â€œA Dignified Death? Living is Dignified, Tooâ€
Bernard Fryshman, Ph.D.
November 25, 2014
- If I had a twin he would be a few years away from turning eighty, and while Iâ€™m in moderate
good health, he might not be. In fact, many of my contemporaries are in failing health, with all
that this means for the health costs to society. All to be expected. People in their seventies begin
to focus on the infirmities of age. One colleague, for example, reputed to be a heartless soul, now
sports a stent to prove to one and all that he does have a heart after all.
For the rest of society, this adds up to increased health costs and therefore, we have become a
burden. My generation is not used to being a burden, and on behalf of my fellows, I offer my
At the same time, I think itâ€™s only fair to remind society that I â€“ and working people like me paid
for all the medical advances, the drugs, the training, the techniques and technology which
enables modern medicine to do so much to save lives and improve living. Perhaps thatâ€™s why so
many of us resent the attitude of younger people (especially medical personnel, too) that
expensive medical care should be reserved for the young. Nobody is so crass as to say it, and
nobody has instituted death panels, but the signals are all there.
â€œWhat do you expect at your ageâ€, a doctor said to me when I complained about a shoulder pain.
I told him I expected him to use the same kind of medical expertise and intervention he would
use on a person twenty five years younger. While practitioners are rarely as abrupt and
forthcoming as this specialist, this kind of thinking prevails. Insurance plans stop paying for
certain medications at a certain age, and the elderly are often ineligible to participate in clinical
trials. Heroic measures arenâ€™t always taken, and families of desperately sick older people are
subjected to advice to pull the plug for the â€˜benefitâ€™ of a suffering relative.
This is a particularly objectionable aspect of the medical profession. The same condition that
would draw every last ounce of effort in trying to save the life of a young person, results in
somber voiced conversations about death with dignity for the aged.
- Why? Wasnâ€™t there a social compact with those of us who supported medical research and
training and facilities through our taxes and otherwise? The fruits of medical science were to be
available to all of us â€“ not just the young. And if we arenâ€™t as spry, as independent, and as well
kempt as we used to be, we still want to live. Whether or not it is inconvenient to others, and
whether or not we have become a burden.
No doubt a case can be made for those who want to end the pain and suffering they experience.
But why the full court press to glorify death as â€œquality end of life careâ€? Some of the puff
pieces by palliative care centers could have been written by high end tourist resorts, down to the
fresh cut flowers in every room.
This advocacy of death with dignity is particularly true of the Institute of Medicine (IOM) whose
â€œDying in Americaâ€ paper runs counter to its mission to improve health. The IOM, a part of the
National Academy of Science, has a mandate to cure, not care. Using the prestige and resources
of this national body to extol the benefits of care rather than cure is a distortion of its function
and a violation of its responsibility to the American people.
Some of the language of this â€œDying in Americaâ€ paper cuts through all the posturing:
â€“ â€œimproving shared decision making and advance care planning that reduces the
utilization of unnecessary medical services and those not consistent with a patientsâ€™
goals for careâ€.
There is a stated need to â€œstabilizing aggregate societal expenditures for medical and related
In a word, the goal is to save money, and everything else in the â€œDying in Americaâ€ report is
window dressing. The IOM urges all medical personnel to receive training in palliative care, and
urges efforts to discuss such issues with patients and family in advance. Not stated is the fact that
the bottom line of palliative care is death. The â€œcareâ€ is a temporary one, unlike a hoped for
â€œcureâ€. The message to friends and relatives of the aged sick is to carefully tailor the emphasize
on the need to â€œreduce sufferingâ€ and permit a dignified death; too rare is the message â€œletâ€™s try
to save this lifeâ€.
- There is no need for a death panel: the awe most of us have for medical professionals make
families reluctant to challenge the tantalizing message of â€œcareâ€. Few of us would dare point out
that their message of â€œpalliative careâ€ is a perversion of the usual meaning of care. Care is
intended to lead to cure and life â€“ rather than a cessation of attempts to heal, preliminary only to
The Institute of Medicineâ€™s â€œDying in Americaâ€ is not a medical document. It addresses the
interaction of the patient, the family, and the medical profession, yet the committee that prepared
it included no members of the public, no clergy, and no advocates for the elderly.
The document targets those who can be conveniently classified as â€œnear the end of lifeâ€, and has
the goal to â€œcontribute to a more sustainable care systemâ€. A noble goal, but not at the cost of
diminished or restricted medical care, whether or not we elderly are deemed to be â€œnear the end
First take care of our medical health. Your financial health will have to wait.