Tuesday, September 22, 1998

Most of us not willing to face issues of dying

A generation of Americans that boasts of its openness and willingness to talk about anything will not talk about death, except in such Victorian euphemisms as "passed on" and "gone to heaven."

That reticence can have severe emotional and financial consequences. People are living longer, and ever-improving technology allows - or forces - them to live even longer, too often in circumstances that are painful and humiliating. The result is a huge distortion in medical spending. The government spends $100 billion a year (about 40 percent of what we spend on national defense) on the last 12 months of life and the bulk of that on the last two.

Death is, as the saying goes, a fact of life, but a Scripps Howard News Service series "Last Rights" - which concludes today - finds that there is something new about dying: More than at any time in history, death can be artificially postponed but the same technology gives the dying unique control over the hour of their parting.

But the series finds that many Americans are unwilling to confront the fact of death.

An SHNS poll finds that 81 percent of adults have not talked with their doctors about the medical issues of dying. Terminally ill patients are still reluctant to discuss the manner of their deaths with their families, and when they do, the families are often too embarrassed to carry out their wishes. Even something as simple as a graceful death is swathed in a techno-euphemism, "pulling the plug."

Relatively few Americans take advantage of living wills and federal laws that allow them to determine the nature and extent of care they will receive in the last hours of their lives. And even when they do, doctors and hospitals often fail to honor those instructions for fear they will be sued if they do and sued if they don't.

No one should have to die like the young AIDS patient, unconscious, in diapers, fed through a tube, or like the elderly minister, pleading with his son to rip out the tubes. With forethought, no one has to.