Before 1950, most Americans died at home, from what were once familiarly described as “natural causes.”
By the 1980s, only about 1 out of 6 deaths occurred at home—most folks died in hospitals or nursing homes. The practice of medicine had expanded to embrace one’s last moments in an institutional setting, instead of the relative comfort of one’s own bed.
The trend toward dying in a hospital bed has reversed itself. Data from 2010 shows that about 45% of Americans departed this life in hospice care, and more than half of those folks received hospice care at home. These U. S. figures are among the highest in the world.
Dr. Atul Gawande writes in Being Mortal: “…our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.”
Dr. Gawande explores the often un-mentioned truth that simply “living as long as possible” isn’t the real wish of many people, and probably isn’t what most people really want.
“We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive.” (1)
Most folks say that “quality of life” is most important at the end.
Read Being Mortal.
Take some time to think about what “quality of life” means to you.
Talk to your doctor and your loved ones about it.
(1) Atul Gawande, Being Mortal: Medicine and What Matters in the End (New York: Metropolitan Books, Henry Holt and Company, 2014), 6, 193, 243, 259.
Copyright © Richard Carl Subber 2015