HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Wednesday, August 10, 2005

The "Good Death"

The New York Times ran a remarkable article in its Sunday magazine this week: "Will We Ever Arrive at the Good Death?"  It's a close up and personal view hospice, palliative care, and other aspects of dying in America.  Here's a brief excerpt:

[T]he new trend in hospice [is] toward ''open access,'' meaning that terminally ill patients can continue chemotherapy and other treatments and still get hospice benefits through Medicare. The idea began in the 1980's, when AIDS patients started enrolling in hospices and weren't quite ready to give up all medical options. Today hospice workers are also aligning with doctors in a field known as palliative medicine -- an approach that emphasizes pain relief, symptom control and spiritual and emotional care for the dying and their families. With hospice becoming so inclusive, and with palliative care on its way to becoming a new medical subspecialty with its own licensing exam, the natural, machine-free deaths we say we want are starting to look a lot like the medicalized deaths they were meant to replace.

The trend reflects society's deep ambivalence about dying. During the long and public agony over the death of Terri Schiavo, debate centered on the right to make end-of-life decisions. But underlying the political posturing was a shared assumption that was barely acknowledged: the belief that dying is something over which we have some control. This death-denying culture has led to a system of care for the terminally ill that allows us to indulge the fantasy that dying is somehow optional.

In many ways, we act as if we can avoid death indefinitely if only we're quick enough or smart enough or prepared enough. Even hospice workers call their field by a new name that accentuates the positive: they used to say they specialized in ''death and dying,'' but today the umbrella term is ''end of life.'' The shift is subtle but significant -- an emphasis on ''life'' rather than ''death.''

What we have, then, is a medical system for the dying that is as ambivalent about dying as we are ourselves.

The accompnaying photographs are really gripping.  [tm]

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