Let’s talk about death. The American Medical Association recently created billing codes for end-of-life conversations between patients and their health care providers. Euphemistically these are sometimes referred to as “advance care planning,” as if it were a chat about organizing a party, or making sure we have everything arranged for our vacation.
Notwithstanding the incendiary and ill-informed hyperbole of Sarah Palin’s “death panels” label, it is bemusing that talking about how we wish to die is such a controversial subject. Obviously, death is a serious subject, but given its inherent ubiquity, avoiding it is like avoiding oxygen.
Talking about how we wish to die is not the same as denying life saving treatment, though I’d be happy to discuss transparently the ethics and dignity of that also. A conversation about death is a conversation that alleviates our anxieties, confronts our fears, and calms our families. A study reported in The BMJ (formerly the British Medical Journal) illustrated that, “Advance care planning improves end of life care and patient and family satisfaction and reduces stress, anxiety, and depression in surviving relatives.” This conversation leaves the inevitable ending moments unburdened by the trauma of swift decisions about treatment, and allows room for emotional warmth and catharsis.
Of course, it is never a single conversation, and numerous thoughtful, caring discussions are necessary. It takes a lifetime of conversations to weigh the single endpoint. While we have no choice about our mortality, we do have a choice about how we wish to face it. Inherent in that choice are conversations relating to our parting. As my father lived his final three years while dying of cancer, he lived them fully and in conversation. It wasn’t easy, but living and dying are complicated. That’s why we should talk about them.