Dying Priorities

The most divisive issue in America is not the economy, politics, war on drugs, racism, health care or our ongoing military wars across the world. The most recent Gallup's annual Values and Beliefs survey of 2010 reported that doctor-assisted suicide is the most controversial of the issues tested. Equally 46% reported that it is moral unacceptability and morally acceptable.

In contrast, Americans are fairly unified in their opposition to another life-ending choice--suicide--with 77% calling this morally wrong. Taking subordinate position in dividing the nation is gay and lesbian relations, abortion and having a baby outside marriage. 

All these issue drive to the heart of the American ideal of personal freedom.  And yet Americans remain fixated on an issue of doctor-assisted suicide—better known as Dying With Dignity Act (DWDA)—where nationally, in 2011, only 71 people died using this option. In contrast to the 2.5 million Americans that die each year, those that die with DWDA are a very very small minority. They are nearly exclusively White, primarily women, educated, and exclusively people with life threatening disease (mainly cancer.)  

While many people are blessed to be released from life from a final act of covert over-medication, such action is necessarily too late. And while most Americans think a good death consists of dying at home, surrounded by family, and free from pain and suffering—regardless of one’s age, gender, ethnicity, or religious background—one in five people die in an Intensive Care Unit. Death for most Americans is a medical failure rather than a dignified release.

Except for physicians, who tend to shy away from aggressive medical treatment when the prognosis is negative, most Americans tend to undergo a lot of unnecessary, expensive and invasive treatment.

But three of every four Americans do not fear death as much as they fear being in pain at the time of death.  Despite these clearly stated and seemingly universal preferences, too many of the 2.5 million Americans who die in health care settings each year suffer needlessly in pain at the end of life.

And this should be the national issue. Nearly eight out of every ten hospital deaths occurred without a palliative care /formal pain management. More than four out of every five older adults in long-term care facility experienced untreated or under-treated pain at the time of death. While 70 percent of all Medicare decedents, regardless of their age or where they died, received an inadequate amount of pain management.

Sara Imhof and Brian Kaskie predicted in 2008 that "we can only conclude that public policies will fall even further behind the advancement of evidence-based pain-policy guidelines, and the number of Americans who continue to suffer needlessly in pain at the time of death will only increase."

It does not have to be this way. Dying in pain is a national travesty. We need to honor the body’s capacity to let go. In studies that looked at voluntary refusal of food and fluids, nurses report that patients die more serenely then with DWDA. The body knows how to shut itself down. We need to incorporate a dignified exit in our health care system where Americans can at least be protected from a painful death.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com