Reclaiming Human Dignity in Death
By - Elizabeth Badalov, Edited By - Melissa-Maria Kulaprathazhe
How you like your morning coffee, which route you will take to get into the city for work, what you’ll read before bed--making choices is central to our everyday lives. Our personal beliefs and preferences shape the decisions we make and how we choose to live. Wrapped up in making our lives as comfortable as we can, we can forget to apply the same principles to our deaths.
In Western societies today, death is frequently ignored or even feared, viewed as a usurping of life rather than a natural part of it. Instead of embracing the finitude of our existence, people oftentimes feel a loss of control over their life. Evidence shows that the fear of death can be reduced “by improving interpersonal communication with all patients,” which almost sounds too good to be true.[1] Despite this seemingly easy fix, end-of-life (EOL) conversations rarely take place between physicians and their patients.
In a study conducted with 7946 respondents, although 68% of participants reported having various concerns about EOL care, 49% reported not having had discussions about the treatment they wished to receive, should they fall seriously ill.[2] An ‘advance directive’ is a primary tool for individuals to communicate their personal preferences, should they lose the ability to make their own health care decisions.[3] Despite this, 63% of Americans have not completed one.[3] This oversight could significantly limit the autonomy a patient could exercise over their care, regardless of whether they are healthy or terminally ill.
Innovations in modern medicine have attempted to—and often succeeded in—taming death by prolonging life. Unfortunately, this can come at the expense of the quality of the life being “saved.”[1] Patients and families often adhere to the misconception that more care is equated with better care, spurring them to push for unnecessary, invasive, and potentially harmful procedures as opposed to receiving high-quality palliative care. Such a decision could lead to a poorer patient outcome, perpetuated by the lack of information on possible outcomes, risks and benefits, or alternative options. This only highlights the need for better interpersonal communication, both in advance of a debilitating illness, and throughout its course.
The principles of medicine dictate that physicians should promote the maintenance of health, relieve pain and suffering, and cure maladies.[4] The final principle is often forgotten—the obligation to assist patients in the pursuit of a peaceful death.[4] Adherence to this principle is as simple as starting a conversation. Primary care physicians should introduce their patients to advanced planning and outline just how many options are available. Patients can assign family members as surrogates to advocate for them should they be incapacitated. Patients can choose to have a ‘do-not-resuscitate’ medical order or express their desire to receive any treatments possible.
Advance directives offer patients the opportunity to exercise their individual autonomy and apply their personal preferences to their death, just as they would to their life. Physicians should make it their mission to become comfortable having EOL discussions with patients and encourage them to consider what matters to them most, what they would truly want for themselves. End of life planning does not have to be frightening—making informed decisions about one’s inevitable future will not manifest death, it will only take back control.
Reference(s)
San Filippo Ph D, D., Historical Perspectives on Attitudes concerning Death and Dying. 2006.
Rao, J.K., et al., Completion of advance directives among U.S. consumers. American journal of preventive medicine, 2014. 46(1): p. 65-70.
ScienceDaily, Two out of three U.S. adults have not completed an advance directive. ScienceDaily, 2017.
THE GOALS OF MEDICINE. 1996. 26(6): p. S1-S27.