Wednesday, December 22, 2010


Somehow I found myself last night in a discussion of what should happen to old people if there is not enough money available to keep them all alive. That is, would there ever be enough money available for health care for all, and if not, what about “death panels,” or, as Senator Grassley and others so genteely put it, “pulling the plug on grandma.” I am interested here only the question of the elderly, not whether or not Arizona can afford liver and heart transplants for all that is, of course, a related issue.

You are all doubtless aware of the claim that Eskimos would sometimes leave their old people to freeze to death when there was not enough food to feed everyone. There is little doubt that old people accepted this as a necessity and perhaps even volunteered themselves. I’m sure there are other examples of old people being sacrificed, willingly and otherwise, if others are to live, as apparently sometimes happened in Japan, among some subsistence-based groups, and so on. So, should a society like the United States be responsible for keeping old people alive as long as possible, or should there be “death panels” of some kind to determine who should live and who should not? And what, exactly, would a death panel actually do, if there were, in fact, such a thing?

First of all, I doubt that anyone really knows very much about what happens to old people in the United States at this time. For example, it is clear that the suicide rate for those over 65 goes up rather sharply. As far as I know the suicide rate for white males over 65 is much higher than for any other age. I think it is entirely possible that many of these suicides are deliberate senilicides, carried out to relieve the potential burden on their survivors, but does anyone really know this? There are also cases that would not be considered suicide but might also be deliberate senilicides. For example, I know of one case of a woman, a great grandmother in her nineties, who when told she could have a mastectomy, simply told the doctors they were being ridiculous and elected to let it run its natural course. I know of another case, a man of my own age, who was told he had cancer, and if he let it run its course he would probably have another four or five years. He declined treatment. What would you do when faced with a possible bankrupting treatment in your fading years, how much would a couple of more years of life be worth to you? This is not merely a philosophical issue but a genuinely real and practical problem. While there is no way of knowing, it appears to me that many Americans in their dotage are already practicing senilicide, sacrificing themselves for the benefit of their children and spouses. I suspect this is far more common than anyone thinks, a modern version of an older practice. There are, of course, all those millions without health insurance who have no choice but to die slowly and miserably because they cannot afford to do otherwise. Why should such individuals have to die slowly in pain and suffering with nowhere to turn, no support, no help? There is, of course, at least one organization, Death with Dignity, that promotes forms of euthanasia for those who are terminally ill and no longer wish to continue suffering. Yet there is active opposition to such practices. There is at least one state, Oregon, that actually permits doctors to assist in end of life situations. Why should this not be the norm rather than the exception? Why should suicide be considered a crime as it apparently is in some places? Why should an old person not be able to end their life on their own terms rather than be kept artificially alive for as long as possible in spite of being in a merely vegetative state? It is true that one can have a so-called “Living Will” that specifies what they want to happen to them when the end is near but as far as I know there is no guarantee their wishes have to be followed unless their survivors agree. I do know of cases, for example, when individuals wished t o be cremated but were buried instead because their survivors did not believe in cremation. But that is a bit of a digression.

This is a real problem. It seems to me it has to do with the American obsession with staying young as long as possible and simply denying their mortality. People grow old. They die. Dying is just as much a part of life as being born and living. Death should not be a taboo topic, nor should it be considered a fate worse than death (ha ha). Even if one has unlimited funds, does it make sense to have repeated expensive treatments to prolong life for another few months of relative misery? How much is a week of life, when one is ninety, really worth? Why should there not be death panels, caring, knowledgeable individuals who can advise people of their proper condition, their chances of further life, and so on? And why should someone’s willingness to die for the benefit of others be considered somehow sinful or shameful, or against the wishes of a church or society? Our attitudes towards death seem to reflect primitive ideas having to do with the fear of the unknown, of heavens and hells, ghosts and goblins, guilt and repentance, angels and devils, eternal damnation, and perhaps the fear of being reincarnated as a lower form of life.

I know a few people who say they would like to live forever. Personally, I cannot imagine wanting to live forever, what with all the anxiety, frustrations, ailments, responsibilities, worries, difficulties, and problems that characterize what I assume is a “normal” life. I suspect one can deal with this for one lifetime, but forever? While I do not look forward to it eagerly I am not afraid of death, although I confess to being a bit nervous about the process of dying. I once had a rather massive dose of morphine. It was the most relaxing and wonderful experience of my life. I suspect death is like that, what is meant when we hear those comforting words, “rest in peace.”

Where I worked for a time in the New Guinea Highlands, when a person is considered so old they are obviously near death, their survivors and others hold a funeral ceremony for them while they are still alive, to let them know they are respected and will be missed (also to placate their potential ghost so it will not hang around causing misfortune). These occasions, perhaps needless to say, are very emotional, the speeches can be endless, and the oldsters are sometimes overcome, weeping and even falling to the ground. This seems to me to be a more sensible and genuine way of saying goodbye and expressing grief than by feeling guilty and regretting you did not do and spend more to prevent the inevitable.

No comments: