End of Life Issues ’08 Update

Recently, I have watched a few films exploring a common theme: The Bucket List, The Diving Bell and The Butterfly, and Ghost Town. Clearly, the common theme for these and many other contemporary movies is “how we live and how we die”. Or, perhaps “how we view death and how we choose to die determines how we live”.

Since I wrote the last Clinical Update on End of Life issues in August of 2007, not only has there been a proliferation of movies about the subject of death but there have been also changes in the business of selling coffins. Costco continues to sell “The Lady of Guadalupe Casket” for $924.99, but the price for “The Mother Casket” dropped from $1,299.99 to $924.99. This very probably reflects the effects of comparison-shopping, as bestpricecaskets.com offers a greater selection and some lower prices than does Costco. Most casket retailers offer rush orders for an extra fee but add the proviso, “Sorry, no returns.” With confidence, they add the comforting promise, “Satisfaction is guaranteed”, which obviously begs some questions.

As psychotherapists and health care providers, we are in a unique position to help the millions of generally well-to-do Baby Boomers, who are determined to die differently than their parents. Attitudes toward death and dying are drastically changing among this group, whose members tend to be determined to age with more awareness, consciousness. Their goal is not only to live long but to live well. There are many signs that Baby Boomers are also more willing to face death more directly and consciously.

• In November of this year, 2008, Washington State will be voting on whether or not to legalize assisted suicide. California and Vermont are not far behind and will put this question on the ballot in the near future.
• By the year 2050, people over 85 are expected to make up 24% of older persons and 5% (numbering over 19 million) of the entire population in the United States. Currently, three-quarters of people who die yearly are older adults.
• Older adults want information about advanced directives, palliative and hospice care, and how to die comfortably at home.
• The fears that most older adults express are: 1) fear of pain, 2) fear of being alone at the moment of death, and 3) fear that health practitioners will ignore their last wishes.
• Curative care is disease-specific and restorative in principle. Palliative care is symptom-oriented and supportive in nature. Hospice care is an extension of palliative care and focuses on preparation at all levels (physical, social, emotional, spiritual and economic) for death.
• Euthanasia is a medical treatment in the Netherlands and Belgium and assisted suicide is a medical treatment in the Netherlands, Belgium and Oregon.
• In the United Kingdom, the British Medical Association’s ethics committee in May 2006 recommended that doctors end the lives of some patients swiftly, humanely, and without guilt.
• Advanced planning for the dying can be a complex process. Having working knowledge of advanced directives, living wills, durable power of attorney for health care, and the protective medical decisions document is imperative for a clinician who spends time with dying clients. Beyond the legal matters, clinicians have to have clarity regarding their own ethical, moral, and spiritual biases.