Paul Kusuda’s column
Life has an end, and it comes
Life has an end, and it comes
By Paul H. Kusuda
I read something that resulted from an American Geriatrics Society conference in Seattle
recently. It noted that most people, even those who are old or sick, don’t document their
wishes about how they prefer to be treated at the end of their life. The written statements
can be advance directives that can include the power of attorney over health concerns and
for some, a living will. Part of the planning process should also include discussions with
family members or close relatives who may have decision-making interests. Many topics
relating to one’s being near death could cover such decisions as Do Not Resuscitate (DNR)
(which decision should be shared with a person’s primary physician), use of feeding,
respiration, or other tubes, narcotic medications, organ donation, when to dispense with
treatment, use of X-ray or chemotherapy, etc.
Dr. Katriina Hopper, an internist and research fellow, conducted a study of 185 people with
an average age of 73 who were living in their communities instead of in institutions. Each
I read something that resulted from an American Geriatrics Society conference in Seattle
recently. It noted that most people, even those who are old or sick, don’t document their
wishes about how they prefer to be treated at the end of their life. The written statements
can be advance directives that can include the power of attorney over health concerns and
for some, a living will. Part of the planning process should also include discussions with
family members or close relatives who may have decision-making interests. Many topics
relating to one’s being near death could cover such decisions as Do Not Resuscitate (DNR)
(which decision should be shared with a person’s primary physician), use of feeding,
respiration, or other tubes, narcotic medications, organ donation, when to dispense with
treatment, use of X-ray or chemotherapy, etc.
Dr. Katriina Hopper, an internist and research fellow, conducted a study of 185 people with
an average age of 73 who were living in their communities instead of in institutions. Each
had advanced cancer, heart failure, or lung disease and met hospice criteria, that is they were likely to die within six
months or a little more. They were asked whether they thought they would die suddenly, within a day or two of a serious
complication, after prolonged illness, or didn’t know. The most frequent answer (40 percent) was “I don’t know.” About a
third expected a prolonged illness. An interesting finding was that the respondents were actually uncertain; 56 percent
changed their minds two or more times. The research results did not reveal why the opinion vacillations occurred, for
example, did doctors share or not share relevant medical information? What role did family members play with respect to
how responses were made? My personal feeling is that the study participants didn’t really give a darn and just responded
to be cooperative.
The major point is that given the uncertainty about death and dying, I think each of us should be concerned about those
who want us to continue living even though we all know that death is inevitable. Persons who are to be left behind deserve
to know how we feel about how we should be allowed to die if such decision should be needed. So, advance directives
should be made, appropriate documents should be drafted to establish a power of attorney for health and a power of
attorney for legal affairs. The person selected to carry the responsibilities in the event that the powers must be instituted
should know the wishes and extent of medical and other services to be provided.
Most of us who are in good or fairly good health, prefer not to deal with the reality that good health is not a permanent
condition and for most of us, death will not be sudden. So, like it or not, we have to plan for the future of our dying, whether
sudden or not.
This discussion reminded me about two work colleagues who talked with me about how they felt about dying. Neither
expressed any fear, nor do I, but we had good discussions about personally dealing with the issue. Bob said that if he had
a “death pill,” he’d use it even though as a devout Catholic he’d have to give it much thought. He had seen people die in
pain, and he felt that quality of life was preferable to living in pain. Bob died years after our talk. Following retirement, we
saw each other at least once a month playing bridge. We both belonged to a group of men who got to know each other as
coworkers in the State Division of Children and Youth and who decided to get together to play duplicate bridge. A few of the
men were quite good while most of us were not too bad or not too good.
Bob and I also played party bridge once a month with two other men whom he knew in Sun Prairie, Wisconsin where he
lived. I was invited to join the three men when one of the members of the group moved to South Carolina. The four of us
enjoyed meeting once a month, moving one home to another. One was a retired physician who had also been the
volunteer team doctor for the local football team. Another was an insurance agent who had been elected a few times and
was a current member of the City Council. Bob and I were retired state social work employees. The foursome changed
from time to time as people moved away or died. Eventually, after two deaths, the group ceased to exist. Bob declined
rather quickly, I thought. He used to exercise by walking four miles each day and kept his weight under control.
Joe, on the other hand, not a Catholic, had no qualms about leaving life of one’s volition. He was a long-time member of
the then-called Hemlock Society. The organization changed its name, but its direction remained constant. The group
favored committing suicide when the inevitability of death was known. Living in pain or just living with all sorts of tubes
being attached was considered completely unnecessary. In fact, some recognition was given to the inappropriate use of
months or a little more. They were asked whether they thought they would die suddenly, within a day or two of a serious
complication, after prolonged illness, or didn’t know. The most frequent answer (40 percent) was “I don’t know.” About a
third expected a prolonged illness. An interesting finding was that the respondents were actually uncertain; 56 percent
changed their minds two or more times. The research results did not reveal why the opinion vacillations occurred, for
example, did doctors share or not share relevant medical information? What role did family members play with respect to
how responses were made? My personal feeling is that the study participants didn’t really give a darn and just responded
to be cooperative.
The major point is that given the uncertainty about death and dying, I think each of us should be concerned about those
who want us to continue living even though we all know that death is inevitable. Persons who are to be left behind deserve
to know how we feel about how we should be allowed to die if such decision should be needed. So, advance directives
should be made, appropriate documents should be drafted to establish a power of attorney for health and a power of
attorney for legal affairs. The person selected to carry the responsibilities in the event that the powers must be instituted
should know the wishes and extent of medical and other services to be provided.
Most of us who are in good or fairly good health, prefer not to deal with the reality that good health is not a permanent
condition and for most of us, death will not be sudden. So, like it or not, we have to plan for the future of our dying, whether
sudden or not.
This discussion reminded me about two work colleagues who talked with me about how they felt about dying. Neither
expressed any fear, nor do I, but we had good discussions about personally dealing with the issue. Bob said that if he had
a “death pill,” he’d use it even though as a devout Catholic he’d have to give it much thought. He had seen people die in
pain, and he felt that quality of life was preferable to living in pain. Bob died years after our talk. Following retirement, we
saw each other at least once a month playing bridge. We both belonged to a group of men who got to know each other as
coworkers in the State Division of Children and Youth and who decided to get together to play duplicate bridge. A few of the
men were quite good while most of us were not too bad or not too good.
Bob and I also played party bridge once a month with two other men whom he knew in Sun Prairie, Wisconsin where he
lived. I was invited to join the three men when one of the members of the group moved to South Carolina. The four of us
enjoyed meeting once a month, moving one home to another. One was a retired physician who had also been the
volunteer team doctor for the local football team. Another was an insurance agent who had been elected a few times and
was a current member of the City Council. Bob and I were retired state social work employees. The foursome changed
from time to time as people moved away or died. Eventually, after two deaths, the group ceased to exist. Bob declined
rather quickly, I thought. He used to exercise by walking four miles each day and kept his weight under control.
Joe, on the other hand, not a Catholic, had no qualms about leaving life of one’s volition. He was a long-time member of
the then-called Hemlock Society. The organization changed its name, but its direction remained constant. The group
favored committing suicide when the inevitability of death was known. Living in pain or just living with all sorts of tubes
being attached was considered completely unnecessary. In fact, some recognition was given to the inappropriate use of
medical services and facilities when quality
of life was absent. I think Joe said he had
accumulated a stash of stuff that would help
him to die if and when the time came. I’m
not certain he had such a plan, but we
stopped short of discussing any personal
plan he had. However, he suggested that I
join the organization because he felt it
provided interesting views
of the subject. I never did. Joe died of
pancreatic cancer. Only a couple of weeks
earlier, he was exercising regularly and was
in good physical condition. For him, the end
came precipitously.
Both Bob and Joe believed in physical
fitness and both followed a regime of
exercise faithfully. I, on the other hand,
move about only as much as I have to. I
have never been athletic or an
outdoorsman. In fact, I move only when I
have to get somewhere. I park as close to
my destination as possible to reduce the
need for extra walking. I attend meetings
and conferences, do my grocery shopping,
mow the lawn, shovel snow, and move
when I have to do so. I’m close to being the
epitome of a couch potato. And yet, I’m still
alive and mobile and almost 90. Go figure!
of life was absent. I think Joe said he had
accumulated a stash of stuff that would help
him to die if and when the time came. I’m
not certain he had such a plan, but we
stopped short of discussing any personal
plan he had. However, he suggested that I
join the organization because he felt it
provided interesting views
of the subject. I never did. Joe died of
pancreatic cancer. Only a couple of weeks
earlier, he was exercising regularly and was
in good physical condition. For him, the end
came precipitously.
Both Bob and Joe believed in physical
fitness and both followed a regime of
exercise faithfully. I, on the other hand,
move about only as much as I have to. I
have never been athletic or an
outdoorsman. In fact, I move only when I
have to get somewhere. I park as close to
my destination as possible to reduce the
need for extra walking. I attend meetings
and conferences, do my grocery shopping,
mow the lawn, shovel snow, and move
when I have to do so. I’m close to being the
epitome of a couch potato. And yet, I’m still
alive and mobile and almost 90. Go figure!
