Thursday, May 21, 2009

Maggie Mahar on Facing Death

You and I are gonna die.

Get over it.

Now go read Maggie's post.

Did you know that a “living will” is not a legal document in New York State or Massachusetts?

Did you know that environmentalists have created nature preserves where you can be buried? “What we are doing is basically land conservation,” says Dr. Billy Campbell, who has created a preserve along Ramsey Creek in South Carolina. “By setting aside woods for natural burials, we protect it from development. At the same time, I think we put death in its rightful place, as part of the cycle of life. Our burials honor the idea of ‘dust to dust.’” Ramsey Creek is just one place where families can arrange “green burials.”

These are a few of the things I learned yesterday at a “Leadership Connection” lunch for women in business, politics and the non-profit sector. There, New York Times health editor Jane Brody spoke about her new book : Jane Brody’s Guide to the Great Beyond: A Practical Primer to Help You and Your Loved Ones Prepare, Medically, Legally, and Emotionally for the End of Life.

This might sound like a morbid subject, but in Brody’s hands it isn’t. Let me put it this way: the book is illustrated with cartoons by artists who publish in the New Yorker. And Brody herself is, by turns, funny, pragmatic and sensitive to the pain that our death-denying culture causes (“Dying can be an extraordinarily lonely experience for children when their parents do not allow the subject to be discussed.”)

Dying is also big business. Times have changed since Jessica Mitford's American Way of Death. Back then the funeral industry was about the most profitable enterprise connected with dying. Thanks to the spirit of Yankee enterprise the last months and years of life offer a gold mine of opportunity for a whole range of professionals, starting with anyone connected with Medicare, especially the cancer doctors, to hospice providers. I was surprised to learn in January when my mother died that the nursing home let me choose among five hospice businesses they commonly see at that facility, but they made it clear that I was free to chose any other group I wanted. They didn't want to appear partial (perhaps not wanting to be accused of collecting a rebate?). I have no idea how many such businesses operate in the Atlanta area, but I got the idea that there were many more than five. I think that during the three weeks my mother lived they came close to the four thousand dollars allowed by Medicare for hospice.

It's no accident that groups using scare tactics to oppose changes to the snatch and grab delivery system we call health care in America are aiming their message at old people. They and their offspring are the group that would be better served preparing to leave this life in comfort and peace instead of fear and dread. In addition to watching helplessly as substantial estates are consumed in the last weeks and months of life, those final weeks and months could be free of unnecessary suffering, both mental and physical.

This post is about facing death, but part of that package includes arrangements that follow. Readers who are interested should also check into the advent of "green cemeteries." The movement is fairly new, but the idea is as old as pre-history. Also, the notion of home funerals is not out of the question. I put up a post about that several years ago.


Deron S. said...

We need to get this end of life stuff figured out because it's very costly as we all know. It's costly because of all of the grabbing hands, and it's costly because we are keeping people alive for the benefit of their family members more than themselves. It's a recipe for a Medicare meltdown.

Hoots said...

You got that right. Working in the retirement community field for the last six years has been an eye-opener for me.

I knew years ago when my parents qualified for Medicare they started getting a level of attention that neither of them had ever enjoyed in their lives. In overall population statistics the US may not look good compared internationally (infant mortality, etc.) but I bet we have the healthiest old people on the planet.

Every time a senior darkens the door of a medical provider it's like a scene from "It's a Wonderful Life" when you hear that little tinkle every time an angel gets his wings. It's the tinkle of the cash register you hear.

The joke I came across some place was "Why do coffins have nails?"
Answer: To keep the oncologists out.

I just had a thought...
With Medicare already covering old people, adding the rest of the population to the system shouldn't be as expensive as it might otherwise be. As a population we have a lot of bad habits and lifestyle challenges that make us sick, but younger people have an edge. The seeds of obesity, heart disease, respiratory issues and dementia may be planted, but younger people are already getting by with minimal attention. Those problems are present in the Medicare set but there is no reason to expect they will cost more earlier. In fact, treated sooner, the overall financial impact could be to bring costs down.