Friday, February 8, 2008

A Graceful Death; Death with Dignity

Jany Brody writes in today's New York Times about people who want to die and those who help them (within the boundaries of the law, of course). Her Heartfelt Appeal for a Graceful Exit opens the door to thinking and talking about the death of an older person.

I wrote her an email that I quote below because I can't really say it better:
I read your column on a Graceful Exit. I had two thoughts. One is that as I age -- I am now 64 -- I am becoming much more aware of the differences between me and younger people. I have led a very dynamic, active life, and in fact, I believe I look, feel and act a lot younger than I am.

But, the actual fact of age, of having lived a lot of years, of having had hopes and dreams and disappointments, of having invested in love and seen it both succeed and fail, of having an aging body, of the difficulty in rebuilding muscle after a total knee replacement and the like, are inhabiting my mind in ways that makes me look at life very differently.

When I watch young people, the children of friends, young men and women striding on sidewalks, riding in elevators, chatting it up in restaurants, I am struck by a feeling of how little they know of what will come to them with life, with time. Si jeunesse savait, si vieillesse pouvait.

As a young person, I looked at life from the rim of the volcano, from the front edge of the white water on a wave. Tomorrow was a real but empty concept. My energy and love of life would carry me forward through whatever I aspired to.

As a sixty-year old I see life from the top of a rise on a big long hill, overlooking fields and bays. There are more mountains to climb and valleys to hike through, but it is at a higher altitude.

As I read Ms. Brody's words about eighty and ninety year olds talking about wanting to die, it seems so obvious that from the perspective of the lives they have lived, that death would be the most natural next step. Not something to be feared, or fought against. And that younger people can't really understand how it feels to be that old. Not simply the body feelings but the whole package of awareness, knowledge, understanding of the arc of a life.

Much as people in their twenties, thirties, forties haven't a clue what it's like to be sixty, even at sixty I can only imagine what it would feel like to be eighty or ninety. Not everyone feels that way, of course, but I imagine a lot do and the issue is not with their feeling that they want to die but with their younger family members who can't imagine that state of mind and so translate it into the feelings of a younger person. Of something that must be desperate or depressed or hopeless.

It's not like that at all. Death is not so far away. Not so much to be avoided.

My work takes me close to the dying; in fact, much of my work is helping people to die (not from a medical point of view but as the decision maker when there is no one else). My awareness and knowledge of death is very different from when I was young. It will be much closer still if I live to be eighty or ninety.

Jane Brody closes her column with a plea for her family to have the wisdom to allow her to die with dignity. My reaction was that each one of us must build that into our health care powers of attorney and advance medical directives. And, more importantly each one of us must talk to family members and possible caretakers and make sure they understand that they are not to substitute what they think is best for what you have said you wanted.

So often, so much damage is done to the elderly -- and those are my clients and wards -- by seemingly well intentioned family members (and other court appointed guardians, conservators and trustees) who think they know better.

It is cruel to be stripped of everything in life except one's joy in the moment (dementia having often robbed one of memory) and the ability to decide what one wants. To then have relatives and caregivers dictate what one can or cannot do is truly unkind.

Part of my law practice is pushing back against such misguided caregivers on behalf of an older person or a disabled person, and trying to get the caregiver to align him or herself with the older person they are caring for and not to substitute his or her own ideas and values for those of the older person.

So, I admonish every reader to be very clear and very firm with your family members about their not doing what they think best, but rather what you know you will want and have told them orally and in writing.

See my earlier post on The Right to Folly. Soon I will write a post on the hell of dying in America. Hell is on This Side of Death, not the other. Also, another post on how to think about advance directives and health care powers of attorney.