Forgetting How to Die

Suffering from pneumonia in a hospital bed at Cedars Sinai Medical Center Groucho Marx found one more way to make his audience smile. On the verge of death, the great comedian went out with one more zinger: “This is no way to live!”

Marx probably did not have bioethics in mind when he cracked his last joke, but medical practitioners and bioethicists like Ezekiel J. Emanuel and Atul Gawande might agree. Our effort to do whatever is possible to extend our lives is no way to live our last days.

In his New York Times essay “Why I Hope to Die at 75,” Emanuel explains what he calls the “American Immortal” – Americans who are obsessed with prolonging life, even at the expense of quality. In his op-ed “The Best Possible Day,” Gawande exposes the flaws of our immortal obsession. Facing incurable cancer, the piano instructor in his story finds triumph not by beating death, but by pursuing her passion for just a few more weeks instead of suffering hopelessly in a hospital with no remedy in sight.

Both authors share the conclusion that clinging to false hope or temporarily propping up a failing body deprives the dying and their loved ones something profoundly important in the dying process: meaningful closure and an honest legacy. By trying to prolong life beyond a certain point, Emanuel writes, “It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.”

When asked what goals she had before her inevitable death, Gawande’s piano instructor could not see past an immediate future of suffering, humiliation over losing control of her body, and the hopeless thought of never leaving the hospital. She had accepted her fate, but some missing element left her bitter and angry. A few simple questions seemed to realign her perspective and while her pain persisted, her life story concluded with inspiration.

The author’s arguments and happy ending anecdotes are calming while sitting here decades removed (hopefully) from the time and circumstances of my own death. Except for my grandparents and beloved pets, I have largely been spared the heartache of losing someone very close to me. It seems foolish to assume my state of mind once facing such permanence. Will I cling, like so many do, to any shred of hope that a medical miracle might give me a few more months or years with my wife and daughter? Or will I look for contentment?

What does being content even mean in that final moment? Will it be looking back on my life’s accomplishments and finding little regret? Is it leaving the world just a little better off than I found it? Or will it be holding the hand of someone I love just one more time? No doctor, no surgeon, no nurse can answer that question for me.

Gawande again turns the spotlight on his own profession when he writes, “Medicine has forgotten how vital such matters are to people as they approach life’s end. People want to share memories, pass on wisdoms and keepsakes, connect with loved ones, and to make some last contributions to the world.“  But are practitioners simply responding to the demands of society? How much responsibility should be placed on the medical community, if it is we who have collectively forgotten how to die?