Our Death-Defying, Death-Denying Society

We (Americans) live in a death-defying, death-denying society where the inevitable outcome is frequently prolonged through futile treatments and heroic measures. A cultural shift must occur regarding peoples' views on death and dying because, even in the face of top-notch medical technology and countless interventions, all living people will die. Death, just like birth, is a very natural part of the circle of life. Nurses Announcements Archive Article

Our Death-Defying, Death-Denying Society

The following is a psychic reading that will eventually prove accurate with every single person in existence today: we're all going to die.

The fact is that life will end, and how Americans choose to cope with this reality gives us an overall picture of our society's position on death; generally speaking, the American attitude is one of avoidance (Johnson, 2004). Simply put, we live in a death-defying, death-denying society.

According to Gemignani (2011), death in times past was not necessarily less tragic to those who lost loved ones, but death was more prevalent, more public, more visible, and more a natural part of life than it is today. Many generations ago, 'passing away' was an intimate affair where aged people lived and died at home surrounded by family, and the surviving relatives provided the post-mortem care in the immediate hours after death. In modern times, death has neatly been removed from the home as the overwhelming majority of deaths now take place in healthcare institutions such as hospitals and nursing homes.

In 2009, Medicare paid $50 billion just for doctor and hospital bills during the last two months of patients' lives - that's more than the budget of the Department of Homeland Security or the Department of Education (CBS News, 2010).

Is the massive amount of money being spent during the final months of life really helping, or are the billions of dollars simply prolonging the inevitable outcome that every person will face?

Countless procedures, medications, treatments, and consults that are ordered during the immediate time frame prior to the end of life end up being futile. Also, many patients and family members want everything humanly possible done to fight off death despite having received a terminal prognosis. This issue is only going to become more widespread as the Baby Boomer generation, which includes a whopping 78 million people, sweeps through the already overburdened healthcare system in the coming decades.

Can the current system be sustained with so many new entrants and so few dollars to spread around?

A national conversation about common issues surrounding death and dying must take place soon. However, in this highly politicized era, I do not envision this happening anytime in the near future. Still, we should make a more heartfelt effort to educate the public on other options such as hospice, palliative care, and private duty nursing. According to CBS News (2010), multiple studies have concluded that most patients and their families are not even familiar with end-of-life options and things like living wills, home hospice and pain management. We must make them aware of all choices and respect their decisions.

Finally, a cultural shift needs to take place regarding our views on death and dying. Until Americans realize that death is a natural part of the circle of life, people will continue to do everything humanly and technologically possible to defy the outcome that every currently living person shall meet.

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TheCommuter, BSN, RN, CRRN is a longtime physical rehabilitation nurse who has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a Registered Nurse.

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NurseDirtyBird

425 Posts

I think this goes hand in hand with the article from last week about the way our society treats our elderly. People are disregarded (and often disrespected) after a certain age. We're so afraid of our own mortality that any reminders of it are shipped off to do their dirty dying business elsewhere. Our culture of youth worship has led to a solid chunk of our population dying alone and suffering, and that's a crying shame.

Good on you, OP, I'm glad there are others who feel the same as I do.

Asystole RN

2,352 Posts

The choice of life or death is a highly personal, culturally, and religiously driven choice. We all view the world through a ethnocentric skew and it is impossible to tell someone what the best choice for them will be. If we think that medicare is going down an unsustainable road then changes need to be made to medicare, not the patients.

TheCommuter, BSN, RN

102 Articles; 27,612 Posts

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
The choice of life or death is a highly personal, culturally, and religiously driven choice. We all view the world through a ethnocentric skew and it is impossible to tell someone what the best choice for them will be.

Very true. . .

However, my next statement might be construed as insensitive, but here it is. The patients and families who are fighting the uphill battle to live in the face of terminal prognoses are not the ones footing the bill. If the family personally had to come up with the $150,000+ worth of medical bills to 'have everything done' for 98-year-old grandfather in the ICU for another three weeks with no feasible chance of recovery, I bet they'd be singing a different tune. They've extended quantity of life for an additional three weeks, but the added time did nothing to contribute to quality of life: more tubes, more drips, more comatose state. The inevitable outcome (death) has merely been extended another three weeks.

In almost every business, cost-conscious customers and consumers help keep prices down. But not with health care. That's because the customers and consumers who are receiving the care aren't the ones paying the bill.

...85 percent of the health care bills are paid by the government or private insurers, not by patients themselves. In fact most patients don't even look at the bills.

The Cost of Dying - CBS News

breaktime

71 Posts

I agree with both of the above posters. I think people should be educated about their options in end-of-life care and death should probably be something we think about more in our society. However I also agree that changes need to happen elsewhere because thinking talking to people about death is going to make them stop taking extraordinary measures to prevent it is naive. Stories about the fountain of youth didn't start in our modern society. People have been trying to stave off death probably since the first caveman keeled over (likely at the ripe old age of 30 or something like that). Look at most modern medicine. A lot of it isn't mean to end suffering, but to prevent death. Take chemo for example: chemo generally makes people miserable, but it might prevent them dying, so people take it (I know this is a broad generalization here, as I'm using it for an example, not an analyses of chemo or the people who use it). My point being we, as humans, are willing to suffer to prevent death. If it turned out that lighting yourself on fire allowed you to live longer, we would be living in a world full of charred centenarians.

Asystole RN

2,352 Posts

Very true. . .

However, my next statement might be construed as insensitive, but here it is. The patients and families who are fighting the uphill battle to live in the face of terminal prognoses are not the ones footing the bill. If the family personally had to come up with the $150,000+ worth of medical bills to 'have everything done' for 98-year-old grandfather in the ICU for another three weeks with no feasible chance of recovery, I bet they'd be singing a different tune. They've extended quantity of life for an additional three weeks, but the added time did nothing to contribute to quality of life: more tubes, more drips, more comatose state. The inevitable outcome (death) has merely been extended another three weeks.

The Cost of Dying - CBS News

That statement I have bolded is not for you, me, or society to decide. The quality of one's life is a personal judgement and the cost/benefit of extending one's life or the life of a loved one is again a personal decision that is based upon one's culture, religion, and personal preference.

At what point does a life become worthless? Are you going to be the one that decides who holds value in society and who does not? At what point do we shut off healthcare? Is a life worth a fiscal cap of 2 million, 3 million, or some other arbitrary number? Should services be cut for those over 65 since they no longer contribute to the GDP and are simply a drain upon society?

Medicare is in shambles and unsustainable, the problem firmly lays in Medicare itself and not with the patients.

PalmHarborMom

255 Posts

At what point does a life become worthless? Are you going to be the one that decides who holds value in society and who does not? At what point do we shut off healthcare? Is a life worth a fiscal cap of 2 million, 3 million, or some other arbitrary number? Should services be cut for those over 65 since they no longer contribute to the GDP and are simply a drain upon society?

I don't believe that a life becomes worthless. But there comes a point in which maybe the family and patient need to savor the last bit of time that they have together instead of putting the patient through unneeded and often painful procedures. If there is no hope of recovery and if treatments will only prolong or cause more pain then it is time to stop. Too often in today's society, doctors do not have the talk with families/patients for fear of being sued. Death is a natural process that we will all go through and sadly comes all to soon for some. Also this is not an issue just about age, it is about our societies inability to handle death. The money factor does come into play at times. There are treatments out there that cost huge sums of money that add 1-2 weeks of life that is not quality. Would it not be better to spend the last couple weeks of life, saying good byes and not being made more miserable but the treatment?

Death is a touchy subject that will never be easy but one that needs to be discussed.

TheCommuter, BSN, RN

102 Articles; 27,612 Posts

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Are you going to be the one that decides who holds value in society and who does not? At what point do we shut off healthcare?
With all due respect, individuals unrelated to the patients and families have been making certain healthcare decisions for a long time.

You'll notice that people generally do not qualify for major organ transplantation beyond a certain age because individuals who serve on the 'committees' or 'advisory board' decided that a certain subset of the population would not benefit. Likewise, many doctors will not perform high risk surgeries on certain patient populations because of the high risk of the patient dying on the operating table. Insurance companies decide to pay or refuse payment on life-prolonging treatments, so you can say that some insurance administrator out there is making decisions on patients' lives.

Others have been deciding who gets what in the healthcare realm. Physicians, insurance administrators, folks on transplant committees, and others have been gatekeeping the precious medical commodities for years, but people act as if it's something new.

Mulan

2,228 Posts

The Cost of Dying - CBS News

"Every other major industrialized nation but the United States has a budget for how much taxpayer funds are allocated to health care, because they've all recognized that you could bankrupt your country without it," David Walker told Kroft.

Susie2310

2,121 Posts

That statement I have bolded is not for you, me, or society to decide. The quality of one's life is a personal judgement and the cost/benefit of extending one's life or the life of a loved one is again a personal decision that is based upon one's culture, religion, and personal preference.

At what point does a life become worthless? Are you going to be the one that decides who holds value in society and who does not? At what point do we shut off healthcare? Is a life worth a fiscal cap of 2 million, 3 million, or some other arbitrary number? Should services be cut for those over 65 since they no longer contribute to the GDP and are simply a drain upon society?

Medicare is in shambles and unsustainable, the problem firmly lays in Medicare itself and not with the patients.

Absolutely.

A national conversation about common issues surrounding death and dying must take place soon. However, in this highly politicized era, I do not envision this happening anytime in the near future.

Just bringing up the conversation will rain down a fusillade of DEATH PANEL! charges upon your head. Given the prevailing belief system in this country, I wonder why the morbid fear of death prevails.

My point being we, as humans, are willing to suffer to prevent death. If it turned out that lighting yourself on fire allowed you to live longer, we would be living in a world full of charred centenarians.

The issue is not about suffering. The issue is about taking extraordinary measures (which often cause great suffering) when there is no realistic chance of a recovery.

There is also the issue of families' overriding the wishes of the patient and demanding that heroic efforts be made to sustain the life of someone who has little quality of life, and might be in great pain.

That statement I have bolded is not for you, me, or society to decide. The quality of one's life is a personal judgement and the cost/benefit of extending one's life or the life of a loved one is again a personal decision that is based upon one's culture, religion, and personal preference.

You're practically saying that we dare not broach this topic. Is it worth sustaining the life of a 98-year-old person in a coma, whose prognosis is grave, at the expense of providing health care to an infant, if it comes to that? As has been stated, it's rarely the 98-year-old who's paying.

At what point does a life become worthless?

The issue is not that life becomes worthless. But then, how much is it worth to sustain the life for two months of a very sick person, with no hope of recovery? A million dollars? A billion dollars? Ten billion dollars? Does life have a value?

Are you going to be the one that decides who holds value in society and who does not? At what point do we shut off healthcare? Is a life worth a fiscal cap of 2 million, 3 million, or some other arbitrary number? Should services be cut for those over 65 since they no longer contribute to the GDP and are simply a drain upon society?

As the original poster stated, there is no call for "death panels." The question is, Why do Americans have such a perverse attitude (by world standards) toward death? Why the extreme fear and denial?

AtMedicare is in shambles and unsustainable, the problem firmly lays in Medicare itself and not with the patients.

Really? Look at how much money goes to end-of-life care. Then tell me what the problem with Medicare is. It's neither in shambles nor is it unsustainable, but if it does go away, so will many elderly. They will die from lack of care, whether or not they're near the end of their natural lives.