There was a thought-provoking article in today’s Wall Street Journal written by Katy Butler, author of the soon to be released book, “The Art of Dying Well: A Practical Guide to a Good End of Life.”
In the article, Butler describes how she hopes to make her death as good as her life has been. Her wish is to die in her own bed, cared for by people she loves—clean, comfortable and relatively free from pain. She hopes to have time to say her goodbyes and give her final blessings.
Butler notes that most people want to face their final days at home, surrounded by loved ones, as free from pain as possible.
But she points out that few people do much in terms of planning so as to make such an outcome possible. As a result, half the people in the U.S. die in nursing homes and hospitals, and more than a tenth are shuttled from one to the other in their final three days. Pain is a major barrier to a peaceful death, and nearly half of dying Americans suffer from uncontrolled pain. And more than a quarter of Medicare members cycle through an Intensive Care Unit in their final month, and a fifth of Americans die in an ICU.
Butler offers the following advice:
- Have a vision: Imagine what it would take to die in peace and work back from there. Talk to those you love about what a good “quality of life” means to you and put it in writing in a letter or advance directive.
- Stay in charge: If your doctor isn’t curious about what matters to you or won’t tell you what’s going on in plain English, fire that doctor and find another.
- Know the trajectory of your illness. If you face a frightening diagnosis, ask your doctor to draw a sketch tracking how you might feel and function during your illness and its treatments.
- Find your tribe and arrange caregivers. Dying at home is labor-intensive. Hospices provide home visits from nurses and other professionals, but your friends, relatives, and hired aides will be the ones who empty bedpans and provide hands-on care.
- Take command of the space. No matter where death occurs, you can bring calm and meaning to the room. Don’t be afraid to rearrange the physical environment.
- Think of death as a rite of passage. Our ancestors were guided by books and customs that framed dying as a spiritual ordeal rather than a medical event. Without abandoning the best of what modern medicine has to offer, return to that spirit. Don’t reduce the end of your life to a medical procedure or strip it of ceremony and humanity. Make sure you live and die as a full human being.
Butler concludes that those who contemplate their aging, vulnerability, and mortality often live better lives and experience better deaths than those who don’t.
Butler certainly offers a lot of good food for thought, on a topic most people try to avoid thinking or talking about.
I was curious what some of the commenters might have to say about Butler’s advice, and I came across this great reply from a nearly 80-year old reader of the Wall Street Journal. Rather than focusing on how to plan for the end of life, Neal Yampol offered advice on how to live life to the fullest for as long as possible.
1-NEVER retire from paid work. My typical financial client is 25-45 years younger then me. Nobody has ever fired me because they thought I am too old.
2-Cut your own grass; spray/pull your own weeds; change your own light bulbs
3-Get a dog – get 2 dogs – walk them daily – go to the dog park- you’ll be surprised how many other “dog people” want to talk to an “old fogie” who comes to the dog park with 2 dogs
4-Go to the YMCA (or equivalent) every other day for a serious workout
5-Take your grandson/granddaughter to lunch and to a ballgame
6-Use HEARING AIDS if needed – don’t worry about the cost – just get them
7-Stay current with your health providers
8-Wear decent shoes
9-Have a “honey” – whatever this means to you
10-Meet friends for lunch frequently
11-Continue following your favorite sports teams-Go Wisconsin Badgers Football & Basketball, Marquette Basketball & GBay Packers
12-Read WSJ -comment often
I love this manifesto, except for the reference to Marquette basketball ( they beat Villanova today). Seems like you can’t go wrong doing any of those things.
May you live long and prosper, and die well…
*image from San Diego Tribune
Borden's Blather 
I have been interested in the topic of dying well for several years even though I’m not that old yet. My husband thinks it’s weird to think and read about this as much as I do, and I think his attitude is symptomatic of our society’s primary interests in heroic measures and belief in life at any cost regardless of the quality. I recommend reading Kerry Egan’s book, “On Living,” for more insight into the experience of life’s final moments and what will really matter then.
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I think about retirement a lot, but not past that. Thanks for the book recommendation!
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