Chun: Gently into that Good Night
This break I had the distinct pleasure of considering the various ways I could become legally incapacitated. As part of granting my parents power of attorney, I was forced to consider several grave scenarios. My reasons for doing so were fairly simple — not only do my parents have my best interests at heart, but they’re also uniquely well-suited for the task, as both both of them are doctors.
A few of the questions posed by the contract were easy to answer. Organs? Sure, I won’t need those if I drown in Occom Pond. Finances? I hereby agree to give Mr. and Mrs. Chun full access, in the case of my incapacitation, to my fortune of a few hundred dollars earned by working retail during the holidays. One group of questions, however, took substantially longer to answer — those concerning end-of-life care.
Three options comprised this portion of the form. Two of them began with, “I want my life to be prolonged.” The other, “I do not want my life to be prolonged.” The latter option authorizes the legal agent to pull the plug if the “burdens of the treatment outweigh the expected benefits.”
In the past, this is what I had often said I would prefer. $88 billion dollars, nearly 30 percent of Medicare’s budget, is spent on patients in the last year of life.
In a recent brief, The Dartmouth Institute for Health Policy and Clinical Practice concluded, “Studies show that more spending, more days in the hospital and more physician visits are not always associated with better outcomes or with the care that patients want. Less intensive and expensive care can both save money and improve quality, satisfaction, and outcomes for many Medicare beneficiaries.”
And yet, despite the slim chances that this legal document would ever be put into practice, something gave me pause. It was not an issue of rational choice, because I knew what was right. Instead, it involved confronting my own death. It was a consideration a hundred times more salient for some 76.4 million aging baby boomers and their families. The sixty-one million boomers will, by 2030, be between 66 and 84 years of age. In addition to the boomers, there will be nine million people born before 1946. Six out of ten will be managing a chronic condition.
For all of us, this presents a serious problem. With end of life and long-term costs at all time highs, Medicare simply cannot handle the strain of the boomers.
And yet, it is clear that the problem at hand transcends economics. It is a problem with the way we perceive death. When a life is lost, we view it as a failure of the medical system or a tragic accident. We “rage against the dying of the light.” But, is that really prudent?
The survival of Medicare and the quality of our last few years may depend on our ability to accept death as a natural process. Staring at the sheet of paper before me, I realized that this is not something that comes naturally. In fact, it goes against human nature.
I’m reminded of Paul Kalanithi, a promising neurosurgeon who, at age 36, was diagnosed with terminal stage IV lung cancer. Kalanithi recently published his memoir, “When Breath Becomes Air.” In it, he described how he pursued medicine to, “keep following the question of what makes human life meaningful, even in the face of death and decay.”
Any discussion of end-of-life care cannot be a simple cost analysis. It will always be an ethical, medical, economic and ultimately, a human decision. At the macro-level, our ability to sustain Medicare may rest on our ability to change our ideas about death.
Albeit difficult, devising a plan in the face of tragedy is a discussion that every family should have. There may be some distant horizon at which we, like certain jellyfish species, will defy age. Until then, we must wrestle with being, by definition, mortal animals who wish they were anything but.