A changing death culture leads to dying with dignity policies
Humans no longer know how to die. To be fair, they may have never truly needed to know.
Today, we’re living much longer than our 18th century ancestors and are able to extend our lives virtually forever with modern medicine. In other words, though unconscious, our organs can be propelled by technology in ways that prevent death, prompting the need for us to learn a new skill: how to die and navigate end-of-life matters.
Atul Gawande explores this idea in his book Being Mortal, where he traces the end-of-life process for the dying and their loved ones. In the book, he comes to realize that many people are living much longer than they actually want to partially because of a blind faith that medical technology will keep them around in good fitness longer, and partially due to a medical system that avoids the topic of death altogether. Ultimately, the problem is that people don’t know how to even begin talking about death.
Westerner’s fear of death may be related to our colonial past. In Stephen Jenkinson’s book, Die Wise, the author critiques the modern, colonial, Christian view of death as the absolute end. Today, there are fewer rituals for the dead, he notes, and less ceremonies and stories to remember and honor the previous generation, leaving us with the feeling that self-worth can only be discovered during life. From this view, after you draw your last breath, you won’t be much considered. As such, people are choosing to delay death as much as possible, and avoid discussing it at all costs. But that doesn’t apply to all.
Some — including mostly younger people — are trying to start the discussion in a myriad of ways.
A study of 84 millennials at California State University Long Beach by assistant professor Nathan Gerard found that young people are eager to discuss wishes they have for the end of their lives. In fact, the study found that 54% of millennials had already spoken with a family member about future end-of-life care.
The market is responding to this trend. The greater death industry — including funerals, memorials, death planning, and more — has begun to boom as a consequence of young peoples’ willingness to discuss end of life. Death doulas, death cafés, and especially a greater openness and curiosity toward death has been seeping into the culture. Contrary to Jenkinson’s assertions, many are wanting to embrace their death and the planning that goes with it.
The policy consequence of this trend has led to dignity with dying acts. Beginning with Oregon in the late 90s, dying with dignity laws — also known as physician-assisted dying or aid-in-dying laws — allow mentally-competent adults with a terminal illness (who have six months or less to live) hasten their death under medical supervision. The policy allows the dying to take control of the end of their life, putting their needs and desires first, rather than the greater medical community.
Statewide policies like these have been gaining traction with nine states and the District of Columbia already implementing the practice into law. While no federal bill has been introduced in Congress, there’s little reason to believe that death and dying acts won’t continue to be implemented in more state legislatures. This appears especially true as people have been reported to go as far as crossing state lines to die in places where the legislation has been enacted.
And mounting evidence is pushing people to be more open and autonomous around their death planning. An article in the British Medical Journal uncovered that enhanced discussion on end-of-life matters during palliative care sessions found those patients’ end-of-life care to be of a higher quality. In his book, Atul Gawande found a similar pattern: the hospital in La Crosse, Wisconsin had improved patient satisfaction and kept end-of-life costs down by having elderly patients discuss their advanced directives well before the last six months of their lives.
While these policies and practices are still in their infancy, many are on the path to figure to uncovering a new mystery technology has provided. They are learning to die wise.