Comfortable and Furious

Death Without Dignity

My profession is to witness and resist the inexorable pull of death. With an armamentarium of medications, I reverse death when it is possible, provide comfort when it is not, and occasionally facilitate its imposition of will on mortal flesh. I am an air traffic controller with a white coat and stethoscope. To mine and my colleague’s amusement, actual air traffic controllers have notoriously high rates of drug use and alcoholism.

No matter what our profession or station, we all are affected by what has become an unhealthy obsession with, and aversion to, death. From a fatalistic collocation like “Kill them all” to the delusional conceit of Heaven, everyone has their opinion when it comes to the edge of the mortal coil. People tend to use odd phrases like that to refer to death, as if it may come calling if mentioned in conversation.

My favorite phrase is ‘Death With Dignity’. This twee turn of phrase refers to the idea that a person shall die on their own terms, rather than languish for an extended period on a feeding tube and/or ventilator to become a pitiful symbol for mankind’s desire to live forever. A noble idea indeed, if it were not for the notion that every special person may not only order a serving of dignity upon death, but are entitled to it. I will not go into how utterly devoid of dignity life generally is, as that is a larger subject.

Death with dignity means that after suffering acute or chronic illness for which there is no reversal into a decent quality of life, all support is withdrawn to allow nature to take its terminal course. This is only possible if a person has had the necessary talk with family, and has made it clear that lingering in an obscene facsimile of life is not their long-term plan. The family must then refrain from going into histrionic convulsions and demand full vegetable status for their loved one, often due to the guilt of a biannual visit to grandma’s nursing home room to clean out their change jar.

It is helpful if the family is unacquainted with religion, as they tend to cling to faint hope and declare that “God will take them when it is their time”. I picture God in the corner with a Snickers bar at discussions like these.

After watching so many families agonize over this decision, I can attest that Death With Dignity and taking the morphine drip is the way to go, rather than allowing guilt to overwhelm ones’ senses and hope for a decent quality of life that will never come. Don’t get me wrong, I agree with the idea of comfort care, palliative care, and so forth, and would recommend it for anyone with an irreversible disease and being unable to interact with other people in any meaningful way. When one is able to make this choice, it really is for the best, and the families involved are universally glad to have been able to make that choice.

What strikes me as strange is that when it comes to health care, people have become accustomed to deciding how their lives end. This is understandable, as we get to order pretty much anything else in a society awash in cheap goods and google searches. If one has the opportunity, then so much the better, but the vast majority of people on this planet not only are deprived of the choice to die with dignity, but to live that way as well.

Regardless of the course taken, life or death amongst the entitled is all about conspicuous consumption. Proof that not only can you out-consume the Joneses, but you can cease being a carbon-based life form when and how you wish. Ten shit-kickers in Alabama sucked into a tornado make international news as a Tragedy. This is not due to the awful circumstances of death, but that they did not die in a place and time of their choosing. Being whipped 100 miles through the air and exploding into pieces in the next zip code just isn’t as dignified as dying in a pool of piss and vomit in a nursing home, apparently.

People would choose dull immortality if they could, but lacking that option, invariably will take the piss pool. So, while a million people die annually from malaria, people are still given the option of eating through a tube to sustain a brain long since departed. Porsches are for amateurs when you can sit pretty on a ventilator, ringing up the annual equivalent of Malawi’s health care budget (I’ll insert a hyperlink to your Malawi article here).

The world is a rough place. Expect nothing, for you are entitled to nothing. This is not pessimism, it is the reality of a blank morality slate in a world where right and wrong do not, as such, exist. Expectation is the bastard offspring of privilege, and blunts one’s ability to learn that a place in the world is no place at all. Fear of death and sex command our every waking hour, unless breeding intrudes and replaces sex with the need for sleep and, in my case, alcohol.

The posturing around the circumstances of death fool nobody who actually deals with it. When one speaks of death with dignity, they express a fear of slow death, and want to get it over with as soon as possible. For a loved one, it is our own fear of death that induces us to keep them alive as a silent food processor. Even the solemn way we ritualize death becomes an exercise in manipulating our fear into some sort of nobility and feigned understanding.

Humans are not entitled to death with dignity, just as they are not entitled to life, puppies, or rainbows. A great elevation in mankind’s understanding will occur when we realize that we simply exist, and perhaps are unique in being able to register the passing. The human species is doomed to become rat food, and the mammalian order doomed to feed the insects, and so forth (I’ll insert a hyperlink to your TFIW review here). There is no heaven, and certainly no dignity to be counted upon to feed our vanity. There is only the inexorable arrow of time and the void behind it.

As ‘Death With Dignity’ becomes increasingly popular in health care circles, I thought it advisable to remind people that such things are hardly guaranteed. Acceptance of the inevitable is a normal part of the grieving process, but do not become too obsessed with ritual, as such things are as useful as wasting a single moment dwelling on the injustice of being mortal in the first place. The time that matters is what you spend with that person while they are alive and in full possession of their faculties, well able to tell you how tough times were when they were your age, and how much easier our lives are now.

In contrast to the histrionics that often surround death, I have had interactions with several families who have dealt with the impending death of a loved one with utter dignity and acceptance once a point of no return had been passed. They prepared for the mourning process, given a bit of time, said their goodbyes, and then gave the order to pull the plug. Apart from taking that time to quietly consider the memory of their loved ones together, these people had in common that they were fearless in the face of death – they did not dwell upon the process.

I had nothing but the deepest respect for them, and could only hope that those presiding over my death show the same restraint. A family can choose whatever route they wish when making decisions on behalf of a family member in a hospitalized setting – they are the boss and the physician will do as they are told. I cannot help but notice that those families that were most happy were those choosing to reflect, rather than become paralyzed by fear.







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