Mindful living, mindful dying

1.... .End-of-life physical-health care can prolong both life AND suffering, depending on the kind of care given. Over one-third of the residents in our retirement home are 90 or older, and none of these (including myself, nearing 92) is without at least one major health issue involving some degree of suffering. When the facility opened eight years ago, few were that old. The wave of the truly old has hit, and it's a tsunami of Medicare-Medicaid costs. Not far out to sea is an even greater wave, the baby boomers beginning to qualify for Medicare.

2.....By age 80 "trips to the doctor" increase, and by age 90 experience a sharp uptick. Some of our residents, approaching 100, see more than one doctor per week. And what is the aim of all this medical attention to the elderly? The mindless prolongation of life at whatever cost in suffering and dollars.

3.....MindLESS, here, means without thinking. But human beings are capable of thinking and (all religious and ethical systems teach) therefore obligated to think, to be mindFULL and intentional about everything. "Everything" should not exclude one's own mortality.

4.....This obligation to be mindful applies to society as well as to the person, the individual human being, a product of both the physical and the social womb. One of the many dimensions of mindfulness is cost-benefit analysis - the cost/benefit to the person, the person's family, the person's society, and the world.
.....We are social creatures, and for help in making major decisions need to talk with one another. For almost all of us, the subject most difficult to talk about is our own death; and those hardest to talk with are, with few exceptions, those closest to us, our family. Friends, maybe. Spiritual guides, possibly. Physicians, only when the subject becomes unavoidable, and Hospice care swims into view.
.....As long the chaplain of Hospice of Cape Cod, my wife's central sadness was that so many so long deferred Hospice care of body, mind, and spirit. Upon concluding that a patient is within six months of death, a physician may certify the patient for Hospice care. But so many deny death until, only weeks or even days before it occurs, they are forced to face it.

5.....We are taught to be responsible for our life, but not for our death. Rather, by default, we are taught that death should occur not by any human intervention but only "naturally." But in our retirement community, at least half of us would be "naturally" dead if there had not been "unnatural" human intervention. It's worse in nursing homes: about 80 percent would be dead had "nature" been permitted "to take its course."

6.....Especially distressing to me, as a religious leader, is the argument that it's "God's will to let nature take its course." Good religion clarifies thinking, bad religion muddies it. The argument is bad religion whichever way it's read: either no medical attention or the diametrical, maximum medical technology to keep the organism alive ALAP (as long as possible). Both meanings are rigid, cruel, and blasphemous.
.....Both meaning are taught. Almost no Americans are taught the first meaning, and almost all Americans assume the second on the basis of "the infinite value of the individual," an Enlightenment idolatry supported by a misreading of the Biblical doctrine of human beings as "created in the image of God." The taught can be re-taught, re-educated.
.....Good religion and good science teach that the bio-sphere is a unity in which a living human being is a single organism dependent on and influencing other organisms and the inorganic world. The members of our species are the only creatures to whom the Creator has assigned conscious responsibilities for other creatures and for the environment (Genesis 1.28 - 2.20), and those responsibilities involve the impact of our footprint (as individuals, groups, and the species).

7.....The older we get, the bigger our footprint: the more resources it takes - monetary, human, environmental - just to stay alive, and the more urgent it is that (facing all our responsibilities) we make end-of-life choices. We need to be informed about our options. It costs us nothing to talk with our spiritual adviser about it: should we have to pay to talk with our physical adviser (our physician), or should Medicare pay for it? I believe Medicare should pay for it - primarily because it should be a service open to all Medicare patients, secondarily because it would reduce Medicare expenses (as some would choose to refuse extraordinary measures to prolong life).

8....."Too many suffer needlessly. Too many endure unrelenting pain. Too many turn to violent means at the end of life." Those are words of the nonprofit, no-charge "Compassion and Choices: End-of-Life Consultation," one more option for conversation about end-of-life decisions. Worth checking out at 1-800-247-7421 or www.compassionandchoices.org.

By Willis E. Elliott  |  November 4, 2009; 9:20 PM ET
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