to each other in so many ways.
We plead to God; we clamber over each other in mad acquisition of this or that good; we calculate our worth in comparison to others by money; we acquire power; we drown ourselves in various pleasures. All to be slightly less insignificant in face of things. The problem is similar to not remaining calm in various other emergency or claustrophobic situations. We need emergency training in suddenly and unexpectedly awakening in a strange environment. Consciousness appears to be still another cause of fight or flight of beasts.
It seems to me humans have yet to handle the shock of becoming conscious so it becomes impossible to speak of a proper stance toward death unless this problem of shock of consciousness is handled first--or rather to properly handle shock of consciousness is to simultaneously prepare for death.
"Shock of consciousness"? Humans are born, and with any honesty as consciousness increases they realize with almost mathematical perfection their utter insignificance in face of the immensity of the universe. Consciousness in such light appears a very cruel thing. What is it to have it driven home that you are nothing? Humans in fact seem to have panicked in this situation and we are continuing to panic. We seem to constantly be communicating and increasing this terror to each other in so many ways.
We plead to God; we clamber over each other in mad acquisition of this or that good; we calculate our worth in comparison to others by money; we acquire power; we drown ourselves in various pleasures. All to be slightly less insignificant in face of things. The problem is similar to not remaining calm in various other emergency or claustrophobic situations. We need emergency training in suddenly and unexpectedly awakening in a strange environment. Consciousness appears to be still another cause of fight or flight of beasts.
6
Some people look at our at least two trillion galaxies that make our universe and see a hint of something or whatever, that beckons, c'mon, figure me out. That is what your evolution and the universe's evolution is all about you know. You and the universe are one and the same. Star dust in various forms and stages performing a still unknown dance.
Daniel12: your ranting has little to do with this article. We gain our true significance with love for one another in our small circle of meaningful friends and our love (if it is there) for our own faith. You are speaking as if you just watched "2012" recently.
1
I agree wholeheartedly that death education is needed if we are to believe we are humane and civilized. One other observation, however, is the glaring omission from your list of sex education subject headings: clitoral stimulation to orgasm for females. Penises get plenty attention in sex ed. I just hope the female organ of pleasure is equally explained.
8
Let me make this really simple....
no doctor I know plans to die or be treated like we do patients in the ICU!
NO ONE I KNOW...
so what is the problem
at least in my family, as paternalistic as it sounds...they listen to me...
why is this an issue? why do aptients family want "everything done"
this article starts the discussion that must be had
Huge amounts of money and effort are wasted on the last weeks of some peoples lives
These are not "death panels"
no doctor I know plans to die or be treated like we do patients in the ICU!
NO ONE I KNOW...
so what is the problem
at least in my family, as paternalistic as it sounds...they listen to me...
why is this an issue? why do aptients family want "everything done"
this article starts the discussion that must be had
Huge amounts of money and effort are wasted on the last weeks of some peoples lives
These are not "death panels"
26
A very necessary and well written article.
8
Thank you for your incredible strength and honesty! May you continue to have the time and place to give this incredibly valuable lesson! As it is said if you are born you eventually have to take that path. Heartfelt gratitude!
8
I've been teaching a "death ed" class at the college level for 20 years and this has always been part of our discussion. Over 90% of my students felt death ed should be taught middle or high school. The conversation has changed somewhat over the last 20 years as death is relatively out of the closet now but the decisions that need to be made have become increasingly complex. Thanks for speaking out and pushing the envelope
20
I'm one to prefer learned firsthand knowledge. However, it would have saved me a lot of trouble had I been taught the g-spot is in fact a myth, rather than hoping all the swirling blow was true. It seems the practitioners of FGM know more about female anatomy, than most.
As for death... It is hard not to romanticize. Composting floats to mind.
As for death... It is hard not to romanticize. Composting floats to mind.
3
Thank you for offering this long overdue conversation about death to teens. As a middle aged woman, I still find it hard to think about my own death, remembering the taboo of talking about it in my childhood. I applaud your efforts to bring it into the schools early, and perhaps you can invite the parents to attend the sessions as well.
8
SW Lover: But these are private schools! What about our public education system in which the political forces imprison our children to not learn the true facts even about sex!
1
The Health Care Industry won't like this idea. One look at its balance sheets will reveal all the lucre made. All"s the better to start the conversation with seniors who are most at risk for what passes for "care" at the end of life in hospitals these days...
7
Ellen Liversidge: Very cynical response! I am watching the living suffering and not getting the adequate medical care and concern that they really need. Have you worked with the chronically ill lately!
Very needed due to the society we live in today. Perhaps this will help lead to a broader cultural change, integrating death into life. It seems somewhat pathetic to say that, but we have lost those parts of our culture. In our medicalized culture, I can see a downside to "death ed" - that it becomes something to be certified in, then to school others about it, rather than to be integrated into life. Knowing the facts about something is well and good, however, it is limited.
6
C. Williams: death is a part of the cycle of life. Get over it already! Death "is integrated into life".
1
While it's extremely important to see death as part of the natural biological cycle, and that prolonging life at all costs should be seen as detrimental to the economic and well-being of all people, it's also critical that we attempt to change the entire cultural conversation and perspective surrounding "DEATH." For example, Halloween teaches little kids that dead people are scary, frightening creatures who escape from cemeteries to return to haunt the living; walking corpses, complete with empty eyeball sockets and ghoulish appearances are, in many people's minds, linked with death. Hamlet fears "that undiscovered country from which no traveler returns" and rather than treating death as a natural event, we teach children to fear it greatly (only public speaking registers higher on the fear spectrum, interestingly enough).
Additionally, many people use euphemisms to refer to death, hide dead pets, or lie about the death of a favorite pet, in order to shield kids from the idea of death.
It's important to let kids know, early on, that death is inevitable and necessary, and not a horrible thing for the people who die. The only problem with death is that those of us left on the planet mourn the loss of a loved one. We, the living, are much more affected by death than those who have "met their maker" "bought the farm" "kicked the bucket" "passed on" etc. etc.
Additionally, many people use euphemisms to refer to death, hide dead pets, or lie about the death of a favorite pet, in order to shield kids from the idea of death.
It's important to let kids know, early on, that death is inevitable and necessary, and not a horrible thing for the people who die. The only problem with death is that those of us left on the planet mourn the loss of a loved one. We, the living, are much more affected by death than those who have "met their maker" "bought the farm" "kicked the bucket" "passed on" etc. etc.
12
Susan: "completed their bucket list".
1
Thank you! Knowledge is power. Sex ed allows us to make informed decisions about sexual health, death ed will do the same for acknowledging the mortality of ourselves and our loved ones. Classes like these are crucial to removing the stigmas associated with topics that are traditionally forgotten by the formal education system.
26
Rebecca McGrath: Please be mindful about the political forces that infringe on "the formal education system". These outside forces question if sex education should even be taught, never mind coming out with "death panel" discussions in our public schools. Whoo Boy! I can hear the shouting already by Right to Lifers!
2
Please, virtually all we hear about is death and dying and disease. The TV commercials are endless, and the lazy good for nothing TV producers run out of real news and they just go to a local hospital to drum ups some awful tragic story. I can't grab the remote fast enough to either change the channel or mute the volume.
NPR, is not much better. It's really an arm of big Pharma giving endless stories of sick, dying, people like zombies droning on about their endless suffering. It's not healthy to obsess constantly about sickness death and dying.
Of course, this being America, where everything is monetized, we have the medical establishment in glee when people get sick. And, if they are worried about getting sick it's almost as good because they spend money to quell their anxiety.
NPR, is not much better. It's really an arm of big Pharma giving endless stories of sick, dying, people like zombies droning on about their endless suffering. It's not healthy to obsess constantly about sickness death and dying.
Of course, this being America, where everything is monetized, we have the medical establishment in glee when people get sick. And, if they are worried about getting sick it's almost as good because they spend money to quell their anxiety.
1
PRant: How incredibly cynical of you! I love NPR and this topic needs to be discussed in every family in America.
3
You have a really skewed view of death and dying. And, no, NPR is not in the pockets of big pharma. Network TV gets a lot of revenues from big pharma ads. May I recommend that you read Atul Gawande's book on death?
6
Yes! Its about time we approached this. I have watched friends and family go through the medical system and for the most part it did them no favors. Part of this is our fear of death, part of it is a reaction to the fear of being sued if they do not put in an all out effort to prevent death. I have also seen someone say " Its time for me to go." That person died with peace, dignity and love at home.
We are all going to die. As the system is presently set up, you must fight to do it your way. Otherwise you will find yourself in a hospital, hooked up to machines, beeping and chirping away, with people coming in every few hours to check off a box on their forms. For those whose approach to death is "Rage, rage against the dying of the light." I guess this is OK.
There is however, another way. It is acceptance, family, love, and the gentleness of a tide going out, one last wave on the shore, and I'm gone. . . .
We are all going to die. As the system is presently set up, you must fight to do it your way. Otherwise you will find yourself in a hospital, hooked up to machines, beeping and chirping away, with people coming in every few hours to check off a box on their forms. For those whose approach to death is "Rage, rage against the dying of the light." I guess this is OK.
There is however, another way. It is acceptance, family, love, and the gentleness of a tide going out, one last wave on the shore, and I'm gone. . . .
137
As one whose wife died four days ago, your last paragraph was proved right on.
7
Excellent article. For those who might say that the teen years are a little young to start discussing death, we might delicately suggest that death is all around us, throughout our lives; and yet we treat it with a cavalier attitude (or outright denial) which is no help when the time (our own or others') arrives. Zitter suggests not dwelling on death but handling it more intelligently within our own long lives. Brave and true.
44
Can't imagine this reasonable benefit for teenagers will be allowed to continue under the Republican regime. Conservatives are unable to stand for an enlightened and informed citizenry. If these young people have this type of education, they might have sex. Then get pregnant. Maybe want an abortion.
Death...oh no. Dementia,choose the time to die, can't teach that. Reasonable
people know sex and death questions should not be legislated...they are up to the individual. Information, properly disseminated, helps young people become adults, capable of making decisions, on these subjects , based on a position of strength, not fear or politics.
Death...oh no. Dementia,choose the time to die, can't teach that. Reasonable
people know sex and death questions should not be legislated...they are up to the individual. Information, properly disseminated, helps young people become adults, capable of making decisions, on these subjects , based on a position of strength, not fear or politics.
8
I agree, but the vast hoard of half-wit who believed in the "death panel" lies will become apoplectic (only metaphorically). Many of them do believe in demons and flouridation-as-mind-control, so reason is probably useless. I wish it were not so, and I wish that sweet reason had a place in our culture, but it hasn't for some time.
4
@grafton
You pivoted from a legitimate and looming issue and tried to knock it down with false equivalencies.
Death subjectivity will arrive, because humans are not prepared to face mortality and the government will not be able to pay for all its health care commitments.
You pivoted from a legitimate and looming issue and tried to knock it down with false equivalencies.
Death subjectivity will arrive, because humans are not prepared to face mortality and the government will not be able to pay for all its health care commitments.
1
what a great article thanks for writing it. unfortunately, we often avoid the topic or dig too deeply into it. By understanding it, actually, not intellectually, its refreshing and comforting.
In the meantime, teach, live, and help your fellow man.
In the meantime, teach, live, and help your fellow man.
3
I recently shared a hospital room with the 90 year old patriarch of a Russian Jewish family who was dying. He was visited by a couple of dozen bilingual family members who had lost control of the situation. One day a pregnant granddaughter appeared who seemed to have an other worldly connection with her grandfather. He's saying this. He's uncomfortable because of that. He's hungry. When you approach death, it clearly helps to have a great, good connection with a pregnant granddaughter.
8
Thank you, Jessica! As an advance care planning and palliative care researcher, I fully support everything you say in this article! I would love to find creative ways for me to help spread this perspective on death and dying education.
7
Excellent article. As a RN and as someone who has cared for several dying family members, I can't overemphasize the value of these conversations.
45
Dr. Zitter seems to be the kind of physician, parent and teacher that I wish the world was full of. And it seems her child goes to an exceptional school, where the parents and administration are open to educating our children (and future leaders) properly. Bravo. Good article.
47
What I remember from my school sex talk is nothing. An adult who thinks that they have moved the bar forward for teenagers because of a single spirited discussion in a classroom has an ego beyond compare. What you learn from a lecture and discussion from a classmate's mother is what that classmate has to deal with when they go home. A bag over the head was a reasonable proposal.
1
Great advice to parents and educators. I'm afraid organized religion is an obstacle to both sex and death education worldwide. And since we're unable to reject the likes of Betsy Devos for education secretary in America, we are a long way from achieving what you suggest.
66
With Republican politicians reinvigorating the fallacy of "death squads," it's hard to imagine our schools having the courage to host conversations on death ed for their students. With that said, I do hope the idea will catch on. Nobody leaves this world alive, and it's critical that we offer people of every age, the tools and knowledge to make it a good passage.
63
The medical industrial complex will not like this article. Show examples of the hospital bill for the last 2 or 3 weeks of life of terminal patients. My father's last 2 weeks cost medicare $500,000.
114
Please stop with this toxic trope. I know it's far easier to blame Big Bad Medicine than it is to have painful and soul-searching conversations about our existential fears, but this problem is on our culture as a whole. I'm tired of hearing medical professionals blamed for national failings, and it's particularly insidious because of the way it lets everyone else off the hook.
I'm an NP hospitalist — meaning that I'm an advanced practice nurse who works full-time in a hospital — and I don't know a single MD, NP, or PA who wants anyone to die hooked to machines. Even the ICU doctors I know desperately wish that they could avert this sort of death for their patients; all morality aside, it's not good medicine. One of my favorite among the critical care doctors I work with will come to a patient's bedside when I call him — not to push for intubation and central lines, but to help me convince family members NOT to ask for that sort of extreme measure.
We (medical professionals) are certainly not *free* of blame in the mess that death has become in our society, for the same reasons as everyone else: medical professionals, too, often find these conversations painful and uncomfortable. That said, I think we have even *more* desire to change this than does the general population. Futile resuscitation attempts on the very ill and/or very elderly are, frankly, horrific. Anyone who has ever been forced to watch or participate in one never wants to do so again. We are not the enemy.
I'm an NP hospitalist — meaning that I'm an advanced practice nurse who works full-time in a hospital — and I don't know a single MD, NP, or PA who wants anyone to die hooked to machines. Even the ICU doctors I know desperately wish that they could avert this sort of death for their patients; all morality aside, it's not good medicine. One of my favorite among the critical care doctors I work with will come to a patient's bedside when I call him — not to push for intubation and central lines, but to help me convince family members NOT to ask for that sort of extreme measure.
We (medical professionals) are certainly not *free* of blame in the mess that death has become in our society, for the same reasons as everyone else: medical professionals, too, often find these conversations painful and uncomfortable. That said, I think we have even *more* desire to change this than does the general population. Futile resuscitation attempts on the very ill and/or very elderly are, frankly, horrific. Anyone who has ever been forced to watch or participate in one never wants to do so again. We are not the enemy.
71
As a physician I would find a video of a death ed class being taught by Dr. Zitter very educational and helpful to my own work. Please add a link where readers can watch this.
29
GREAT idea.
10
Long, long overdue. What could be more natural, more taboo, than death ed as the follow up to sex ed? May the Revolution be beginning now, thanks to pioneers like Jessica Zitter, Dawn Gross, Atul Gawande and Stephen Jenkins. I am bringing my own version of death ed into my college English class - and being met first with high anxiety and then even greater relief.
11
Not for kids (unless they're very mature), I suggest adults read Atul Gawande's Being Mortal. It's a compassionate intro to death ed.
4
Good idea.
3
My late mother-in-law knew she was dying and wanted to leave the hospital and go home. She refused forced feeding. Her doctor was furious and screamed as he exited her room, "I don't let my patients die!"
Deeply religious, the doctor and my father-in-law got her pastor to tell her it was god's will that she remain in the hospital and submit to the doctor's orders.
She died a week later hooked to machines.
Doctors and hospitals make a tremendous amount of money off the dying. I agree that education is essential...some of that education also needs to be in medical schools.
Deeply religious, the doctor and my father-in-law got her pastor to tell her it was god's will that she remain in the hospital and submit to the doctor's orders.
She died a week later hooked to machines.
Doctors and hospitals make a tremendous amount of money off the dying. I agree that education is essential...some of that education also needs to be in medical schools.
144
That doctor is not the norm. Every physician I've worked with wants to respect the patient's wishes, and will do so even when they personally disagree (and for the most part, it's the physician who believes a very sick patient should be DNR DNI and a patient or family member who wants full steam ahead). At least in my hospital, the ICU is a scarce resource, so there is no monetary incentive to keep dying patients alive against their wishes - they can and should go to hospice, and open up that bed for someone else who needs it.
2
Thank you!!! Keep doing this. I wish someone would do this at my grandchildrens' schools. Ignorance is not bliss.
4
Many religious education classes get the death message across. And that is why we should all practice the ten commandments instead of today's slander and hatred. The world would be a much better/nicer place. If one gets to certain age mileages the apparent should become obvious about how one has lived a life or wasted that life.
Thank you.
2
This combined curriculum in sex and death ed for kids might be called "la petite mort" (or "little death," a French expression for orgasm). But all joking aside, it's a great idea to increase cultural literacy about death and dying. Strategies for better deaths will help us lead better lives.
3
Kudos to Dr. Zitter! Giving teens the skills to talk about death, learn to make their own choices and listen to those of their loved ones is a lifelong gift. Thank you!
But, does she also explore the essential qualities of health care in the US? That the overmedicalized patient is a customer, the ICU is a profit center, and the intersections of their life paths and the health care system are dependent on their material wealth and their ability to feed profits in the largest sector of the US economy?
Seems like an important part of life skills education.
But, does she also explore the essential qualities of health care in the US? That the overmedicalized patient is a customer, the ICU is a profit center, and the intersections of their life paths and the health care system are dependent on their material wealth and their ability to feed profits in the largest sector of the US economy?
Seems like an important part of life skills education.
11
What is this "we" he speaks of?
I live in Oregon, a state with Death with Dignity laws. Those laws are about to be under massive attack from the Trump administration and the Supreme Court, again. Death ed is a tough sell in much of the country not on a coast.
The author of the article lives in the country of California, where there is still some freedom to teach sex ed to kids. Used to was, California was the place that great ideas and freedoms were created and then they spread to the rest of the country. But now, in the time of Trump and the gutless Congressional Republicans, the flow is from the religious right to the rest of the country. I so applaud the author of this article and hope his classes spread.
Hugh Massengill
I live in Oregon, a state with Death with Dignity laws. Those laws are about to be under massive attack from the Trump administration and the Supreme Court, again. Death ed is a tough sell in much of the country not on a coast.
The author of the article lives in the country of California, where there is still some freedom to teach sex ed to kids. Used to was, California was the place that great ideas and freedoms were created and then they spread to the rest of the country. But now, in the time of Trump and the gutless Congressional Republicans, the flow is from the religious right to the rest of the country. I so applaud the author of this article and hope his classes spread.
Hugh Massengill
26
Just to point out: The author is a female physician. I am glad you [hope [her] ideas spread."
6
Ah, thank you. There is an old joke that has the punch line, the doctor was a woman, pointing out the sexism in many minds. The gender of the article's author went by me, and I thank you for pointing this out.
I am 70, and went to school when sex ed was not allowed, not to mention death ed. My loss.
Hugh Massengill, Eugene Oregon
I am 70, and went to school when sex ed was not allowed, not to mention death ed. My loss.
Hugh Massengill, Eugene Oregon
2
Wonderful! I have a dear 90 yo friend, suffering from lung cancer. She's terrified of dying. Wants "everything" done, including more chemo which sickens her terribly. I care for her with, I hope, compassion without demanding that she change. But I am so sorry for the lost possibilities.
8
Medical care in the United States is far higher than in any other country. And something like 80 percent of the expenditures for our medical care occurs during the last months of life. Any rewrite or replacement of the Affordable Care Act should address this issue. (No, this is not "Death Panels.")
6
A major consideration should be learning to discern if someone is really peaceful and pain free or if they've simply been so medicated that they can't make their discomfort known. I've been medicated with morphine after major surgeries and each time fell in to a state somewhere between sleep and waking. I'd desperately want to open my eyes and wake up but I was stuck in a place that was full of nightmarish images and terror. I looked like I was resting peacefully however.
I've made it clear to my family that morphine should be avoided if they ever need to "make me comfortable."
It's important that caretakers understand fully that their job is to make the dying person's passage as comfortable as possible. This won't necessarily mean that it will comfortable for the caretaker. I knew a man who wanted to be "present" for his death, even though he knew he'd be in pain. He had led a deeply spiritual life and genuinely wanted to experience his own final moments as fully as possible even though they would be painful. His family and caretakers insisted on medicating him. this struck me as being for their comfort not his. It can be difficult to be with someone who is dying, but it's their choice not ours how they choose to depart.
I've made it clear to my family that morphine should be avoided if they ever need to "make me comfortable."
It's important that caretakers understand fully that their job is to make the dying person's passage as comfortable as possible. This won't necessarily mean that it will comfortable for the caretaker. I knew a man who wanted to be "present" for his death, even though he knew he'd be in pain. He had led a deeply spiritual life and genuinely wanted to experience his own final moments as fully as possible even though they would be painful. His family and caretakers insisted on medicating him. this struck me as being for their comfort not his. It can be difficult to be with someone who is dying, but it's their choice not ours how they choose to depart.
8
Back in the days when education wasn't run by inane standards and the standardized tests which accompany them, we used to be able to choose English, Social Studies, and Science classes by the quarter or semester. I took recycling fort for science, for a quarter, the Holocaust for Social Studies and and Death for English in 8th grade. In Death we read The Loved Ine, Mary Kubler Ross's stages of death, short stores, nonfiction articles. Some films too including The Loved One. One of the best classes I took as were they all. Better than taking generic English classes with "modules" which is what is done now.
3
Easily the most original thoughts in the NYT in the past couple of weeks. In my experience the problem isn't with doctors failing to explain the situation to the patient or his family, just failing to understand that most patients and their families don't really understand what they are being told and what to do with that information. Doctors understandably don't want to catch hell from a family who thinks the doctor is sticking his nose into family business by trying to explain to the patient, in relatively firm terms, that it is time to go. For a country so purportedly Christian we seem to be highly reluctant to know when the party is over.
6
What we all need to fear and act to prevent is a needlessly painful death imposed by culture, religion, family members or the law. Death education will encourage and help people to prevent senseless, needless, purposeless suffering at the end of life.
An additional thing PROPER death education will surely help to overcome is fear of suffering after death. That fear is every bit as senseless as harboring a fear of never having been born, yet billions of people allow what we call religions to terrorize them from the moment they're told there's a hell. If there really were a "hell" after death, people who terrify children (and adults!) with stories about it should surely belong there.
An additional thing PROPER death education will surely help to overcome is fear of suffering after death. That fear is every bit as senseless as harboring a fear of never having been born, yet billions of people allow what we call religions to terrorize them from the moment they're told there's a hell. If there really were a "hell" after death, people who terrify children (and adults!) with stories about it should surely belong there.
12
"What people want when it comes to end-of-life care is almost never as much as what we give them."
My dad, a retired physician, was a case in point. Long before he had been diagnosed with Parkinson's disease, he had written up his end-of-life care directives and a living will. Those directives asked for "no heroic measures" and spelled out many details such as no defibrillators, no intravenous antibiotics, no breathing tubes, no stomach feeding tubes, among them.
In his 8th year of living with Parkinson's and having endured a litany of what he considered gross indignities, he developed a urinary tract infection. He was overjoyed as he clearly thought that this diagnosis coupled with his health care directives would "take him out." He said as much in plain English.
He was taken to a rehab against his wishes. There, also against his wishes, as he is saying repeatedly to the nurses preparing the intravenous antibiotic that the attending physician had heedlessly ordered, "Read my chart! Read my chart. It's in my health care directives: no intravenous antibiotics." Nobody listened. He survived the infection.
As he was already starting to have periods of dementia due to the Parkinson's and upon coming out of them, recognizing them as periods that would only get longer, more frequent, and of deeper mental helplessness. He recognized the care givers would not heed his directives and that he would kill himself by "doing nothing." For 21 days he refused food and water. Suffering.
My dad, a retired physician, was a case in point. Long before he had been diagnosed with Parkinson's disease, he had written up his end-of-life care directives and a living will. Those directives asked for "no heroic measures" and spelled out many details such as no defibrillators, no intravenous antibiotics, no breathing tubes, no stomach feeding tubes, among them.
In his 8th year of living with Parkinson's and having endured a litany of what he considered gross indignities, he developed a urinary tract infection. He was overjoyed as he clearly thought that this diagnosis coupled with his health care directives would "take him out." He said as much in plain English.
He was taken to a rehab against his wishes. There, also against his wishes, as he is saying repeatedly to the nurses preparing the intravenous antibiotic that the attending physician had heedlessly ordered, "Read my chart! Read my chart. It's in my health care directives: no intravenous antibiotics." Nobody listened. He survived the infection.
As he was already starting to have periods of dementia due to the Parkinson's and upon coming out of them, recognizing them as periods that would only get longer, more frequent, and of deeper mental helplessness. He recognized the care givers would not heed his directives and that he would kill himself by "doing nothing." For 21 days he refused food and water. Suffering.
10
Thank you, Dr. Zitter. Death is not the enemy, it is part of each of our lives. Sadly, along with so many other Americans, I have had terrible experiences with older relatives whose over-medicalized deaths turned their last weeks into torture.
Far from the grotesquely caricatured "death panels," all efforts to talk more openly about end of life care can only mean progress from the difficult state of end of life care today, where too often hundreds of thousands of dollars are spent making patients and their families miserable. Our technology has outstripped our ability reason about a good verses a bad death and it's well past time for that to change.
Far from the grotesquely caricatured "death panels," all efforts to talk more openly about end of life care can only mean progress from the difficult state of end of life care today, where too often hundreds of thousands of dollars are spent making patients and their families miserable. Our technology has outstripped our ability reason about a good verses a bad death and it's well past time for that to change.
7
This is a great idea. But we need more.
First, we need to make it easier to enforce the wishes of dying people. More and more people live alone and have no dependable friend or relative to be their medical advocate. We need to be able to wear a bracelet or tattoo with links to an Internet form expressing our wishes.
Second, we need broader protections built into the system. Very few people recover after CPR, yet it's impossible to stop EMTs and medics from administering it. Chances are you'll be far from your living will - let alone your medical rep - if you lose consciousness. http://www.cnn.com/2013/07/10/health/cpr-lifesaving-stats/
And there's no excuse for doctors lying to patients about their medical conditions. They even recommend life-threatening surgery and invasive tests for people who are in their 90s and/or close to death.
It takes a very, very strong advocate to stop these painful, unnecessary medical interventions. Even when advocates are present, they often have to pull techs off a dying patient or argue with the doctors. And more and more of us will not have anyone to fight for us.
The article leaves out an important fact. Doctors and hospitals are not motivated to stop these cruel treatments because they make a lot of money from those treatments.
First, we need to make it easier to enforce the wishes of dying people. More and more people live alone and have no dependable friend or relative to be their medical advocate. We need to be able to wear a bracelet or tattoo with links to an Internet form expressing our wishes.
Second, we need broader protections built into the system. Very few people recover after CPR, yet it's impossible to stop EMTs and medics from administering it. Chances are you'll be far from your living will - let alone your medical rep - if you lose consciousness. http://www.cnn.com/2013/07/10/health/cpr-lifesaving-stats/
And there's no excuse for doctors lying to patients about their medical conditions. They even recommend life-threatening surgery and invasive tests for people who are in their 90s and/or close to death.
It takes a very, very strong advocate to stop these painful, unnecessary medical interventions. Even when advocates are present, they often have to pull techs off a dying patient or argue with the doctors. And more and more of us will not have anyone to fight for us.
The article leaves out an important fact. Doctors and hospitals are not motivated to stop these cruel treatments because they make a lot of money from those treatments.
59
When my husband died from an aggressive cancer at 51, his doctors never mentioned death. It was the proverbial elephant in the oncology ward. I spent the one month he was ill engaged in magical thinking because despite everything, I didn't realize he would die. When I developed my own cancer a year later, I immediately asked my doctor if I was going to die. Oh, don't even say that, he replied. But I told him I wanted a serious answer, if only for my family's sake. Doctors don't want to talk about death becuase it is seen as medical failure. And it's a difficult and awkward conversation, to say nothing of the fact that doctors have no acceptable way to grieve. Except perhaps to offer overly aggressive care to the next terminal patient. But death is not a failure, it happens to everyone. I certainly have no thoughts on whether death ed would be valuable, but maybe just a living will or an honest end of life conversation with the family doctor would be enough.
12
The sane world wants information, wants empowerment and wants reality. The insane world shuns information and wants to bask in la la land.
I do hope that enough of the sane world remains that I can continue to live in the land of the sane. I have lived in the land of the insane and don't want to go there again.
Thanks for educating the next generation of decision-makers.
I do hope that enough of the sane world remains that I can continue to live in the land of the sane. I have lived in the land of the insane and don't want to go there again.
Thanks for educating the next generation of decision-makers.
6
One might argue that when teaching sex ed to 7th graders, some of the students might not be ready for this education. However, bearing in mind the normal course of things, many are and those not are not too far away from being ready to be educated. (Practice is a different issue).
Death is a different matter. No 9th grader should be "ready" to face issues of death or be prepared for this. It is likely that some 9th graders might lose grandparents or suffer losses of other kinds, but to teach death on a formal basis would most likely put most of the class in a position they do not need to be in and should not be in.
And death is not just facing the death of a loved one through disease, the likely cause of death in a private, progressive school. In other types of schools there would be issues perhaps of death through violence, local or in war, and perhaps even more cases of family violence.
I think perhaps psychological counseling on an ad hoc basis might be more appropriate and cause less damage to those who are not ready to face death in any form, beyond a TV program.
Death is a different matter. No 9th grader should be "ready" to face issues of death or be prepared for this. It is likely that some 9th graders might lose grandparents or suffer losses of other kinds, but to teach death on a formal basis would most likely put most of the class in a position they do not need to be in and should not be in.
And death is not just facing the death of a loved one through disease, the likely cause of death in a private, progressive school. In other types of schools there would be issues perhaps of death through violence, local or in war, and perhaps even more cases of family violence.
I think perhaps psychological counseling on an ad hoc basis might be more appropriate and cause less damage to those who are not ready to face death in any form, beyond a TV program.
3
As a father of a son who died by his own decision 29 month ago, I face every day the difficulties that people have to deal with death. Comforting a family, helping the ones who suffer is something many otherwise caring and compassionate people simply can not do. Me and my wife participate in group of parents of deceased children: we all feel like "the others" (family members, friends, colleagues, aquintaces...) many times ad pain to the suffering ones just by not knowing how to deal with the subject. Some desapear from your life -when you really, really need them; many just not know what kind of approach is the best (a hint: the natural one is; frankly and openly talking abou the decesead, listening with an open hart is the way if you want to help someone who is suffering from a loss). For many, death is something that we should not mention, specially if related to our own children. Is to frightening, is something unnatural and that rarely happens, but when it does, it always happens to others. But when your son or daughter dies, you awake to the obvious fact that people die and many of them have mothers and fathers... so being a parent of a deceased children is not that rare as we wish. Openly talking about death, understanding that it is a part of our life and that we will lose people we love, and somehow be prepared for it, is nothing but good.
10
Educators should not teach only the fear of death or the hollow of life to children. If they can teach children the value or the hope of life by explaining the importance to prepare for death, death education will be meaningful.
2
Death Ed will need to, first, teach that it is inevitable. It will arrive. We cannot avoid its certainty. It shapes our living with its looming presence. It forces us to think carefully about both our choices and about the consequences of those choices.
Death is also inextricably linked to a continuum of life that precedes us and will endure long after our Earthly bodies no longer serve as the vessels for our souls.
Aha, this is where you and I and many others part company. And this is why I am skeptical that I need you and a government agency dreaming up a talk on death with my children. Thankfully, they are past the age to be influenced by your rather interesting idea.
You will need to engage those areas of life and death for which you have less interest. Why are we here, on this rock, seemingly endowed with powers that awe evolution? Is life sacred? Are we part of the design of a divine power to which we are accountable? What is our death? Is it the end of cell division or is it the beginning of an eternal existence that is immutable?
I don't think you ultimately have those answers. Your death is transactional. It is the need to increase the convenience on the living. It is an admission that we turn from pain and, therefore, should snuff pain from the living even in the event it requires snuffing the living from life.
We do a lot to justify those things which are easier for us. In the case of death, I think many of us probably feel we have this covered.
Thanks, tho.
Death is also inextricably linked to a continuum of life that precedes us and will endure long after our Earthly bodies no longer serve as the vessels for our souls.
Aha, this is where you and I and many others part company. And this is why I am skeptical that I need you and a government agency dreaming up a talk on death with my children. Thankfully, they are past the age to be influenced by your rather interesting idea.
You will need to engage those areas of life and death for which you have less interest. Why are we here, on this rock, seemingly endowed with powers that awe evolution? Is life sacred? Are we part of the design of a divine power to which we are accountable? What is our death? Is it the end of cell division or is it the beginning of an eternal existence that is immutable?
I don't think you ultimately have those answers. Your death is transactional. It is the need to increase the convenience on the living. It is an admission that we turn from pain and, therefore, should snuff pain from the living even in the event it requires snuffing the living from life.
We do a lot to justify those things which are easier for us. In the case of death, I think many of us probably feel we have this covered.
Thanks, tho.
2
Thank you, Dr. Zitter. But, in addition to teaching Death Ed universally to high school students, let's make it part of the medical school curriculum as well. Patients rely on their doctors for accurate medical information, and doctors seem to lack the tools to effectively explain to patients the seriousness of their health problems. I appreciate the difficulty of the task, but hoping a high school student brings up palliative care and changes the course of an older relative's passing is expecting that kid to do the physician's task.
18
The dearth of comments to this article speaks volumes. Death is a fact of life that most people don't want to think about, but it is also probably one of the most important things, in life, to plan for no matter how far in the future you think it might be. Too many people die needlessly painful deaths (at times more psychologically painful than physically) because people ignore planning, and making those plans known, until it happens to them. Death presents itself at inopportune times and in inopportune ways. The medical community does its share by either being afraid to "fess up" or by looking, unfortunately, at death from the bottom line of business. We all have choices, can say no to treatments, and should have the ability to plan our own deaths, in advance, if lucky enough to be given the understanding and the tools. I watched the three people closest to me die (brain tumor, lung cancer, and uterine cancer) And, even with only palliative treatments and utilizing hospice care at home, I can guarantee that any one of those people would not have chosen to prolong their death if they'd had the choice and the legal means. Perhaps these educated children can make the changes that can make a difference for the peaceful end when their own times come.
9
We (family, friends, and caregivers) recently supported my father in his last months, days, and hours.
The pivotal moment for us was learning that hospitals are organized around responding to health challenges, while hospices are organized around comfort for the patient and those who care about them.
Second, we were fortunate to have a medical team that drew the line on medical care when there was no more benefit to be had. They called in a palliative care team to help us understand what happens next and what options we could choose.
Third, we were fortunate that my father was realistic. While there was something that could be done, he asked for medical assistance. Once no more could be done to restore his quality of life, he accepted that we would be concerned for his comfort.
This ability to accept the inevitable when it becomes inevitable is a social process that the patient, family, and caregivers have to go through together. One can prepare for it, and should, so that when the time comes, everyone can go from unwillingness to relinquish a life to support and acceptance.
The pivotal moment for us was learning that hospitals are organized around responding to health challenges, while hospices are organized around comfort for the patient and those who care about them.
Second, we were fortunate to have a medical team that drew the line on medical care when there was no more benefit to be had. They called in a palliative care team to help us understand what happens next and what options we could choose.
Third, we were fortunate that my father was realistic. While there was something that could be done, he asked for medical assistance. Once no more could be done to restore his quality of life, he accepted that we would be concerned for his comfort.
This ability to accept the inevitable when it becomes inevitable is a social process that the patient, family, and caregivers have to go through together. One can prepare for it, and should, so that when the time comes, everyone can go from unwillingness to relinquish a life to support and acceptance.
6
It's good to know that people are finally confronting the subject of death. After all, we all have to do it eventually. My main concern is that Death Ed, like Sex Ed will be challenged by the religionistas. They will block every reasonable treatment of the subject with their hocus pocus nonsense. Be ready.
9
Our daughter was just four when my husband's 14 y.o. son committed suicide. Life handed her that lesson early, and compelled me to face it as well.
"Normalizing" death, as is my takeaway from the article, came to me in my thirties via "The Tibetan Book of Living and Dying". I wasn't afraid of dying; I was afraid of losing loved ones to death. Loss.
One of my husband's childhood friends was extremely close to his grandfather, who died when he was 12. His family didn't tell him until a few years later to "spare" him. It didn't.
Now 16, our daughter knows what our preferences are for a living will and burial. No one should have to make big decisions alone on behalf a loved one; and everyone should spare their loved ones that by thinking it through and writing it down.
The author's idea to make the subject part of high school curriculum has merit. Wonder what kind of push back will come from the fearful folk.
"Normalizing" death, as is my takeaway from the article, came to me in my thirties via "The Tibetan Book of Living and Dying". I wasn't afraid of dying; I was afraid of losing loved ones to death. Loss.
One of my husband's childhood friends was extremely close to his grandfather, who died when he was 12. His family didn't tell him until a few years later to "spare" him. It didn't.
Now 16, our daughter knows what our preferences are for a living will and burial. No one should have to make big decisions alone on behalf a loved one; and everyone should spare their loved ones that by thinking it through and writing it down.
The author's idea to make the subject part of high school curriculum has merit. Wonder what kind of push back will come from the fearful folk.
20
I have been going through life approaching 70 now without yet having been killed or caught. Mostly my experience has been autodidactic since "look and learn" and since simple and ancient examination and deductions have been very adequate, I have tended to shy away from helpers, coaches and classes. Nonetheless, doctor, I am reassured that I read your fine opinion piece before replying.
My main criticism of your method, and there is probably no way of your getting around it, is that I get the feeling that the teenagers…lucky they are that you strike me as engaging and interested and critical of your environment when needed…the teenagers and others are receiving the type of end-of-life advice that enables them to be more comfortable with the end-of life of another and to prepare to organize the details for the one who is taking that long voyage. All well and good and indispensable for the child whose parent's affairs are no longer taking care of themselves.
I am further heartened that the person who cannot necessarily prepare for the expected but not scheduled will have someone such as his or her assigned responsibility through such as the Advanced Medical Directive protocol.
Briefly, whether it's dating, sexuality, contemplating suicide to determine resolve persisting in life, or settling up, it's best to do the learning oneself. Avoid those who help because this is really impersonal. Cherish those whose interest is in keeping others personal even after life.
My main criticism of your method, and there is probably no way of your getting around it, is that I get the feeling that the teenagers…lucky they are that you strike me as engaging and interested and critical of your environment when needed…the teenagers and others are receiving the type of end-of-life advice that enables them to be more comfortable with the end-of life of another and to prepare to organize the details for the one who is taking that long voyage. All well and good and indispensable for the child whose parent's affairs are no longer taking care of themselves.
I am further heartened that the person who cannot necessarily prepare for the expected but not scheduled will have someone such as his or her assigned responsibility through such as the Advanced Medical Directive protocol.
Briefly, whether it's dating, sexuality, contemplating suicide to determine resolve persisting in life, or settling up, it's best to do the learning oneself. Avoid those who help because this is really impersonal. Cherish those whose interest is in keeping others personal even after life.
6
As with sex ed, I think efforts to educate people — not just high-school students, but a lot of supposedly savvier older people too — about death are devoutly to be wished. Unfortunately, as with sex ed, various religious factions prefer that these subjects not be mentioned. We need more voices like yours to get past these sanctions.
18
I was a member of a research team a number of years ago conducting a randomized controlled trial designed to test the effectiveness of a program designed to encourage patients to articulate their end of life wishes. Listening to the tapes of the counseling sessions, I'll never forget the response elicited from a man whose heart failure had left him with an ejection fraction of about 9%-- a normal ejection fraction is closer to 60%. When asked what he hoped for as he neared the end of life, he said he wanted to see one of his 3-year old nieces graduate from high school and get married. The lack of self-awareness likely left him with the ultimate surprise and little time to plan. Truly pathetic.
6
Thank you for this well written piece about life and death. I am a physician and spend a lot of my time with end of life situations. I blame the medical system itself in large part for failure in discussing end of life, but it seems in recent years to be improving somewhat.
Doctors strongly feel that death is somehow a failure, a poor reflection on their care, rather than a medical fact. Many doctors can't face this in their own lives much less in those of their patients, and I think this is because death and end of life issues are not discussed enough in medical school. Why?
My cynical self believes the absence of end of life discussion has to do with the fact that, until recently, doctors weren't reimbursed for the time needed to address this important topic. We simply haven't been given the time. As a result, we have ignored the specter of death. The fact that we are now able to be reimbursed suggests end of life discussion is now seen as important (for the time being, at least) by third party payers, allowing us the opportunity to discuss end of life concerns.
We are taught that death is not supposed to be an outcome of our care, and yet it is inescapable. The presence of palliative care teams has lifted the responsibility for dealing with this off the shoulders of many physicians, but we have a long way to go in dealing with death in our own lives as well as in medical training.
Doctors strongly feel that death is somehow a failure, a poor reflection on their care, rather than a medical fact. Many doctors can't face this in their own lives much less in those of their patients, and I think this is because death and end of life issues are not discussed enough in medical school. Why?
My cynical self believes the absence of end of life discussion has to do with the fact that, until recently, doctors weren't reimbursed for the time needed to address this important topic. We simply haven't been given the time. As a result, we have ignored the specter of death. The fact that we are now able to be reimbursed suggests end of life discussion is now seen as important (for the time being, at least) by third party payers, allowing us the opportunity to discuss end of life concerns.
We are taught that death is not supposed to be an outcome of our care, and yet it is inescapable. The presence of palliative care teams has lifted the responsibility for dealing with this off the shoulders of many physicians, but we have a long way to go in dealing with death in our own lives as well as in medical training.
4
Death was isolated by industry over time. Beginning at the end of the civil war. Old homes had "parlors" to display your dead relatives the wording changed an became removed from the home with funeral parlor and house got "living" rooms and now we have funeral homes that take death away.
Death was a very common occurrence. In my home town of 1500 people in 1910 there were 7 deaths of children in a week, you could die of an ear infection.
My child has dealt with death more than myself at her age and handles it better than I do.
It's just one of the things we all really can't escape.
Death was a very common occurrence. In my home town of 1500 people in 1910 there were 7 deaths of children in a week, you could die of an ear infection.
My child has dealt with death more than myself at her age and handles it better than I do.
It's just one of the things we all really can't escape.
5
Sex education is still, devastatingly, largely a joke in the USA. Constituting at best a few days per year of instruction, the rest of the curriculum - the arts, the sciences, math, social studies and ELA, with ample opportunities to explore the multiple dimensions of sex education, simply never happens. One of the most important drivers of humanity - sex and reproduction are left out of public school curricula, with profound implications for their health and happiness. A similar analysis could be said about death education. This is a greater problem in American education than all the nonsense about test scores.
6
Dr, Zitter, I could not agree more with you, but unfortunately, given the hard right tilt of our politics these days, particularly with the relentless demands by the extreme Christian right, the likelihood of teaching about either sex education or death education is rapidly disappearing. The so-called "right to life" crowd has manufactured an entire set of fictions to justify their corrosion of the separation between church and state/federal laws, and at this point, they are rapidly destroying women's right to self determination, privacy and primacy when it comes to reproductive healthcare, from contraception to abortion. These same extremists are legislating fraudulent, fact-free "scripts" that physicians must follow, and, contrary to their "keep big gub'mint out of capitalism," they are also legislating prohibitions against insurance coverage for abortion and contraception, and mandating that women ask permission of men for health services. Death with dignity? Forget it - these religious extremists decry such personal and private decisions, as grotesquely evidenced by Jeb Bush, Bill Frist, and George W. Bush's interference in the private agony of Terry Schiavo and her husband. Indeed, "the sooner we start talking about it, the better" - but don't expect that to happen under the GOTP. "Let the market decide" doesn't apply when their religious beliefs are paramount. 2/18, 3:21 PM
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@Rebecca
Your freedom and others' freedoms are actually mutually intrusive when not restrained.
I trust you to do all the Death Ed you need within your home, with doctors like this who share your worldview, and through whatever means you feel is needed without touching government funds to do so.
I think what the Left most abhors is not being given the right to press its ways, its superior knowledge, on every living person. It is actually quite self-righteous.
It is most ironic to hear you assail those who act the same way merely because you disagree with them.
Your freedom and others' freedoms are actually mutually intrusive when not restrained.
I trust you to do all the Death Ed you need within your home, with doctors like this who share your worldview, and through whatever means you feel is needed without touching government funds to do so.
I think what the Left most abhors is not being given the right to press its ways, its superior knowledge, on every living person. It is actually quite self-righteous.
It is most ironic to hear you assail those who act the same way merely because you disagree with them.
3
We all die. For my father, life meant being active, engaged, able to enjoy the outdoors, a glass of red wine in the evening, a good political discussion with my husband, hiking and canoeing with his granddaughters, reading and thinking. He had made it very clear he did not want to end his life in a nursing home. The strength of his wishes made it possible for me to let him die when the time came to do that, and I'm forever grateful with what we called our "just shoot me" conversations.