Tuesday, April 10, 2007

The Odds of Dying an Undignified Death: One in Five So They Say

Did you ever stop to think how the last chapter in the book called Your Life may transpire? Are you fantasizing that your “final act” will be staged in your own comfortable bed under dim lighting, and surrounded by loved ones, sweet flowers, soft music, satin sheets, and on-demand medications? Or, perhaps you thought you would “phase out” with only the sandman and/or your guardian angel supervising your final moments on planet earth.

Well, you might want to prepare yourself for the harsh reality that your death or the deaths of those you hold dear may be less than dignified and more reminiscent of a documentary. According to a new book, A Social History of Dying, authored by Allan Kellehear, Professor of Sociology at the University of Bath the deaths of >50% of population will be managed by medical personnel following serious injury or ill health, with only a small proportion of persons dying suddenly and unexpectedly. As the author explains, people are significantly more likely to die a lonely and prolonged death in a long-term care facility or hospital preceded by multiple organ failure, pneumonia, or dementia.1,2 One in 5 persons are expected to die from deaths that would be considered “shameful” (ie, dying alone with dementia and without dignity) by individuals from previous generations. As the aging baby-boomer population increases and as average life-expectancy increases, it is probable that dying a less-then-dignified death will be more likely to transpire. In addition, advances in science and medicine and the increasing dementia epidemic have been implicated in delayed death.1,2

Unfortunately, it seems more likely that your final “act” will be staged under fluorescent lighting, in a hospital bed in the confines of a nursing home room shared with >1 bedridden strangers. Your “music” will be a PA system, your on-demand medications will be administered based on your nurse’s busy schedule, and the only “sweet flower” in the room may be the wilting, recycled carnation that was popped on your cafeteria lunch tray.

Trends have shown that the best way to deal with older persons in ailing health has been to develop more long-term care facilities. Yet the quality of healthcare at these facilities continues to be a debated subject. Major concerns with institutional care include lack of attention to cultural needs and cognitive function of their long-term care residents. Professor Kellehear cautions that many persons are unprepared and lack foresight on the realities of their own death, such as medical advances that delay the dying process. He predicts that suicide among elderly and terminally ill persons will increase in coming years and indicates that the largest age-related group of suicides exists for person aged >80 years. When it comes to taking their own life, elderly persons are less likely to provide warning and are more likely to successfully carry out suicide compared with other younger persons: 50% of persons aged >65 succeed in suicide versus 25% of younger persons. “The act of dying appears to be disintegrating” noted Professor Kellehear. Results from a survey of older persons revealed some of the reasons why older persons do not want to live to the ripe old age of 100. These included the refusal to face disability, pain, cognitive decline, lose bodily and social autonomy, and loss of dignity.1,2
While Professor Kellehear’s book is not considered academic by any means, he cites several salient yet controversial points. Some major takeaways that deserve greater consideration include the right to control the way in which we die, the quality of care of persons who are dying, and potential policies and ethical issues associated with the dying process.1,2

“I am not dead just yet” is the adage that comes to mind after reading more about Kellehear’s perspectives. Essentially, dying is a component of the living process and one that deserves greater thought, respect, and planning on the parts of ordinary citizens, medical personnel, organizations, as well as government.

1. One in five people will face a ‘shameful’ death-could it be you? Medical News Today Web site. Available at: http://www.medicalnewstoday.com/medicalnews.php?newsid=66847. Accessed April 2007.
2. Kellehear A. A Social History of Dying. Port Melbourne, VIC: Cambridge University Press; 2007. Available at: http://www.cambridge.org/aus/catalogue/catalogue.asp?isbn=9780521694292&ss=exc. Accessed April 2007. [excerpt]

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