March 23, 2019

How to Die Well

“I recently turned 70 in Marin County, Calif., home to some of the healthiest, wealthiest and longest-lived people in the country. I swim daily, take no medications and can still hoist my roll-aboard bag into an overhead bin. But there is no denying that somewhere beyond the horizon, my death has saddled his horse and is heading my way. And I’m hoping to make that death as good as my life has been.

My wish is to die in my own bed, cared for by people I love—clean, comfortable and relatively free from pain. I hope to have time to say my goodbyes and give my final blessings. But in our technologically advanced society—despite the billions we spend on end-of-life medical care—this simple, old-fashioned and once-inexpensive death is harder to achieve than you might think.

According to a 2017 Kaiser Foundation study, seven in 10 Americans hope to die at home. But half die in nursing homes and hospitals, and more than a tenth are cruelly shuttled from one to the other in their final three days. Pain is a major barrier to a peaceful death, and nearly half of dying Americans suffer from uncontrolled pain. Nobody I know hopes to die in the soulless confines of an Intensive Care Unit. But more than a quarter of Medicare members cycle through one in their final month, and a fifth of Americans die in an ICU.

In his final year of life, retired IBM manager Ed Walski, who had Parkinson’s disease and dementia, was shuttled nine times between his assisted living apartment and hospitals and nursing homes. “The first few times I’d say, OK, we got him through this, and now he’s going to get rehab and be back where he was,” said his daughter Karen Randall, a veterinarian in Silver Spring, Md. “But he never came back. It was a stair step down to the basement.” Despite financial resources and a devoted daughter, Walski’s dying was far more chaotic and painful than it needed to be.”

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