Death & Morality

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What does it mean to "die well"? There is a lot of debate about that today because the ability of medical technology to extend life doesn't always translate into an ability to make that life pleasant or meaningful. Sometimes, people feel that it would be better not to extend life so much and allow a person to die a bit sooner. This has led to greater attention on euthanasia, but just as important has been the attention given to efforts to improve the quality and dignity of the end of life in order to avoid having to go as far as physician-assisted suicide.

Unfortunately, this latter debate tends to get lost in the din of arguments over euthanasia itself - but if the quality of life and personal dignity can be reinforced or maintained for as long as possible, then the situations where people are inclined to ask for help in suicide will be reduced. Who can argue that that wouldn't be a good thing? Many times people who think about suicide are simply afraid about what will happen when they come close to death - a fear which itself can impact the way a person lives long before any physical ailments become a serious problem.

Thus, discussions about hospice, palliative care, and the spiritual needs of the dying, not to mention advance directives to settle legal matters, are absolutely critical. Here a recent book edited by Robert M. Baird and Stuart E. Rosenbaum, Caring for the Dying: Critical Issues at the Edge of Life, can be a big help.

The articles in this volume discuss the nature of hospice care (explaining it, debunking many myths, etc.) the nature of palliative care (explaining the nature of pain, the use of drugs to relieve pain, the nature of suffering, etc.), the spiritual needs of people approaching death (including the relationship between caregivers and patients, how to discuss religion, etc.), and finally the legal aspects of end-of-life care (advance directives, Medicare funding, the power of attorney, etc.).

All of these essays were contributed by various experts in the fields like law, nursing, medicine, and social work, including representatives of major organizations like Compassion in Dying and the American Hospice Foundation. Although they come from many different backgrounds and perspectives, they do agree on one point: that patients themselves are diverse and cannot be treated as a monolithic whole. That may seem obvious, but in the past there has been and predisposition to treat all of the dying alike, giving them the same services and treatments; yet that really isn't appropriate.

Because everyone is different, their attitudes towards life and death will differ. This means that how they are treated will have to differ as well. People have different pain thresholds, different ideas about "suffering," and different religious or spiritual concerns. This is where the "caring" comes in - you can't be involved in "caring" for those who are dying unless you put them and their needs first:

[I]n any caring relationship with one who is dying, the first responsibility is to be open to individuals in order that they may be permitted the luxury of revealing where they are in terms of their present attitude toward death.

The purpose of the book is to help people understand this and as well as the various ethical dilemmas and responsibilities that come with end-of-life heath care. Like other volumes in Prometheus' "Contemporary Issues" series, this draws together a remarkable collection of essays which provide a solid grounding in an subject too often neglected.