Why are we so afraid of death and the process of dying?

I don't know . . . perhaps it's because I'm from Africa, where life has always been more or less tenuous in the rural areas, and even more so as one gets into conflict zones . . . but I can't understand why modern First World societies are so reluctant to confront the reality of growing old, declining in health, and dying.  I saw this many times as a pastor.  When someone became gravely ill, or got very old, there was an almost instinctive shying away from the prospect of their death - not so much by the person concerned, but by those around them.  If the victim - for want of a better word - wanted to talk about it, they were shushed and told not to be silly, or morbid, or whatever.  If the pastor - that would be me - wanted to discuss it and prepare the dying person for eternity as best he could, there was an almost resentful attitude, as if one was mentioning the unmentionable.

Yet, for all of us, death is a reality that's absolutely certain.  We may die old or young, in good health or in bad, peacefully in bed or fighting for our lives . . . but we are going to die.  That's the way it is.  We can't possibly avoid it.

I've long maintained that there's far too much emphasis in the medical profession on maximizing the quantity of life - i.e. how long one lives - at the expense of quality of life - i.e. how well one lives.  I've seen far too many cases where loved ones insisted on pursuing medical treatments that merely postponed the inevitable, almost always at great expense, consuming everything the soon-to-be-deceased had saved and then leading them into crippling debt that they wouldn't survive to pay.  The residue of their estate would be consumed by such debts.  What's more, the burden of pain and suffering associated with that all-too-brief extension of life was often very great indeed.  In some cases the patient became incontinent, incapable of caring for him- or herself, and lost all awareness of who and/or where he or she was.  I regarded it as equivalent to torture to force them to stay alive like that, when the normal and inevitable end of their lives would have come sooner (and much more mercifully) if nature had been allowed to take its course.

Two news articles made me think about these things this morning.  The first is about a retired nurse who decided to end her own life because old age was 'awful', in her experience.

A leading palliative care nurse with no serious health problems has ended her life at a Swiss suicide clinic because she did not want to end up as a “hobbling old lady”.

Gill Paraoh, 75, who wrote two books giving advice on how to care for the elderly, was not suffering from a terminal disease.

She said she had seen enough of old age to know that she was “going over the hill” and wanted to take action to end her life while she was able to do so.

. . .

Two months before her death, Gill wrote an article, entitled My Last Word, in which she set out her decision to end her life.

“Day by day, I am enjoying my life. I simply do not want to follow this natural deterioration through to the last stage when I may be requiring a lot of help,” she wrote.

“I have to take action early on because no one will be able to take action for me. The thought that I may need help from my children appals me. I know many old people expect, and even demand, help from their children but I think this is a most selfish and unreasonable view.”

She said her experience as a nurse had shown her the reality of elderly life.

“If you work in a nursing home and you have people who are incontinent, who use bad language, who walk around the rooms and just take things, it is very difficult. It is not a job you enjoy,” she said.

“I just felt it was so bleak and so sad. We all did what we could but, for many of those old people, there wasn’t a lot you could do. We do not look at the reality. Generally, it is awful.”

There's more at the link.

I regret her decision, because I don't believe we have the right to play God with our lives or anyone else's.  Allowing the process of death to take its natural course is one thing.  Short-circuiting that process by suicide or euthanasia (which is nothing less than judicially approved murder, IMHO) is entirely another.

A nationally renowned firearms instructor, whom I knew in South Africa before both of us ended up in the USA, had taken a similar decision many years ago.  In a 2008 interview, Louis Awerbuck said:

LA: I really don’t care about my death. I’ve had a hundred years packed into sixty. Why would I? I’ve got nothing to live for. I’ve got nothing to lose. I’ve got no Achilles heel. I’m not the average person. I’m an exception to the rule. The average person — wife and kids, lineage, wants to see their grandchildren play football or through college or whatever. Fine. I’m the end of the line. I’m the end of the blood line, completely.

Q: Most adults wrestle with some sort of fear or anxiety. It can be their financial well-being, their health, or their personal safety. What do you fear most in life?

LA: Probably physical incapacitation, if I were cognizant of it. Dependency, physical dependency, and being cognizant of it. Having Alzheimer’s and knowing I’ve got Alzheimer’s and not being able to [pauses] end it. That’s it. I don’t fear anything else because … Mr. Roosevelt said, “There’s nothing to fear but fear itself.” I don’t want to be dependent on anybody else. There is nothing else.

To my great sorrow, last year, after encountering serious health problems, he took his own life.  That may have solved his problems, from his perspective . . . but he left behind a lovely partner, and many friends and acquaintances who still miss him.  It was a selfish way to die, and one I wish he hadn't chosen.  Still, according to his lights, he'd had enough.  He didn't share my faith in God, but he had no fear of death as the natural end to life.  (Personally, if I didn't have faith that something or Someone waited for me beyond the boundary of death, I'd be a lot more reluctant to cross it!)

The other article pointed to the problem of unnecessary, extremely expensive, and ultimately unsuccessful medical treatments to delay the inevitable.

An important new medical study finds that chemotherapy does not extend life for end-stage, terminal cancer patients. What's more, those who received chemotherapy treatment near the end of their disease had a worse quality of life than those who didn't.

This study could reshape the debate about end-of-life care in America, one that often focuses on the idea of "rationing" care for terminal patients. It suggests that what's good for patients — better quality of life — doesn't always mean more treatment and more spending. It also makes a compelling case that more medicine isn't always best, and that a preference for more aggressive treatment can make someone's final moments of life worse.

. . .

The healthier patients who received chemotherapy had a worse quality of life than those who did not pursue treatment.

Researchers also interviewed caregivers shortly after their patients' deaths and found that chemotherapy was associated with worse quality of life in the patients' final week, too.

Again, more at the link.

I think that's a very valid conclusion, and one that squares with my own experience of working with the dying.  Unfortunately, it's also going to be seized upon by advocates of State-funded medical care, as a reason to deny such treatment to all terminally ill patients on the grounds that it's a waste of money.  In some cases, I think it certainly is - but who are faceless bureaucrats to make that decision on the patient's behalf?  And what about those patients for whom it would not be a waste of money?  How will they be identified - if at all?  Who will make that decision?

We badly need a more open, honest, informed discussion about end-of-life realities, options and choices:  but in the present state of our society, we're unlikely to get one . . . more's the pity.

Peter